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| Section | Objectives |
|---|---|
| Topic 1: Physician Activities | - Assessment
|
| Topic 2: Dimensions of Care | - Health Promotion and Illness Prevention
|
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NEW QUESTION # 318
A 34-year-old woman, gravida 3, para 2, comes to your office for prenatal care. Past medical history includes
2 precipitous uncomplicated term deliveries of infants greater than 4200 g. Which one of the following is she most at risk of developing?
Answer: D
Explanation:
This patient's obstetric history suggests recurrent fetal macrosomia (birthweight > 4000-4500 g) and rapid (precipitous) labours. MCCQE objectives emphasize identifying maternal risk factors for postpartum hemorrhage (PPH) , particularly those associated with uterine atony , the most common cause of PPH.
Delivery of a macrosomic infant increases uterine overdistension, which reduces effective postpartum uterine contraction and predisposes to atony and hemorrhage. In addition, precipitous labour can be associated with genital tract trauma, which can also contribute to postpartum bleeding, but the strongest and most consistent risk factor in the options provided is PPH from atony related to prior large infants.
The other choices are less supported by the stem: prior macrosomic term deliveries do not inherently increase risk of preterm delivery, gestational hypertension, or DVT. Therefore, the most likely risk to anticipate and plan for is postpartum hemorrhage, prompting proactive intrapartum planning (active management of the third stage, readiness with uterotonics, and risk-based monitoring).
NEW QUESTION # 319
A physician attending a sporting event with his family provides emergency treatment to a 65-year-old man who suffers a seizure followed by a cardiac arrest. The patient is successfully resuscitated by the physician on the scene and transported to a hospital, where he is found to have critically low blood sugar and subsequently suffers irreversible brain damage. Which one of the following statements is most accurate?
Answer: B
Explanation:
MCCQE objectives emphasize the distinction between ethical obligations and legal duties in emergency
"Good Samaritan" situations. Physicians generally do not have a legal obligation to provide care outside of a formal physician-patient relationship, nor are they legally required to accompany a patient to hospital. Good Samaritan laws are designed primarily to protect healthcare providers from liability when they voluntarily provide emergency assistance in good faith and within the scope of their competence; they do not compel physicians to act.
Professional ethical standards, however, state that physicians should render reasonable assistance in emergencies , considering their own safety, competence, and available resources. This reflects the profession' s commitment to beneficence and social responsibility. In this case, the physician appropriately provided emergency resuscitation. Subsequent poor outcome (irreversible brain injury due to hypoglycemia) does not imply negligence if care was reasonable and provided in good faith. Therefore, the most accurate statement is that professional ethics require physicians to render reasonable
NEW QUESTION # 320
You are counselling the wife of a 75-year-old man admitted under your care after a fall. The patient is confused, disoriented, barely sleeps at night and has complex visual hallucinations of animals running through his room. Given his state, which one of the following is the best advice for the wife?
Answer: A
Explanation:
This scenario describes acute delirium, common in hospitalized elderly patients. Patients may say things they don't mean. Reassuring family members not to take hurtful comments personally is an important part of family counseling.
Toronto Notes 2023 - Geriatrics, "Delirium":
"Patients may become agitated, hallucinate, or be aggressive. Families should be counseled not to take the behavior personally and continue to support orientation." MCCQE1 Objectives (Geriatrics > 41-1: Cognitive Disorders):
"Candidates must support caregivers of delirious patients, providing guidance on managing emotional and behavioral symptoms." Avoiding visits (A), confronting the patient (C), or emotional withdrawal (E) are counterproductive.
Providing gentle information is appropriate (contradicts B).
NEW QUESTION # 321
A 26-year-old woman, gravida 2, para 1, presents with a positive pregnancy test. Her previous pregnancy was associated with preeclampsia, and she delivered a 1000 g boy at 34 weeks ' gestation. Her blood pressure is
130/86 mm Hg. Which one of the following is the best recommendation for this pregnancy?
Answer: C
Explanation:
Accurate dating is critical in pregnancies at high risk for preeclampsia and intrauterine growth restriction.
First-trimester ultrasound is used to establish gestational age, which guides monitoring and interventions.
Toronto Notes 2023 - Obstetrics, High-Risk Pregnancy:
"In women with a history of preeclampsia, early and accurate dating allows for appropriate fetal surveillance and timely delivery." MCCQE1 Objectives - Obstetrics > Prenatal Care:
"Candidates should recognize the importance of accurate pregnancy dating in high-risk pregnancies." Prophylactic labetalol (E) is not indicated in normotensive patients. Genetic testing (A, B) is not appropriate unless additional risk factors are present. Bed rest (D) is not evidence-based for preeclampsia prevention.
NEW QUESTION # 322
A 26-year-old woman, gravida 2, para 2, aborta 0, has just delivered a full-term newborn via spontaneous vaginal delivery after 4 hours of labor. Following oxytocin administration and placental expulsion, there continues to be a steady trickle of bright red blood from her vagina. On examination, the placenta is intact and the fundus feels firm. Her vital signs are within normal range.
Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
Comprehensive and Detailed Explanation:
In postpartum hemorrhage with a firm uterine fundus and intact placenta, a common cause is trauma such as a vaginal or cervical tear. Uterine atony (A) typically presents with a boggy uterus. The absence of systemic instability or coagulopathy makes options D and E less likely.
Toronto Notes 2023 - Obstetrics, Postpartum Hemorrhage:
"Continued bleeding despite a firm fundus and intact placenta should raise suspicion for genital tract trauma, especially cervical or vaginal lacerations." MCCQE1 Objectives - Obstetrics > Postpartum Complications:
"Candidates must differentiate causes of postpartum hemorrhage and identify when bleeding is due to trauma vs uterine atony."
NEW QUESTION # 323
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