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| Section | Weight | Objectives |
|---|---|---|
| Physician Activities | 50% | - Psychosocial Aspects - Professional Behaviours - Management - Communication |
| Dimensions of Care | 50% | - Chronic Care - Acute Care - Assessment and Diagnosis - Health Promotion and Illness Prevention |
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NEW QUESTION # 188
A 72-year-old man presents to your clinic accompanied by his 70-year-old husband. The patient reports that, over the last several months, his libido has been very low. Which one of the following would be the best next step?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Decreased libido in elderly patients can be multifactorial, but depression is a common and important cause that must be ruled out before hormone therapy or other steps. A proper mental health screen should precede further interventions.
Toronto Notes 2023 - Psychiatry / Geriatrics:
"In elderly men, reduced libido may be linked to depression, medical illness, or medications. Depression screening is essential." MCCQE1 Objectives (Psychiatry > 71-1: Mood Disorders / Sexual Health):
"Candidates must consider depression as a common cause of decreased libido and assess accordingly before initiating hormone therapy." Testosterone testing (D) may follow. Prescribing (C) is premature. Couples counselling (B) may help if interpersonal issues are identified. Interviewing together (A) may inhibit disclosure.
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NEW QUESTION # 189
A mumps outbreak is occurring in your community, with higher attack rates among post-secondary students.
Which one of the following is the most effective intervention?
Answer: E
Explanation:
Mumps is a contagious viral illness spread by respiratory droplets, with transmission occurring from shortly before symptom onset through the early symptomatic period. MCCQE objectives in outbreak management emphasize using effective, feasible source control measures that reduce onward transmission. The most effective intervention listed is exclusion (isolation) of symptomatic clinical cases from school and workplace during the infectious period, because symptomatic individuals are the main identifiable sources of spread and removal from congregate settings directly reduces contact rates and secondary cases.
Antivirals are not standard, effective therapy for mumps and do not control outbreaks. Excluding asymptomatic contacts before symptoms develop is generally less effective and often impractical, because many contacts will never become ill and transmission may already occur before recognition; blanket exclusion can also cause major disruption with limited incremental benefit. Closing an entire post-secondary institution is a high-impact measure with uncertain added benefit compared with targeted case exclusion and is typically reserved for extreme circumstances. Immunoglobulin is not an effective post-exposure prophylaxis for mumps. Therefore, isolating/excluding clinical cases is the best and most effective intervention among the options.
NEW QUESTION # 190
A 1-month-old boy is brought to your clinic after being born with asymmetric intrauterine growth restriction (third percentile at birth). He was born at 36 weeks' gestation. He has been breastfeeding well and continues to grow around the third percentile. Which one of the following would be the best next step?
Answer: C
Explanation:
This infant was born late preterm (36 weeks) with asymmetric intrauterine growth restriction (IUGR) and remains at the 3rd percentile. Although he is breastfeeding well, infants with IUGR and late prematurity often require enhanced caloric intake to support catch-up growth. MCCQE objectives emphasize optimizing postnatal nutrition in growth-restricted infants to promote appropriate weight gain while monitoring growth velocity.
Caloric fortification of expressed breast milk (or use of higher-calorie formula if needed) increases energy density without increasing feeding volume, supporting growth in infants who are small for gestational age.
Simply continuing standard feeds may not provide sufficient calories for catch-up growth.
High-dose vitamin D is not indicated; routine supplementation (400 IU daily) is appropriate for breastfed infants. Early introduction of solids is not recommended before about 6 months of age. Switching to hydrolyzed formula is unnecessary without evidence of milk protein allergy.
Therefore, caloric-fortified feeding is the most appropriate next step to promote optimal growth in this infant.
NEW QUESTION # 191
A 46-year-old woman presents with concerns because she has not had a period for the past 13 months. She has not had any hot flashes or night sweats, but she has noted some problems staying asleep for the past 6 months. She feels "foggy," which has made her work more difficult. She is in a same-sex relationship and has no pain with sexual activity. In discussing options with her, which one of the following is most appropriate?
Answer: A
Explanation:
Amenorrhea for #12 consecutive months in a woman over age 45 is diagnostic of menopause and does not require laboratory confirmation in the absence of atypical features. MCCQE objectives emphasize that routine measurement of estrogen or progesterone levels is unnecessary in typical cases, as hormone levels fluctuate widely during the perimenopausal transition. This patient has mild menopausal symptoms (sleep disturbance and cognitive "fog") without vasomotor symptoms, abnormal bleeding, or pelvic pain.
Pelvic ultrasound or endometrial biopsy is not indicated because she has no postmenopausal bleeding. SSRI therapy may be considered for significant vasomotor or mood symptoms but is not first-line for mild cognitive or sleep complaints in otherwise healthy menopausal women. Sleep apnea investigation is not suggested by the history.
Therefore, the most appropriate step is to explain that she is menopausal and provide reassurance, along with education about lifestyle strategies for sleep and cognitive symptoms, and discussion of treatment options if symptoms become bothersome.
NEW QUESTION # 192
A 16-year-old girl is brought to the Emergency Department with a 12-hour history of worsening right lower quadrant abdominal pain and nausea. She is in no distress and vital signs are normal. Her abdomen is soft but locally tender in the right iliac fossa, and bowel sounds are active. White blood cell count is 7.6 × 10#/L (4-
10), C-reactive protein is 2.3 mg/L ( < 10) and serum beta human chorionic gonadotropin is undetectable.
Ultrasound reveals a small amount of fluid in the pelvis, and the appendix is not clearly apparent. Which one of the following is the best next management step?
Answer: A
Explanation:
This adolescent presents with possible early appendicitis but currently has mild clinical findings, normal vital signs, normal white blood cell count, and low CRP. Ultrasound does not visualize the appendix and shows only minimal pelvic fluid, which can be physiologic in adolescent females. According to MCCQE surgical objectives, when the diagnosis of appendicitis is uncertain and the patient is clinically stable, the preferred approach is observation with serial abdominal examinations rather than immediate imaging with CT or operative intervention.
CT scanning exposes a young patient to ionizing radiation and is not indicated when clinical suspicion is low to moderate and the patient is stable. Immediate appendectomy is inappropriate without stronger clinical or laboratory evidence. Empiric IV antibiotics are reserved for confirmed or strongly suspected appendicitis.
Serial radiography has no role in diagnosing appendicitis.
Careful monitoring over 12-24 hours allows progression of signs if appendicitis is present, improving diagnostic accuracy while avoiding I have cross-referenced your exam scores with NVIDIA's official technical documentation for **DGX H100
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### **Batch 1: Questions 1 - 5
NEW QUESTION # 193
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