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| Section | Objectives |
|---|---|
| Dimensions of Care | - Acute Care
|
| Physician Activities | - Communication
|
>> MCCQE Latest Study Notes <<
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NEW QUESTION # 175
A 14-year-old girl is brought to the Emergency Department with a 20-minute history of difficulty breathing that started during a school assembly. She has had similar symptoms 3 times in the last 2 weeks. These episodes develop rapidly and resolve gradually over several minutes. She reports tingling in her fingers and toes. On examination, her vital signs are as follows:
Blood pressure
120/80 mm Hg
Heart rate
100/min
Respiratory rate
22/min
Oxygen saturation on room air
95%
Temperature
36.9 °C, orally
Apart from mildly dilated pupils, her examination is otherwise normal. Which one of the following is the most likely diagnosis?
Answer: C
Explanation:
This teenager presents with acute-onset dyspnea, paresthesias, and normal physical findings, consistent with a panic attack. Panic attacks often mimic cardiopulmonary pathology but are marked by symptoms like hyperventilation, tingling in the extremities, palpitations, and subjective air hunger with normal vitals and oxygenation.
Toronto Notes 2023 - Psychiatry:
"Panic attacks are characterized by sudden onset of intense fear or discomfort, accompanied by somatic symptoms such as dyspnea, paresthesias, tachycardia, and fear of losing control." MCCQE1 Objectives (Psychiatry > 71-3: Anxiety Disorders):
"Candidates must recognize panic attacks based on clinical features and differentiate them from cardiopulmonary conditions." Normal O2 saturation and physical exam rule out asthma or pericarditis. Cocaine use would present with more systemic toxicity. PSVT would cause consistent tachycardia.
NEW QUESTION # 176
A 20-year-old woman, gravida 0, para 0, presents with increased facial hair. Her periods are regular and moderate. Her BMI is 24, and her blood pressure is 110/70 mm Hg. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Idiopathic hirsutism is the most likely diagnosis because this patient has isolated hirsutism with normal vital signs, normal BMI, and regular menstrual cycles , suggesting preserved ovulation and no clinically significant endocrine disturbance. MCCQE objectives emphasize that the most common causes of hirsutism are PCOS and idiopathic hirsutism; PCOS typically includes menstrual irregularity/oligo-ovulation and often metabolic features (overweight, insulin resistance), none of which are present here. Androgen-secreting ovarian tumors (hilar cell or Sertoli-Leydig cell tumors) usually cause rapid onset, severe hyperandrogenism and virilization (deepening voice, clitoromegaly, marked acne) and often disrupt menses-features not described. Nonclassic congenital adrenal hyperplasia can present with hirsutism, but it more commonly associates with acne, infertility, or menstrual abnormalities and requires biochemical suspicion rather than being the "most likely" with normal cycles. Therefore, idiopathic hirsutism-often due to increased peripheral androgen sensitivity or local 5-alpha reductase activity-is the best fit.
NEW QUESTION # 177
A 33-year-old primigravid woman presents to the office with gestational hypertension. Her pregnancy is at 37 weeks' gestation. The ultrasound findings are as follows:
Head circumference: 5th percentile
Biparietal diameter: 10th percentile
Abdominal circumference: 5th percentile
Femur length: 25th percentile
Amniotic fluid volume: 5.0 cm
Umbilical Doppler: Reversed end-diastolic flow
Which one of the following is the best next step?
Answer: B
Explanation:
This pregnancy demonstrates fetal growth restriction (FGR) with biometric measurements at or below the
10th percentile and oligohydramnios (AFI 5 cm). Most concerning is the finding of reversed end-diastolic flow (REDF) in the umbilical artery Doppler, which indicates severe placental insufficiency and significantly increased risk of fetal hypoxia, acidosis, and intrauterine demise. MCCQE objectives emphasize that abnormal umbilical artery Doppler findings-particularly absent or reversed end-diastolic flow-represent critical fetal compromise.
At 37 weeks' gestation, the fetus is term. The risks of continued intrauterine exposure in the setting of REDF outweigh the risks of delivery. Therefore, immediate delivery is indicated. Expectant management with nonstress testing or delayed reassessment is inappropriate because REDF is associated with high perinatal mortality.
Prompt delivery (often by cesarean section depending on fetal status and cervical factors) is required to prevent stillbirth and severe neonatal morbidity.
NEW QUESTION # 178
A 45-year-old woman presents with a 2-week history of a sore left breast. It has become red and swollen. She was previously well, and her menstrual cycles are regular. She has no history of breast cancer, and she has no children. On examination, she has a red, tender, indurated area in her left breast that has only partially responded to oral antibiotics after 10 days. Which one of the following is the most appropriate next step?
Answer: B
Explanation:
In a non-lactating woman with a partially responsive breast mass after antibiotics, inflammatory breast cancer must be ruled out. A breast biopsy (core or excisional) is indicated to assess for malignancy. Inflammatory breast cancer may mimic mastitis but does not improve with antibiotics.
Toronto Notes 2023 - Breast Disorders:
"In non-lactating women, persistent breast inflammation should raise suspicion for inflammatory breast cancer. If symptoms persist after antibiotic therapy, proceed with imaging and biopsy." MCCQE1 Objectives - Gynecology > Breast Disease:
"Candidates must differentiate between mastitis and inflammatory breast cancer and initiate appropriate investigations such as biopsy when response to antibiotics is incomplete." Options A, D, and E may be appropriate for a confirmed abscess or infectious cause, but further investigation is mandatory in this scenario. NSAIDs (C) are symptomatic but do not address the diagnostic concern.
NEW QUESTION # 179
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 growthrestriction. 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 # 180
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