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| Section | Objectives |
|---|---|
| Topic 1: Dimensions of Care | - Acute Care
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| Topic 2: Physician Activities | - Assessment
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NEW QUESTION # 105
A 26-year-old man presents to the office with a tender mass in his right neck. He was recently treated for a dental infection but is otherwise well. On examination, there is a 2-cm tender, mobile lymph node in the right anterior cervical chain. No other lymphadenopathy or abnormalities are found on physical examination.
Which one of the following is the best next step?
Answer: B
Explanation:
A tender, mobile lymph node following a recent localized infection (e.g., dental infection) is most likely reactive. In a young, otherwise well patient with no systemic symptoms or concerning features, observation is appropriate.
Toronto Notes 2023 - Internal Medicine, Lymphadenopathy:
"In patients with localized lymphadenopathy and a recent infection, observation for 4-8 weeks is often appropriate before further investigation." MCCQE1 Objectives - Internal Medicine > Hematology:
"Candidates should recognize benign features of lymphadenopathy (tender, mobile, <2 cm, localized) and manage conservatively unless red flags are present." Biopsy (B) and imaging (C, E) are premature. Bone marrow biopsy (D) is not relevant.
NEW QUESTION # 106
A 30-year-old woman presents to the office with her partner and reports that they are planning for her to conceive soon. They visited Mexico recently and are concerned about exposure to the Zika virus. Which one of the following is the best next step?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
The Zika virus can be sexually transmitted and poses a serious risk of congenital Zika syndrome if infection occurs during pregnancy. The CDC and WHO recommend that couples delay conception for at least 3 months after potential male exposure due to the virus's persistence in semen.
Toronto Notes 2023 - Infectious Diseases / Travel Medicine:
"Zika virus may persist in semen for weeks. Couples should delay conception for 3 months after male exposure, even if asymptomatic." MCCQE1 Objectives (Public Health > 65-3: Travel Medicine and Reproductive Health):
"Candidates must counsel appropriately regarding risks of Zika in conception and apply current public health recommendations." Testing (B) is not reliable for asymptomatic individuals. Antivirals (E) are ineffective. Condoms (D) do reduce risk. Specialist referral (A) is not needed in most cases with no complications.
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NEW QUESTION # 107
You are working in a busy family practice. Your colleague's 48-year-old female patient presents with a 6- month history of fatigue and gastrointestinal symptoms. A recent colonoscopy was normal. Her chart indicates multiple investigations for similar symptoms over the past 2 years, all of which have been non- revealing. Your working diagnosis is somatic symptom disorder. Which one of the following is the most appropriate treatment?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
Cognitive behavioral therapy (CBT) is the most effective first-line treatment for somatic symptom disorder. It helps patients reframe dysfunctional thoughts and improve coping strategies for perceived physical symptoms.
Toronto Notes 2023 - Psychiatry, "Somatic Symptom and Related Disorders":
"CBT is first-line for somatic symptom disorder. Antidepressants may be considered if comorbid depression or anxiety is present." MCCQE1 Objectives (Psychiatry > 71-2: Somatic Symptom Disorders):
"Candidates must manage somatic symptom disorder with appropriate psychosocial interventions." Citalopram (B) or amitriptyline (E) may be used adjunctively if mood symptoms are prominent. Risperidone (C) and ERP (D) are not indicated.
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NEW QUESTION # 108
A 4-month-old boy is brought to the office by his parents to ask about the rotavirus vaccine. They would like to avoid the possibility of the infant coming down with gastroenteritis. Their older child was hospitalized with gastroenteritis at age 10 months. They have a friend who had intussusception after getting the rotavirus immunization, and they are worried about a possible link to the vaccine. Which one of the following is the most appropriate response?
Answer: B
Explanation:
The most appropriate response is to recommend vaccination and explain that the risk of intussusception after rotavirus vaccination is extremely low , while the benefits in preventing severe rotavirus gastroenteritis are substantial. MCCQE objectives in immunization and preventive pediatrics emphasize balancing risks and benefits using evidence-based data. Current rotavirus vaccines are associated with a very small increased risk of intussusception (on the order of a few additional cases per 100,000 vaccinated infants), but this risk is far outweighed by the prevention of hospitalizations, severe dehydration, and complications from rotavirus infection.
Option B overstates the risk as "markedly increased," which is inaccurate and may heighten parental anxiety.
Intussusception is not always easily treatable and can be serious (C). It occurs most commonly in infants under 1 year, not only in 1- to 3-year-olds (D). Rotavirus can cause significant morbidity in healthy infants, so routine vaccination is recommended (E). Clear, balanced counselling supports informed parental decision- making.
NEW QUESTION # 109
A 68-year-old man presents with a 3-day history of multiple tender joints. On examination, he has a temperature of 38.2°C and swelling and redness of his left large toe. Which one of the following is the most likely diagnosis?
Answer: A
Explanation:
This patient presents with acute onset of joint pain, fever, and classic involvement of the first metatarsophalangeal joint (podagra) with swelling and erythema. MCCQE objectives emphasize recognizing the characteristic presentation of crystal-induced arthropathy , particularly gout. Gout commonly affects older men and presents with sudden, severe monoarthritis, often involving the great toe. Systemic symptoms such as low-grade fever may occur during acute attacks.
Viral arthritis typically causes symmetric polyarthritis without marked erythema of a single joint.
Osteoarthritis presents with chronic, non-inflammatory joint pain and minimal warmth or redness. Psoriatic arthritis is usually associated with psoriasis, nail pitting, or dactylitis. Rheumatoid arthritis typically presents as chronic, symmetric small-joint polyarthritis rather than acute podagra.
Although this patient reports multiple tender joints, the prominent inflamed great toe is classic for gout, and polyarticular involvement can occur, especially in older individuals. Diagnosis is ideally confirmed by joint aspiration showing monosodium urate crystals. Initial management includes NSAIDs, colchicine, or corticosteroids.
NEW QUESTION # 110
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