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| Section | Objectives |
|---|---|
| Dimensions of Care | - Chronic Care
|
| Physician Activities | - Assessment
|
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NEW QUESTION # 216
A 22-year-old woman presents to the office for episodic mood changes that her boyfriend has noticed. During such episodes, she cries suddenly, is irritable and sad, and withdraws from socializing. Which one of the following would be most useful in establishing a diagnosis?
Answer: E
Explanation:
A mood journal is a structured tool that allows the patient to record mood fluctuations, triggers, and timing. It is particularly helpful in identifying mood disorders such as premenstrual dysphoric disorder, bipolar disorder, or cyclothymia.
Toronto Notes 2023 - Psychiatry, Mood Disorders:
"Mood diaries are useful in identifying temporal patterns, such as menstrual cycle-linked mood changes, and in distinguishing between affective disorders." MCCQE1 Objectives - Psychiatry > Diagnostic Evaluation:
"Candidates should use clinical tools such as symptom diaries to assist in establishing the pattern and nature of psychiatric symptoms." Personality testing (A) is not first-line. Urine drug screen (B) is only indicated with suspicion of substance use. Lorazepam (D) treats symptoms, not diagnosis. Interviewing the boyfriend (E) may help, but only as a supplement to direct observation and self-report.
NEW QUESTION # 217
A 59-year-old woman comes to the office because her 48-year-old sister was recently diagnosed with cervical cancer. Your patient thinks her mother may have also had cervical cancer. A Papanicolaou (Pap) test performed 16 months ago had normal results, as did all previous Pap tests. Which one of the following is the best next step?
Answer: B
Explanation:
For women aged 25-69 years who have had adequate negative screening, the recommendation is to repeat cervical cytology (Pap test) every 3 years, regardless of family history. Cervical cancer is caused primarily by HPV infection, not hereditary genetics. Family history does not alter the screening interval.
Toronto Notes 2023 - Gynecology, Cervical Cancer Screening Section:
"Routine screening with Pap test is recommended every 3 years in women aged 25-69 who have had three consecutive negative tests. Family history of cervical cancer does not modify the screening interval." MCCQE1 Objectives - Obstetrics and Gynecology > Cancer Screening:
"Candidates must apply population-based cervical cancer screening guidelines. Family history is not a risk modifier for screening frequency in cervical cancer." Options A and B are inappropriate as they increase screening frequency without indication. HPV testing (D) or colposcopy (E) are not recommended without abnormal cytology.
NEW QUESTION # 218
A 31-year-old nulligravid woman presents to your office after 5 months of attempting to get pregnant without success. Her menses are regular, and she is otherwise healthy. Her husband is healthy and has never fathered any children before. Which one of the following is the best next step?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse in women under 35 years. Since she has been trying for only 5 months, reassurance is appropriate.
Toronto Notes 2023 - Gynecology:
"Investigations for infertility in women under 35 should begin after 12 months of attempting to conceive, unless other risk factors are present." MCCQE1 Objectives (Gynecology > 82-1: Infertility):
"Candidates must apply appropriate timing and indications for infertility investigations based on patient age and history." Earlier testing is not warranted here. Options A-D are part of the infertility work-up but not before 12 months.
NEW QUESTION # 219
Which one of the following bodies decides whether a physician is permitted to practise medicine in a province or territory?
Answer: A
NEW QUESTION # 220
A 43-year-old man is referred to you for an incidental finding of elevated hemoglobin. Laboratory results are as follows:
Hemoglobin
185 g/L (130-170)
Mean corpuscular volume
92 fL (60-100)
White blood cells
7.8×1037.8×103 / L (4-10)
Platelets
250×103250×103 / L (130-400)
His BMI is 23. He has type 2 diabetes for which he takes gliclazide MR 60 mg daily. Which one of the following features on history could explain his laboratory abnormality?
Answer: C
Explanation:
Elevated hemoglobin in the absence of polycythemia vera can be due to secondary causes such as chronic hypoxia. Central sleep apnea, often associated with diabetes or neurologic conditions, leads to intermittent hypoxia and compensatory erythropoiesis.
Toronto Notes 2023 - Hematology and Respiratory Medicine, "Polycythemia" Section:
"Secondary erythrocytosis may result from hypoxic conditions including sleep apnea, COPD, or high altitude.
Assess for sleep-disordered breathing in patients with elevated hemoglobin and no myeloproliferative features." MCCQE1 Objectives (Internal Medicine > 76-7: Hematologic Abnormalities):
"Candidates must investigate secondary causes of elevated hemoglobin, including hypoxia-related conditions." Hypertension (A), hypothyroidism (C), and cirrhosis (D) do not cause polycythemia. Alcohol (B) typically causes macrocytosis and anemia.
NEW QUESTION # 221
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