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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Dimensions of Care | 50% | - Chronic Care - Acute Care - Assessment and Diagnosis - Health Promotion and Illness Prevention |
| Topic 2: Physician Activities | 50% | - Management - Psychosocial Aspects - Professional Behaviours - Communication |
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NEW QUESTION # 226
A 2.5-year-old boy is brought to the Emergency Department after he consumed a button-shaped battery. Chest and abdomen radiographies are performed. Which one of the following locations mandates urgent removal of the battery?
Answer: D
Explanation:
Button batteries lodged in the esophagus require urgent endoscopic removal due to risk of tissue necrosis, perforation, and tracheoesophageal fistula within hours. Batteries beyond the esophagus may pass spontaneously if the child is asymptomatic.
Toronto Notes 2023 - Pediatrics, "Foreign Body Ingestion":
"Button batteries in the esophagus are medical emergencies and must be removed immediately. Batteries in the stomach or intestines may be observed if the child is asymptomatic." MCCQE1 Objectives (Pediatrics > 78-2: Gastrointestinal Emergencies):
"Candidates must identify when foreign body ingestion poses immediate risk and requires emergency intervention." Batteries in the stomach or intestines (A-C, E) usually pass without complication, especially if the child is asymptomatic and the battery is <2 cm.
NEW QUESTION # 227
A 9-year-old girl from a remote community is brought to the clinic with a 2-week history of swelling in her neck. She has been afebrile but has had some night sweats. On examination, you note a fixed, unilateral, and nontender supraclavicular lymph node measuring 3 cm. The overlying skin color is unremarkable. In addition, you note a slightly enlarged spleen and liver. Which one of the following is the most likely diagnosis?
Answer: B
Explanation:
This child presents with "red flag" features for malignancy: a firm, fixed, nontender supraclavicular lymph node >2 cm in size, with associated hepatosplenomegaly and night sweats. These features are most concerning for lymphoma.
Toronto Notes 2023 - Pediatrics, "Lymphadenopathy in Children":
"Malignant lymphadenopathy tends to be firm, fixed, painless, and located in supraclavicular areas. Systemic signs (fever, weight loss, hepatosplenomegaly, night sweats) are concerning for lymphoma." MCCQE1 Objectives (Pediatrics > 78-3: Hematology/Oncology):
"Candidates should differentiate between benign and malignant lymphadenopathy and recognize features suggestive of lymphoma." Cat-scratch disease (B) is usually tender and associated with cat exposure. Kawasaki disease (C) presents with fever and mucocutaneous findings. Acute bacterial lymphadenitis (D) is painful, warm, and rapid in onset.
Viral lymphadenopathy (E) is often bilateral, small, and tender.
NEW QUESTION # 228
A 10-day-old boy is brought to the Emergency Department with a fever. The newborn looks well. Other than a rectal temperature of 38.6 °C, findings of the physical examination are unremarkable. When you list all the recommended testing their baby will have to undergo, the parents become upset at all the testing their baby will have to undergo. Which one of the following is the best approach?
Answer: E
Explanation:
A febrile neonate (#28 days old) requires a full sepsis evaluation (e.g., blood cultures, urine testing, lumbar puncture) because of the high risk of serious bacterial infection despite a well appearance. MCCQE objectives emphasize both appropriate medical management and effective communication with parents. When caregivers are distressed about painful procedures, the best approach is empathetic communication and reassurance that adequate analgesia and comfort measures (e.g., topical anesthetic, oral sucrose, swaddling) will be provided.
Threatening child protection involvement is inappropriate unless there is clear refusal of life-saving care after thorough discussion. Saying the infant "will not remember" dismisses parental concerns and undermines trust.
Proceeding without addressing concerns violates principles of shared decision-making. Excluding parents from procedures may increase anxiety and is not routinely recommended.
The physician should acknowledge concerns, explain the rationale for testing (risk of occult sepsis), outline pain-control strategies, and invite questions. This maintains trust while ensuring timely, evidence-based care.
NEW QUESTION # 229
A 3-year-old boy is brought to your office because his daycare teachers are concerned about his language development. His parents speak both English and French at home, and he can say around 15 words combined in both languages. His history reveals that he has minimal interest in playing with other children. Which one of the following is most appropriate?
Answer: D
Explanation:
A limited vocabulary (fewer than 50 words by age 2-3 years) and reduced social interaction (limited interest in peers) raise concern for autism spectrum disorder (ASD). Screening for ASD is the most appropriate next step.
Toronto Notes 2023 - Pediatrics, Development and Behaviour:
"Red flags for autism include delayed language, limited social reciprocity, and poor peer interaction.
Screening should be initiated early when clinical signs are present."
MCCQE1 Objectives - Pediatrics > Developmental Disorders:
"Candidates must identify key signs of ASD and initiate appropriate screening and early intervention." Multilingual households do not typically cause such delays (E is incorrect). ADHD (B) presents with attention
/hyperactivity issues, not language/social delay. Reassurance (A) is inappropriate. Neurology referral (C) may follow but is not first-line.
NEW QUESTION # 230
An 87-year-old man presents with a 2-week history of stiffness in both shoulders and both hips. On further questioning, he tells you that he has experienced a 2 kg unintentional weight loss over the last month. His past medical history is otherwise unremarkable and he is on no medications. On examination, he has limited range of motion due to pain in his shoulders and hips. The remainder of his examination, including muscle strength and joint exam, is normal. Which one of the following will you specifically ask about regarding his history?
Answer: B
Explanation:
Comprehensive and Detailed Explanation:
This is a classic presentation of polymyalgia rheumatica (PMR), characterized by pain and stiffness in the shoulders and hips in older adults. PMR is closely associated with giant cell arteritis (GCA), which presents with unilateral headache, jaw claudication, visual symptoms, and scalp tenderness. Given the risk of vision loss with GCA, it's critical to screen for these symptoms in all patients with suspected PMR.
Toronto Notes 2023 - Rheumatology, PMR and GCA:
"Patients with PMR should be assessed for symptoms of GCA such as headache, visual changes, and jaw claudication. GCA can result in permanent vision loss if not promptly treated." MCCQE1 Objectives - Internal Medicine > Rheumatology:
"Candidates must identify signs of GCA in patients with PMR and understand the need for prompt diagnosis and treatment."
NEW QUESTION # 231
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