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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Physician Activities | 50% | - Communication - Psychosocial Aspects - Management - Professional Behaviours |
| Topic 2: Dimensions of Care | 50% | - Health Promotion and Illness Prevention - Chronic Care - Assessment and Diagnosis - Acute Care |
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NEW QUESTION # 297
A 70-year-old woman consults you for progressive vision problems. She describes seeing haloes at night around street lights and having double vision. Her near vision has improved. Which one of the following is an ophthalmologic examination most likely to uncover?
Answer: E
Explanation:
The symptoms described - haloes at night, monocular diplopia, and improved near vision (second sight) - are classic signs of nuclear sclerosis-type cataracts. On exam, the most consistent finding would be an altered red reflex due to lens opacification.
Toronto Notes 2023 - Ophthalmology, Cataracts:
"Cataracts can cause glare, monocular diplopia, and improved near vision. A diminished or irregular red reflex is commonly seen on direct ophthalmoscopy." MCCQE1 Objectives - Internal Medicine > Ophthalmologic Disorders:
"The candidate must recognize symptoms and physical findings of cataracts, including changes in red reflex and visual acuity." Options A and B are associated with lipid deposition and Wilson's disease, respectively. Retinal exudates (D) suggest diabetic or hypertensive retinopathy. Increased intraocular pressure (E) suggests glaucoma but is not supported by this clinical picture.
NEW QUESTION # 298
A 71-year-old man is brought to the Emergency Department with sudden onset of shortness of breath and chest pain. He was discharged from hospital 1 week ago after a total hip arthroplasty. On examination, his respiratory rate is 32/min. There is visible respiratory distress, and chest auscultation is clear. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
Sudden onset dyspnea and pleuritic chest pain in a postoperative patient with tachypnea and clear lung fields are classic features of a pulmonary embolism (PE). Recent orthopedic surgery significantly increases VTE risk. Clear lungs on auscultation support this over pneumonia or CHF.
Toronto Notes 2023 - Respiratory, "Pulmonary Embolism":
"Presentation includes sudden dyspnea, pleuritic chest pain, and tachypnea. Risk factors include recent surgery and immobilization. Examination often reveals clear chest auscultation." MCCQE1 Objectives (Internal Medicine > Cardiopulmonary > 44-1):
"Candidates must recognize PE in patients with risk factors (e.g., surgery) and classic features and initiate appropriate diagnosis and management." Fat embolism (B) usually presents with petechiae, neurologic symptoms, and occurs within 24-72 hours post- op. Cholesterol emboli (E) are more chronic and systemic.
NEW QUESTION # 299
A 62-year-old woman is taken to the operating room for an elective laparoscopic cholecystectomy. Induction of anesthesia triggers a severe hypertensive crisis that ultimately resolves after administration of a 5 mg bolus of phentolamine.
Which one of the following is most consistent with this presentation?
Answer: B
Explanation:
This presentation is classic for an undiagnosed pheochromocytoma, which causes episodic or crisis-level hypertension due to excess catecholamines. Anesthesia or surgical manipulation can trigger massive catecholamine release, leading to hypertensive crisis. Phentolamine, an alpha-blocker, is the appropriate treatment.
Toronto Notes 2023 - Endocrinology, Pheochromocytoma:
"Pheochromocytomas may precipitate hypertensive crises during surgery. Elevated plasma catecholamines and urinary metanephrines confirm diagnosis." MCCQE1 Objectives - Internal Medicine > Endocrinology:
"Candidates should suspect pheochromocytoma in perioperative hypertensive crises and confirm with plasma or urine catecholamines/metanephrines." Low metanephrines (E) would argue against pheochromocytoma. TSH (A), cortisol (D), and renin (C) are unrelated to acute intraoperative hypertensive episodes of this nature.
NEW QUESTION # 300
Which one of the following bodies decides whether a physician is permitted to practise medicine in a province or territory?
Answer: A
NEW QUESTION # 301
A physician attending a sporting event with his family provides emergency treatment to a 65-year-old man who suffers a seizure followed by a cardiac arrest. The patient is successfully resuscitated by the physician on the scene and transported to a hospital, where he is found to have critically low blood sugar and subsequently suffers irreversible brain damage. Which one of the following statements is most accurate?
Answer: E
Explanation:
MCCQE objectives emphasize the distinction between ethical obligations and legal duties in emergency
"Good Samaritan" situations. Physicians generally do not have a legal obligation to provide care outside of a formal physician-patient relationship, nor are they legally required to accompany a patient to hospital. Good Samaritan laws are designed primarily to protect healthcare providers from liability when they voluntarily provide emergency assistance in good faith and within the scope of their competence; they do not compel physicians to act.
Professional ethical standards, however, state that physicians should render reasonable assistance in emergencies , considering their own safety, competence, and available resources. This reflects the profession' s commitment to beneficence and social responsibility. In this case, the physician appropriately provided emergency resuscitation. Subsequent poor outcome (irreversible brain injury due to hypoglycemia) does not imply negligence if care was reasonable and provided in good faith. Therefore, the most accurate statement is that professional ethics require physicians to render reasonable
NEW QUESTION # 302
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