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| Section | Objectives |
|---|---|
| Topic 1: Physician Roles (CanMEDS Framework) | - Professional
|
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NEW QUESTION # 174
A 58-year-old woman presents to your office with refractory bipolar I disorder. She is on the following medications: lithium carbonate, valproic acid, and olanzapine. She also takes acetaminophen for osteoarthritis and pantoprazole for gastroesophageal reflux. Lately, she has noticed she bruises very easily. Laboratory work displays a platelet count of 70 × 10#/L (normal 130-400). Which one of the following is most likely to induce this side effect?
Answer: D
Explanation:
Valproic acid is well known to cause thrombocytopenia, especially at higher serum concentrations or in patients over 60. Bruising with platelet count <100 × 10#/L is a classic manifestation.
Toronto Notes 2023 - Psychiatry, Mood Disorders & Pharmacology Section:
"Valproic acid is associated with hematologic side effects including thrombocytopenia. Platelet counts should be monitored regularly." MCCQE1 Objectives - Psychiatry > Pharmacotherapy:
"The candidate must recognize adverse effects of mood stabilizers including hematologic complications of valproic acid." Other listed medications (A-D) have no common or direct link with thrombocytopenia in this context.
NEW QUESTION # 175
A couple is diagnosed with primary infertility secondary to azoospermia. They are not interested in in vitro fertilization techniques, so you recommend insemination with a sperm donor. The male partner is hesitant. He thinks he might have difficulty accepting raising a child who is not biologically his. Which one of the following is the best next step?
Answer: A
Explanation:
When couples face infertility-related decisions-particularly involving donor insemination-psychosocial counseling is essential. A mental health consultation helps explore emotional concerns, expectations, and readiness for non-biological parenting.
Toronto Notes 2023 - Gynecology, "Infertility and ART":
"Psychological counseling is recommended for couples considering donor gametes to address emotional, ethical, and identity issues before proceeding." MCCQE1 Objectives (ELOM > Reproductive Ethics > 83-1):
"Candidates must understand the ethical and psychosocial considerations of assisted reproductive techniques and provide appropriate referrals." Suggesting adoption or switching care dismisses valid concerns (B, C). Ovulation induction (D) does not address azoospermia.
NEW QUESTION # 176
The parents of a 12-year-old boy present to your clinic to discuss their son's submersion injury. The patient was seen in hospital for 6 months after being pulled unresponsive from a lake at his friend's house; he had been submerged for an estimated 20 minutes. After extended resuscitation and a 2-month stay in the intensive care unit, he remains in a persistent vegetative state but needs no respiratory or cardiac support. When evaluating the discharge from hospital, which one of the following is most appropriate?
Answer: A
Explanation:
Comprehensive and Detailed Explanation:
The patient is in a persistent vegetative state and medically stable, meaning he does not need continued hospitalization. The goal is to provide appropriate long-term care in the least restrictive setting, typically at home with robust home care support services. This approach aligns with ethical care, family-centered goals, and medical appropriateness.
Toronto Notes 2023 - Pediatrics / Neurodevelopment & Chronic Care:
"Home care with appropriate medical and caregiver support is often the best setting for children with severe neurological impairments who are medically stable." MCCQE1 Objectives (Pediatrics > 77-5: Chronic Neurological Disorders):
"Candidates must assess discharge planning and coordinate home care support for children with long-term care needs." Palliative facility (B) is not appropriate unless end-of-life is imminent. School (C) is not feasible in this state.
Hospital readmission for respite (D) is not standard. Rehabilitation (E) has little utility in persistent vegetative state.
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NEW QUESTION # 177
A 21-year-old man presents to the Emergency Department with a 6-month history of unusual behavior. He believes that he has been specially chosen to found a new religion. He says he has seen visions of angels in his bedroom. He appears disheveled and malodorous. On further inspection, you note that he drinks 2 liters daily.
Which one of the following is the most appropriate initial management?
Answer: E
Explanation:
Comprehensive and Detailed Explanation:
The patient presents with classic symptoms of schizophrenia: delusions, hallucinations, social withdrawal, and disorganized appearance. The first-line treatment is antipsychotic medication-risperidone is a well-tolerated option among second-generation antipsychotics.
Toronto Notes 2023 - Psychiatry, "Schizophrenia":
"Schizophrenia is treated with second-generation antipsychotics such as risperidone. These reduce positive symptoms like delusions and hallucinations." MCCQE1 Objectives (Psychiatry > 71-3: Psychotic Disorders):
"Candidates must recognize and manage schizophrenia with antipsychotics and distinguish from other mood or personality disorders." CBT (E) is supportive but not first-line. ECT (A) is used for severe depression or catatonia. Valproic acid (C) and carbamazepine (D) are mood stabilizers, not first-line for schizophrenia.
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NEW QUESTION # 178
A 72-year-old woman presents with swelling of her right leg that developed overnight. She had an abdominal hysterectomy 10 days ago. On examination, there is pitting edema of the leg that extends from the foot to the groin. The calf is 3 cm larger in diameter than the calf on the left leg. Which one of the following is the most likely diagnosis?
Answer: E
Explanation:
This patient has classic features of proximal deep vein thrombosis (DVT) after recent major pelvic surgery:
acute unilateral leg swelling with pitting edema and a significant calf circumference difference ( > 3 cm). The edema extending from foot to groin strongly suggests a proximal (iliofemoral) thrombosis, which produces more extensive swelling than calf-vein DVT because venous outflow from the entire limb is impaired.
MCCQE objectives highlight postoperative patients as high risk for venous thromboembolism due to immobility, endothelial injury, and hypercoagulability.
Superficial thrombophlebitis typically causes a localized, tender, palpable cord along a superficial vein rather than diffuse whole-leg edema. Phlegmasia cerulea dolens is a severe, limb-threatening form of massive DVT characterized by marked pain, tense
NEW QUESTION # 179
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