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NEW QUESTION # 103
A 45-year-old woman presents with a 2-week history of a sore left breast. It has become red and swollen. She was previously well, and her menstrual cycles are regular. She has no history of breast cancer, and she has no children. On examination, she has a red, tender, indurated area in her left breast that has only partially responded to oral antibiotics after 10 days. Which one of the following is the most appropriate next step?
Answer: C
Explanation:
In a non-lactating woman with a partially responsive breast mass after antibiotics, inflammatory breast cancer must be ruled out. A breast biopsy (core or excisional) is indicated to assess for malignancy. Inflammatory breast cancer may mimic mastitis but does not improve with antibiotics.
Toronto Notes 2023 - Breast Disorders:
"In non-lactating women, persistent breast inflammation should raise suspicion for inflammatory breast cancer. If symptoms persist after antibiotic therapy, proceed with imaging and biopsy." MCCQE1 Objectives - Gynecology > Breast Disease:
"Candidates must differentiate between mastitis and inflammatory breast cancer and initiate appropriate investigations such as biopsy when response to antibiotics is incomplete." Options A, D, and E may be appropriate for a confirmed abscess or infectious cause, but further investigation is mandatory in this scenario. NSAIDs (C) are symptomatic but do not address the diagnostic concern.
NEW QUESTION # 104
A 10-year-old girl is brought to the Emergency Department by her mother because her daughter is crying and says she "can't pee." Her daughter fell on the monkey bars at school earlier that day. On examination, there is a large vulvar bruise anteriorly. Which one of the following is the best next step?
Answer: D
Explanation:
In pediatric trauma, inability to void with perineal bruising raises concern for urethral injury or urinary retention due to soft tissue swelling. The most immediate step is to attempt bladder catheterization. If unsuccessful, consult gynecology or urology urgently to avoid bladder overdistension.
Toronto Notes 2023 - Pediatrics, Genitourinary Trauma:
"In females, perineal trauma can lead to urinary retention due to labial hematomas or urethral injury. If catheterization is difficult, consult gynecology or urology for assistance." MCCQE1 Objectives - Pediatrics > Trauma and Emergency Care:
"Candidates must recognize when specialist consultation is required in pediatric genitourinary trauma, especially in cases of failed catheterization." Options B and D delay necessary care. Coagulation studies (C) may be considered if bleeding is unexplained.
Abuse assessment (E) may be necessary later but does not address immediate retention.
NEW QUESTION # 105
A 21-year-old man presents to the office with persistent pain and swelling of the wrist 2 weeks after falling on his outstretched hand. Anteroposterior and lateral radiographs of the wrist taken at the time of the injury showed no evidence of fracture or dislocation. Which one of the following is the most likely cause of the patient's symptoms?
Answer: C
Explanation:
Scaphoid fractures are often radiographically occult on initial presentation and can present later with persistent pain and swelling in the anatomical snuffbox. They typically occur following a fall on an outstretched hand. If missed, they can lead to avascular necrosis.
Toronto Notes 2023 - Orthopedics, Wrist Injuries:
"Scaphoid fractures are the most common carpal fractures. X-rays may be negative early, so high suspicion requires immobilization and repeat imaging after 10-14 days." MCCQE1 Objectives - Surgery > Musculoskeletal Trauma:
"Candidates must recognize that some fractures, such as scaphoid, may not appear on initial imaging but require clinical suspicion and follow-up imaging or immobilization." Other options (B and C) are less likely without radiographic evidence. De Quervain tenosynovitis (D) presents with radial wrist pain unrelated to trauma and worsens with thumb movement.
NEW QUESTION # 106
A 77-year-old woman is brought to the Emergency Department by ambulance because she has severe heel ulcers and dehydration. Her husband reports that she has been sick for the past 6 to 8 weeks with a cough and congestion. He shares that he has tried to bring her to medical attention on several occasions, but she refused.
The paramedics reported that her bed at home was soiled and that they could hardly reach her room due to clutter. On questioning, her answers seem reasonable. Which one of the following is the most critical next step?
Answer: D
Explanation:
When elder neglect is suspected-especially in cases of self-neglect or unclear caregiver dynamics-the most important immediate step is to assess the patient's decision-making capacity. If she lacks capacity, protective intervention is warranted.
Toronto Notes 2023 - Geriatrics, "Elder Abuse and Capacity Assessment":
"Decision-making capacity must be assessed when a patient is refusing care despite evidence of harm or risk." MCCQE1 Objectives (ELOM > 90-1: Capacity and Consent):
"Candidates must assess capacity in elderly patients before attributing decisions to autonomy, particularly in complex care situations." Evaluating criminal records (B) or clutter (C) may be relevant later but do not take precedence over capacity assessment. Alcohol/substance use (D) and financial abuse (E) are differential concerns, not the critical first step.
NEW QUESTION # 107
A 17-year-old boy is brought by his 2 roommates to the emergency department (ED) after a party where he had been drinking and smoking cannabis. He reportedly was having a good time when he suddenly wanted to jump out of a window. His roommates describe him as "normal prior to a breakup with his girlfriend a week ago." He has since become anxious and unable to sleep. On examination, he is somnolent and appears intoxicated. Which one of the following is the most appropriate initial management?
Answer: C
Explanation:
This adolescent exhibited acute suicidal behavior (attempted to jump out of a window), which is a psychiatric emergency. Regardless of intoxication or cause, such behavior mandates a safety-first approach: involuntary psychiatric assessment and protection from self-harm.
Toronto Notes 2023 - Psychiatry, "Suicide and Crisis Intervention" Section:
"Involuntary psychiatric admission is indicated when a patient poses a danger to themselves or others.
Suicidal ideation or attempts require immediate evaluation and monitoring." MCCQE1 Objectives (Psychiatry > 79-2: Suicide and Risk Management):
"Candidates must identify suicidal behavior and initiate appropriate action, including involuntary admission if necessary for safety." Observation (B) may miss the window for action. Parents (A) should be contacted but are not a substitute for admission. Chlordiazepoxide (C) is not first-line in this scenario.
NEW QUESTION # 108
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