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NEW QUESTION # 195
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: C
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 # 196
A 20-year-old man is brought by a friend to the emergency department with an elevated temperature, generalized muscle rigidity, hypovolemia, a fluctuating level of consciousness, and impaired attention. The patient also may be responding to auditory hallucinations. The friend informs you that the patient overdosed with a prescribed medication. Which one of the following medications is most likely to cause these symptoms?
Answer: E
Explanation:
This presentation is classic for neuroleptic malignant syndrome (NMS), a rare but life-threatening reaction to antipsychotic drugs (particularly dopamine antagonists like risperidone). Features include hyperthermia, rigidity, altered mental status, and autonomic instability.
Toronto Notes 2023 - Psychiatry, "Neuroleptic Malignant Syndrome":
"NMS is associated with antipsychotic use. Key features: hyperthermia, lead-pipe rigidity, altered consciousness, autonomic dysfunction. Elevated CK, leukocytosis often present." MCCQE1 Objectives (Psychiatry > 71-5: Adverse Effects of Psychotropics):
"Candidates must recognize and manage neuroleptic malignant syndrome and differentiate it from other drug toxicities." Amitriptyline (B) overdose causes anticholinergic symptoms. Lamotrigine (A) causes rash or seizures in toxicity. Lithium (D) leads to tremor, ataxia, and GI upset. Lorazepam (E) causes CNS depression, not rigidity or fever.
NEW QUESTION # 197
You are called to the Emergency Department to see a 6-month-old boy with a 3-day history of fever. Physical examination reveals an irritable infant with a temperature of 38.1°C. His vital signs are:
Blood pressure: 87/50 mm Hg
Respiratory rate: 80/min
Heart rate: 140/min
Oxygen saturation: 92% on room air
The infant has no skin findings. On chest examination, you hear coarse crackles on the right side of the chest.
Which one of the following is the best next step in the management of this child?
Answer: C
Explanation:
This 6-month-old presents with signs of systemic illness, tachypnea, hypoxia, and focal lung findings. In this age group, pneumonia can rapidly progress, and given the severity of symptoms, oral treatment is insufficient.
Intravenous antibiotics are urgently indicated.
Toronto Notes 2023 - Pediatrics, Respiratory Infections in Infants:
"Infants under 6 months with signs of systemic illness, hypoxia (SpO2 < 94%), and respiratory distress should receive IV antibiotics. Delayed treatment may result in rapid clinical deterioration." MCCQE1 Objectives - Pediatrics > Respiratory Conditions:
"Candidates must recognize signs of serious lower respiratory tract infection in infants and initiate prompt IV antibiotic therapy when criteria for hospitalization are met." Oral antibiotics (C) are appropriate for mild outpatient pneumonia. Reassurance (B) and oral steroids (A) are inappropriate. IV fluids (D) may be supportive but do not address the infectious cause.
NEW QUESTION # 198
You are being consulted for a 79-year-old man who is about to undergo a total hip arthroplasty. His orthopedic surgeon is aware of the diagnosis of Alzheimer disease and would like your suggestions to help avoid acute postsurgical delirium. To that end, which one of the following is the most effective strategy?
Answer: B
Explanation:
One of the strongest modifiable risk factors for postoperative delirium in older adults is exposure to anticholinergic medications (e.g., diphenhydramine, certain antidepressants). Avoiding these can reduce delirium risk.
Toronto Notes 2023 - Geriatrics, "Delirium Prevention":
"Avoid high-risk medications including anticholinergics, benzodiazepines, and narcotics if possible. Maintain orientation cues and adequate pain control." MCCQE1 Objectives (Medicine > Geriatrics > 41-1: Cognitive Impairment):
"Candidates must recognize predisposing factors for delirium and apply prevention strategies, including medication review." Opiates (B) should be used judiciously; untreated pain can also cause delirium. Cognitive screening (C) is helpful for baseline but does not prevent delirium. Benzodiazepines (D) increase delirium risk. Family involvement is actually helpful (E).
NEW QUESTION # 199
On screening for dyslipidemia, a 45-year-old man is found to have a low high-density lipoprotein (HDL) cholesterol level. Which one of the following recommendations is the most appropriate?
Answer: E
Explanation:
Low HDL is best managed with lifestyle changes such as increased aerobic physical activity, smoking cessation, and weight loss. Vigorous exercise has the strongest evidence for raising HDL levels.
Toronto Notes 2023 - Cardiology, Dyslipidemia:
"Increasing physical activity is among the most effective ways to raise HDL cholesterol. There is no consistent benefit to supplements such as garlic, nor does reducing salt or caffeine meaningfully raise HDL." MCCQE1 Objectives - Population Health > Cardiovascular Risk Management:
"Candidates should recommend evidence-based lifestyle interventions such as exercise to improve lipid profiles, particularly to increase HDL." Alcohol cessation (C) is generally beneficial for overall health but may actually lower HDL slightly. Garlic (D) and caffeine (E) are not evidence-based interventions for dyslipidemia.
NEW QUESTION # 200
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