NEW QUESTION 109
A 59-year-old woman is referred to you because of a 2-month history of left nipple discharge. She is otherwise healthy and is not on any medication. There are no palpable lesions on breast examination. She is able to express a small amount of blood-tinged liquid from her breast. Which one of the following would be the best next step?

NEW QUESTION 110
A 45-year-old man with a developmental delay and a history of disruptive behavior presents to the clinic looking for his family doctor. He is well known to the clinic. He appears drunk and has accidentally broken 2 large beer bottles in the waiting room but remains calm. The office staff requests your help to deal with this situation. Which one of the following is the most appropriate initial step?

NEW QUESTION 111
An investigator interested in the etiology of neonatal jaundice conducted a study where he selected 150 children diagnosed with this condition and 150 children born in the same time period and in the same hospital who did not have a diagnosis of neonatal jaundice. He then reviewed the delivery records of their mothers to determine various prenatal and perinatal exposures. This is an example of which one of the following?

NEW QUESTION 112
A 3-month-old girl is brought by her parents to the emergency department with a 3-day history of cough, coryza, and low-grade fever; she was previously well. In the last 24 hours, she has been noted to have rapid breathing with audible wheezing. Which one of the following pathogens is the most likely cause of the patient’ s symptoms?

NEW QUESTION 113
An 88-year-old man is admitted to hospital with an upper gastrointestinal bleed. He is confused on admission, but his sensorium clears with resuscitation and stabilization. The patient lives in his own home with assistance from his children. Work-up shows metastatic gastric carcinoma for which no curative treatment can be offered. The family insists that the patient not be told the diagnosis because they fear he will have a “mental breakdown.” Which one of the following is the best next step?

NEW QUESTION 114
A 12-year-old girl is brought to your clinic by her parents 6 weeks after experiencing a minimally displaced buckle fracture of her distal radius. It was immobilized in a cast for 3 weeks. On examination, she supports her forearm with the opposite hand. She is unwilling to move her elbow, wrist, and fingers. The findings of her neurovascular examination are normal, and the soft tissue is supple. A repeat radiograph shows bony union. Which one of the following is the most likely diagnosis?

NEW QUESTION 115
A 63-year-old man is brought to the Emergency Department by ambulance after he injured his abdomen.
While working on a house, he fell 1 m from a scaffold and landed on a metal pipe. He is clinically stable but reports localized abdominal pain. On examination, he has a 17-cm laceration to his abdomen in the left hypochondrium. The laceration is 4 cm deep, but there is no fascial laceration. Which one of the following is the best next step?

NEW QUESTION 116
A surgical clinic would like to respond to the Truth and Reconciliation Commission of Canada: Calls to Action report. The clinic has implemented a mandatory cultural safety course for all employees and ongoing faculty development that includes teachings from Elders and Knowledge Keepers and teaching sessions about harm reduction, trauma-informed care, and antiracism. Which one of the following steps would further the clinic’s goal of responding to this report?

NEW QUESTION 117
A health authority implements the first-ever colon cancer screening program in its territory. Which one of the following colon cancer indices will likely increase?

NEW QUESTION 118
A 33-year-old woman presents to a walk-in clinic with a severe right-sided facial paralysis that started suddenly this morning. She denies any numbness or limb weakness. She has no headache or fever. Which one of the following findings on history/physical examination would suggest a more concerning diagnosis?

NEW QUESTION 119
A 16-year-old boy presents to the emergency department with a 12-hour history of fever and rigors. He has sickle cell anemia. On examination, his vital signs include the following:
Heart rate
110/min (60-100)
Respiratory rate
20/min (12-18)
Temperature
38.8 °C, oral (36.5-37.5)
Which one of the following places this patient at risk for sepsis?

NEW QUESTION 120
A 53-year-old man presents to the Emergency Department with a 3-week history of believing his neighbor is poisoning him by pumping gas through his home’s air vent. He appears distracted, irritable, and is speaking very quickly. He has a family history of depression. Which one of the following is the most likely diagnosis?

NEW QUESTION 121
A 55-year-old man with alcohol use disorder presents with a 2-day history of confusion. Onexamination, you note a sixth nerve palsy and a horizontal nystagmus. Which one of the following is the most likely diagnosis?

NEW QUESTION 122
An 80-year-old man is admitted to hospital with what turns out to be tuberculosis. The attending physician informs all staff at the hospital of the patient ‘ s identity and diagnosis. Which one of the following best describes privacy concerns in this situation?

NEW QUESTION 123
A 29-year-old man comes to the office for an initial visit. He is being treated for schizophrenia and epilepsy.
He has a 20 pack-year history of smoking. His medications are carbamazepine, clozapine, and quetiapine. In the past year, he has gained a considerable amount of weight. Asidefrom a BMI of 32, the results of his physical examination are unremarkable. Which one of the following conditions should he be investigated for?

NEW QUESTION 124
A 16-year-old girl is brought to the Emergency Department with a 12-hour history of worsening right lower quadrant abdominal pain and nausea. She is in no distress and vital signs are normal. Her abdomen is soft but locally tender in the right iliac fossa, and bowel sounds are active. White blood cell count is 7.6 × 10#/L (4-
10), C-reactive protein is 2.3 mg/L ( < 10) and serum beta human chorionic gonadotropin is undetectable.
Ultrasound reveals a small amount of fluid in the pelvis, and the appendix is not clearly apparent. Which one of the following is the best next management step?

NEW QUESTION 125
A 54-year-old woman presents to your office to discuss breast cancer screening. She is asymptomatic with no history of breast cancer. She had a fibroadenoma removed when she was 24 years old. The patient is not on any medications. Her family history is significant for a great-aunt with breast cancer. The patient has not had genetic testing but had normal breast screening 2 years ago. Which one of the following is the best next step?

NEW QUESTION 126
A new patient, a 19-year-old man, presents to your office with low back pain. He has a history of opioid dependence and is now on a methadone maintenance treatment program. He is requesting opiate analgesics.
After examination, you decide not to prescribe opiates for pain control. The patient gets upset and threatens to file a complaint with your licensing authority. Which one of the following is the best next step?

NEW QUESTION 127
An intoxicated 28-year-old man is brought to the Emergency Department after being found in the snow. His vital signs are as follows:
Temperature: 33°C
Respiratory rate: 22/min
Heart rate: 123/min
The patient is shivering and displays some dysarthria and ataxia. After his wet clothing is removed, he is provided with a warm blanket. The results of the subsequent physical examination are unremarkable, except for frostbite of the ears and fingers. Which one of the following is the best next step?

NEW QUESTION 128
A 79-year-old woman is brought by a long-term care (LTC) facility staff member to your clinic with concerning behaviours. On history, she was admitted to an LTC facility 6 months ago with vascular dementia.
Three days ago, she became very aggressive towards her caregivers. There is no clear pattern to her aggression. Some staff members report that she is quieter than usual, whereas others report that she is agitated, talks to herself, and picks at her clothes. On examination, she appears very confused. She does not finish her answers and seems to “drift off” during conversation. Which one of the following is the most likely diagnosis?