Choose MCCQE most accurate study material

A 42-year-old man comes to your family practice. He has started seeing a reflexologist to help manage his chronic back pain. He presents to you a letter from the reflexologist outlining the weekly necessary treatments, each costing $300, and a list of blood tests for the patient to have done. The patient asks you to order the laboratory testing and send the results to his "other doctor." Which one of the following is the best next step?

• A. Report the reflexologist to the medical regulatory authority.
• B. Tell your patient to stop seeing this practitioner.
• C. Order the tests and arrange to send them to the reflexologist.
• D. Decline to order the tests but inquire further about his back pain.
• E. Report the reflexologist to the regulatory authority for alternative and complementary practitioners.

A 28-year-old woman presents to the office in great distress because she has no money for groceries or rent.
She is a single mother of a 7-year-old girl. She has a history of gambling disorder. She has felt unable to cope for the last 3 months and has started gambling again. Today, she is crying, and she shares that her boyfriend became violent with her yesterday. Which one of the following is the highest priority for assessment?

• A. Screen for recreational drug and alcohol use.
• B. Determine the risk of violence to the patient and her child.
• C. Evaluate for depression.
• D. Investigate the patient ' s need for financial assistance.
• E. Define the extent of the patient ' s gambling disorder.

A 6-week-old boy is brought to your office by his parents for a follow-up following a recent urinary tract infection. His abdominal ultrasound shows dilated urinary bladder and ureters as well as bilateral hydronephrosis. Which one of the following historical findings would be most helpful in establishing the correct diagnosis?

• A. Poor urinary stream
• B. Crying during micturition
• C. Macroscopic hematuria
• D. Recent circumcision
• E. Malodorous urine

A 20-year-old woman from a remote northern community presents to the office with a 2-week history of malaise and a 2-day history of disabling pain in her left elbow. She had a sore throat 4 weeks ago. She also notes that she has had 2 weeks of pain and swelling in her right knee, followed by pain and swelling in her left elbow. On examination, you note 0.5-cm to 1-cm nodules just above both her elbows. You find no active joint swelling. An electrocardiogram shows a prolonged PR interval. Which one of the following is the most appropriate investigation?

• A. Echocardiography.
• B. Antistreptolysin O titre.
• C. Pharyngeal culture.
• D. Rheumatoid factor.
• E. Excisional biopsy of nodules.

A 33-year-old primigravid woman presents to the office with gestational hypertension. Her pregnancy is at 37 weeks' gestation. The ultrasound findings are as follows:
Head circumference: 5th percentile
Biparietal diameter: 10th percentile
Abdominal circumference: 5th percentile
Femur length: 25th percentile
Amniotic fluid volume: 5.0 cm
Umbilical Doppler: Reversed end-diastolic flow
Which one of the following is the best next step?

• A. Biophysical profile in 1 week.
• B. Biometry in 2 weeks.
• C. Twice-weekly nonstress tests.
• D. Induction of labour on the due date.
• E. Immediate delivery.