Question 1

A 32-year-old woman, gravida 0, comes to your office for contraception counselling, specifically about insertion of a levonorgestrel-releasing intrauterine device. She has a past history of breast cancer and is presently on tamoxifen. Which one of the following is the best advice for your patient?

Options :

A : She has a high risk of irregular bleeding following insertion

B : After consultation with her oncologist, she may choose this option

C : It may increase her risk of breast cancer recurrence

D : She will require pre-procedure antibiotics

E : This device will increase her risk of future infertility

Answer: B

Question 2

A 22-year-old woman is brought to the Emergency Department by her boyfriend, who says that she is experiencing a fentanyl overdose. She is unresponsive and cyanotic. She regains consciousness after naloxone is injected intravenously and demonstrates no further respiratory depression during 8 hours of observation. She states that she is 22 weeks' pregnant and wants to stop using opioids. Which one of the following is the best next step?

Options :

A : Admit the patient for medically supervised detoxification

B : Refer the patient for initiation of methadone

C : Prescribe medications for symptom control so that the patient can detoxify at home

D : Refer the patient for opioid use disorder counselling

Answer: B

Question 3

A 30-year-old woman presents to the office with her partner and reports that they are planning for her to conceive soon. They visited Mexico recently and are concerned about exposure to the Zika virus. Which one of the following is the best next step?

Options :

A : Refer the couple to an infectious disease specialist

B : Request serologic testing

C : Recommend ceasing conception until 3 months after the couple's return to Canada

D : Explain that condoms are ineffective in preventing sexual transmission of Zika virus

E : Prescribe a prophylactic antiviral medication

Answer: C

Question 4

A 60-year-old woman presents with a 7-day history of bloody diarrhea and diffuse mild abdominal tenderness. Stool tests (culture, ova/parasites) are negative. Which one of the following is the best next step?

Options :

A : Prescribe broad-spectrum antibiotics.

B : Order a diagnostic colonoscopy.

C : Recommend symptomatic observation.

D : Recommend a trial of loperamide.

E : Prescribe tapered-dose steroids.

Answer: B

Question 5

A patient's mother comes to you with a prospective cohort study linking autism to the measles, mumps and rubella vaccine. After reviewing the study carefully, you question the results because of problems with the study design and execution. Which one of the following sources of error would be most important in the study design or execution?

Options :

A : Reporting standard error with point estimates of difference

B : Vaccine company sponsorship of study

C : Recruitment of study families at an autism seminar

D : Parental recall of vaccine administration

E : Not accounting for all potential confounders during recruitment

Answer: C

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