Question 1

A 23-year-old woman with borderline personality disorder is brought to the Emergency Department having ingested non-lethal substances after her boyfriend broke up with her. The staff tells you that she has consulted 8 times under similar circumstances in the past 3 years. Which one of the following pieces of information would be useful to provide to the staff?

Options :

A : Not much can be done with personality disorders

B : She will never commit suicide

C : Suicidal thoughts must be an indication of major depressive disorder

D : She is overusing health care services

E : Symptoms of borderline personality disorder will likely attenuate over time

Answer: E

Question 2

A 94-year-old woman with severe dementia is referred for vaginal bleeding and a persistent foul odour from the vagina. She lives in a long-term care facility. She has been using a ring pessary for the past 15 years. Her current pessary has not been replaced in 2 years. On examination, there is moderate vaginal atrophy. After removing the pessary, which one of the following is the best next step?

Options :

A : Arrange for a hysteroscopy and endometrial biopsy.

B : Prescribe vaginal metronidazole gel.

C : Start vaginal estrogen.

D : Wash the pessary and recommend a daily saline douche.

E : Perform a vaginal biopsy.

Answer: C

Question 3

An 88-year-old married man is admitted following a cardiac arrest at home. He was not expected to recover, and after 2 weeks, he remains in a coma. His wife states, "I cannot let him go. That would be murder." As the attending physician looking after her husband, which one of the following is the best next course of action?

Options :

A : Say nothing further and wait until she comes around to accepting his state

B : Remove him from life support as this would not be murder

C : Emphasize that the duration of his stay in the Intensive Care Unit will be limited

D : Encourage her to imagine what her husband would have wanted

E : Seek advice from the provincial or territorial public guardian

Answer: D

Question 4

A 43-year-old man comes to your office for the first time. He has not seen a doctor in over 5 years and has no known past medical history. On examination, his blood pressure is 120/70 mm Hg, and the remainder of his examination is normal. As part of the initial visit, you order some screening blood work that reveals a fasting blood glucose of 6.3 mmol/L (3.3–5.8) and a hemoglobin A1c of 6.1% (4–6). Which one of the following is the best next step?

Options :

A : Order thyrotroph (thyroid-stimulating hormone) level.

B : Test capillary blood glucose 4 times a day.

C : Order a urine albumin:creatinine ratio.

D : Perform a 75 g oral glucose tolerance test.

E : Order an exercise stress test.

Answer: D

Question 5

There are many expenses which are considered part of providing care to patients. Under Canadian legislation, which one of the following is an acceptable means of covering these costs?

Options :

A :

Collecting annual fees from patients to supplement fees disbursed by the public payer for insured services.

B : Collecting fees from patients for home visits.

C : Collecting fees from patients for uninsured services provided.

D : Offering rapid access to insured services for a fee.

E : Collecting fees from patients who are seen after hours.

Answer: C

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