A 29-year-old concert pianist with severe chronic kidney disease presents with a 6-month history of loss of appetite and pruritus. Although the issue of initiating dialysis has been discussed with him and his questions answered, he has declined dialysis thus far. You understand his concerns that it will interfere with his concert tour and recording schedule. Which one of the following is the best next step?
A 30-year-old man (assigned female at birth) presents to your clinic for a periodic health examination. He declines a gynecologic examination because such examinations lead to intense emotional distress for him. He also believes that he does not require a Papanicolaou (Pap) test because he is not in a sexual relationship with a man. After acknowledging the patient's distress and providing education regarding the need for Pap screening, which one of the following would be the best next step?
You are asked to see a 30-year-old woman, gravida 8, para 4, aborta 1, for symptoms of postpartum depression. She immigrated to Canada 8 months ago. She has been reluctant to speak to members of the medical team without her family members, even when an interpreter is present. Which one of the following is the best next step?
Following a potluck supper organized by the residency director of your training program, many of your fellow residents and other guests fall ill with gastroenteritis. Which one of the following is the best way to identify the source of this food-borne outbreak?
An 18-year-old woman presents to the Emergency Department with a 3-day history of vomiting and right upper quadrant pain. She is alert but appears unwell and jaundiced. She was previously healthy and has not travelled recently. She has no risk factors for blood-borne pathogens. She denies hematemesis or hematochezia. On further history, she reports that she took a full bottle of pills that she found in her parents’ medicine cabinet several hours before she started vomiting. Without intervention, which one of the following is the most likely outcome?
A 42-year-old man presents to your office with acute left knee pain and difficulty walking. He denies any trauma. He reports 2 painful episodes involving his right great toe in the last year. He smokes half a pack of cigarettes a day and drinks at least 3 beers daily. He has a temperature of 38.2°C and has a red, swollen and warm left knee. Which one of the following is the best next step?
A 73-year-old woman is seen in the office 2 weeks after a coronary bypass surgical procedure. The site of saphenous vein removal in the left thigh shows an area of tenderness and a 3 × 5 cm palpable mass. The skin is intact. Her temperature is 37.7 °C, hemoglobin is 110 g/L (125–167), and white blood cell count is 8 × 10⁹/L (4–10). Which one of the following is the most likely diagnosis?
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 60-year-old man has a strong family history of aortic aneurysms. Screening abdominal ultrasonography reveals an incidental <1 cm mass in his left kidney. Computed tomography confirms that the mass is consistent with renal adenocarcinoma. Which one of the following is the most appropriate step in management?
You are counselling the wife of a 75-year-old man admitted under your care after a fall. The patient is confused, disoriented, barely sleeps at night and has complex visual hallucinations of animals running through his room. Given his state, which one of the following is the best advice for the wife?
