Download Full Version MCCQE Medical Council of Canada Exam

The correct next step is to communicate with the patient and disclose the error . MCCQE objectives emphasize physicians’ ethical and professional obligations regarding disclosure of adverse events and medical errors . When a clinically significant abnormal result was identified and appropriate follow-up was not arranged, this represents a potential error in care. Physicians have a duty to disclose errors that may have contributed to harm, provide an explanation, express regret, and outline next steps in management.

Withholding disclosure violates principles of honesty, transparency, and respect for patient autonomy. Blaming office staff or the radiologist deflects responsibility and does not address the ethical obligation to the patient. Forwarding the report to oncology does not fulfill the duty of disclosure. The physician should arrange a timely, compassionate conversation with the patient, explain the missed follow-up, discuss implications, and outline ongoing management. Documentation of the discussion and engagement in quality improvement processes are also appropriate subsequent steps.

Comprehensive and Detailed Explanation:

The image and clinical history are consistent with physiologic pubertal gynecomastia, which is common in adolescent boys. It usually resolves spontaneously within 6 months to 2 years and does not require investigation unless other signs of endocrine pathology are present.

Toronto Notes 2023 – Pediatrics / Endocrinology:

“Pubertal gynecomastia is benign, self-limited, and common in adolescent males. No further investigation is needed in the absence of systemic signs.”

MCCQE1 Objectives (Pediatrics > 77-2: Endocrine Disorders):

“Candidates must differentiate physiologic gynecomastia from pathologic causes based on history and physical exam.”

Other tests (A–C, E) are unnecessary unless there are red flags (e.g., testicular mass, rapid progression, neurological symptoms).

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Comprehensive and Detailed Explanation:

This patient demonstrates excellent exercise tolerance (17 METs) and no ischemic changes or exertional symptoms, which makes cardiac ischemia unlikely. However, the hypertensive response to exercise (BP > 190 systolic) indicates masked or latent hypertension. This should be managed proactively, typically starting with a thiazide.

Toronto Notes 2023 – Cardiology:

“An exaggerated hypertensive response during exercise is predictive of future hypertension. Treatment with antihypertensive agents such as thiazides may be warranted.”

MCCQE1 Objectives (Internal Medicine > 31-1: Hypertension and Risk Management):

“Candidates must identify abnormal BP responses to exercise and initiate appropriate treatment.”

Reassurance alone (A) ignores the hypertensive response. Catheterization (C) and beta-blockers (D) are unnecessary without ischemia. Advising against exercise (B) is counterproductive in a young, otherwise healthy patient.

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Oral contraceptives increase the risk of thromboembolic events, particularly in patients with risk factors such as smoking and obesity. However, informing the patient’s partner of potential contributing factors in a factual, non-judgmental manner is appropriate and does not imply fault.

Toronto Notes 2023 – ELOM, “Informed Consent and Risk Communication”:

“Patients and families should be informed of all relevant information, including potential drug-related adverse events. Blame must not be assigned without full investigation.”

MCCQE1 Objectives (ELOM > 90-2: Physician–Patient Communication):

“Candidates must be able to communicate adverse outcomes factually, while respecting confidentiality and without prematurely assigning fault.”

Discussing the case with the ethics committee or reporting the prescribing doctor without context is premature and inappropriate (A, D). Telling the partner the physician was at fault (C) is speculative and unethical.

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