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?

• A.Insist on conducting the interview with the patient alone
• B.Interview the patient and the family together
• C.Allow 1 family member to stay and act as the interpreter
• D.Ask the patient to write down her history and have it translated

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A 27-year-old woman presents to her family physician's office and states that she is pregnant and would like to be referred for an abortion. She is at approximately 9 weeks' gestation by dates. The family physician has personal conscience-based objections to the procedure. Which one of the following would be the best next step for this physician?

• A.Explain their personal views about therapeutic abortion to the patient
• B.Refer the patient to another physician
• C.Ask the patient to return in 2 weeks to give her time to consider her options
• D.Recommend that the patient consider adoption

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A 17-year-old boy presents to your clinic with a 6-month history of recurrent headaches. The headaches are excruciating, and he describes them as a stabbing pain, usually around his right eye. They occur several times daily for 2 to 3 weeks and recur every few months. The headaches are associated with tearing from his right eye and tend to get worse when he is overtired. Which one of the following is the most likely diagnosis?

• A.Sinusitis
• B.Migraine
• C.Brain tumour
• D.Cluster headache
• E.Post-concussive headache

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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?

• 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

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A 37-year-old man comes to the office for follow-up of his opioid use disorder. He receives opioid agonist treatment, including some take-home doses. At this follow-up visit, he reports some nonprescription opioid use since his last visit. Which one of the following is the best next step?

• A.Taper the dosage of the opioid agonist
• B.Discontinue take-home doses
• C.Increase the frequency of follow-up visits
• D.Prescribe a cannabinoid
• E.Slowly taper and discontinue the opioid agonist

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