ECFMG Medical Knowledge & Clinical Science 2 — Questions and Answers
Question 1: A 45-year-old man presents with episodic hypertension, headache, and diaphoresis. 24-hour urine shows elevated catecholamines. Which imaging is the FIRST-LINE localization study?
- CT of abdomen and pelvis (Correct answer)
- MRI of abdomen and pelvis
- MIBG scintigraphy
- PET scan
Correct answer: CT of abdomen and pelvis
CT of the abdomen and pelvis is the first-line imaging for pheochromocytoma localization due to its wide availability and high sensitivity.
Question 2: A 28-year-old woman at 32 weeks gestation presents with BP 158/102, proteinuria, and headache. Which medication is CONTRAINDICATED for acute BP control?
- Labetalol IV
- Hydralazine IV
- Nifedipine oral
- ACE inhibitor (Correct answer)
Correct answer: ACE inhibitor
ACE inhibitors are contraindicated in pregnancy due to fetal renal toxicity, oligohydramnios, and fetal growth restriction.
Question 3: A 60-year-old smoker presents with a lung mass and hyponatremia. Serum osmolality is low and urine osmolality is high. What is the most likely cause of hyponatremia?
- Adrenal insufficiency
- Hypothyroidism
- SIADH (Correct answer)
- Cerebral salt wasting
Correct answer: SIADH
SIADH is classically associated with small cell lung carcinoma and causes euvolemic hyponatremia with inappropriately concentrated urine.
Question 4: A patient with rheumatoid arthritis on methotrexate develops megaloblastic anemia and oral ulcers. What is the mechanism of methotrexate's toxicity here?
- Direct bone marrow suppression
- Folate antagonism via DHFR inhibition (Correct answer)
- Vitamin B12 depletion
- Iron chelation
Correct answer: Folate antagonism via DHFR inhibition
Methotrexate inhibits dihydrofolate reductase, blocking folate metabolism and causing folate-deficiency manifestations including megaloblastic anemia.
Question 5: A 55-year-old man has ST-segment elevation in leads II, III, and aVF on ECG. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
Inferior STEMI (ST elevation in II, III, aVF) is most commonly caused by occlusion of the right coronary artery.
Question 6: A child presents with fever, drooling, tripod positioning, and stridor. She appears toxic and cannot swallow. What is the MOST appropriate immediate action?
- Lateral neck X-ray in radiology
- Direct laryngoscopy in the ED
- Emergent airway securement in the OR (Correct answer)
- High-flow oxygen and IV antibiotics
Correct answer: Emergent airway securement in the OR
Epiglottitis with impending airway compromise requires controlled airway securement in the operating room with surgical backup available.
Question 7: A 70-year-old woman is found to have a serum calcium of 11.8 mg/dL and low PTH. Chest X-ray shows bilateral hilar adenopathy. What is the most likely diagnosis?
- Primary hyperparathyroidism
- Familial hypocalciuric hypercalcemia
- Sarcoidosis (Correct answer)
- Multiple myeloma
Correct answer: Sarcoidosis
Sarcoidosis causes hypercalcemia via activated macrophage production of 1,25-dihydroxyvitamin D, with low or suppressed PTH and characteristic hilar adenopathy.
ECFMG Medical Knowledge & Clinical Science 2
A 45-year-old man presents with episodic hypertension, headache, and diaphoresis. 24-hour urine shows elevated catecholamines.
Which imaging is the FIRST-LINE localization study?