ECFMG Medical Knowledge & Clinical Science 3

Question 1

A 35-year-old woman presents with ascending weakness starting in her legs 2 weeks after a GI illness. CSF shows elevated protein with normal cell count. What is the most likely diagnosis?

Accepted Answer

Guillain-Barré syndrome

Answer

Guillain-Barré syndrome presents with ascending paralysis post-infection and the classic CSF finding of albuminocytologic dissociation (high protein, normal cells).

Question 2

A 50-year-old alcoholic man presents with confusion, ataxia, and ophthalmoplegia. What is the immediate treatment?

Accepted Answer

Thiamine IV then glucose

Answer

Wernicke's encephalopathy requires immediate IV thiamine before glucose to prevent precipitation or worsening of the thiamine-deficient state.

Question 3

A 40-year-old woman has a butterfly rash, arthralgia, and a positive ANA. Her anti-dsDNA is elevated and complement levels are low. Which organ complication carries the worst prognosis in her condition?

Accepted Answer

Lupus nephritis

Answer

Lupus nephritis is the most serious organ complication of SLE and is a major cause of morbidity and mortality if untreated.

Question 4

A neonate develops projectile vomiting at 3 weeks of age. The vomit is nonbilious and the infant is hungry after vomiting. Ultrasound shows pyloric wall thickness of 5 mm. What is the definitive treatment?

Accepted Answer

Pyloromyotomy

Answer

Hypertrophic pyloric stenosis is definitively treated with Ramstedt pyloromyotomy after correcting electrolyte abnormalities.

Question 5

A 62-year-old man with type 2 diabetes has a creatinine of 2.1 mg/dL and eGFR of 38 mL/min. Which antidiabetic agent requires dose adjustment or avoidance?

Accepted Answer

Metformin

Answer

Metformin is contraindicated when eGFR falls below 30 and should be used cautiously below 45 due to risk of lactic acidosis in renal impairment.

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

ECFMG Medical Knowledge & Clinical Science 3