ECFMG Medical Knowledge & Clinical Science 4

Question 1

A 68-year-old man with COPD has PaO2 55 mmHg and PaCO2 58 mmHg on ABG. What is the primary acid-base disorder?

Accepted Answer

Respiratory acidosis with metabolic compensation

Answer

Chronic CO2 retention (respiratory acidosis) in COPD is accompanied by renal bicarbonate retention (metabolic compensation), reflected by an elevated serum HCO3.

Question 2

A 30-year-old woman is found unconscious. ABG: pH 7.24, PaCO2 20 mmHg, HCO3 8 mEq/L. Serum glucose is 540 mg/dL with ketonuria. What drives the respiratory response?

Accepted Answer

Kussmaul breathing as compensation for metabolic acidosis

Answer

Kussmaul breathing (deep, rapid respirations) is the compensatory hyperventilation that reduces PaCO2 in response to severe metabolic acidosis in DKA.

Question 3

A 55-year-old woman presents with a palpable thyroid nodule. Fine needle aspiration shows follicular neoplasm. What is the NEXT best step?

Accepted Answer

Thyroidectomy or hemithyroidectomy

Answer

Follicular neoplasm on FNA cannot distinguish adenoma from carcinoma cytologically; surgical excision is required for definitive diagnosis.

Question 4

A 4-year-old boy presents with periorbital edema, proteinuria of 4 g/day, hypoalbuminemia, and hyperlipidemia. Kidney biopsy shows effacement of foot processes on electron microscopy. What is the treatment of choice?

Accepted Answer

Prednisone

Answer

Minimal change disease (nephrotic syndrome in children with foot process effacement) responds to corticosteroids as first-line therapy in over 90% of cases.

Question 5

A 45-year-old woman develops proximal muscle weakness, heliotrope rash around the eyes, and Gottron's papules over the knuckles. Which malignancy is MOST commonly associated with this condition in adults?

Accepted Answer

Ovarian cancer

Answer

Dermatomyositis in adult women is most commonly associated with ovarian cancer, making gynecologic malignancy screening essential.

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

ECFMG Medical Knowledge & Clinical Science 4