ECFMG Patient Care & Clinical Skills 2 — Questions and Answers
Question 1: A 68-year-old man presents with sudden onset of severe headache described as 'the worst of his life.' What is the most appropriate next step?
- Administer analgesics and reassess in 2 hours
- Perform a non-contrast CT of the head immediately (Correct answer)
- Schedule an outpatient MRI within 48 hours
- Prescribe sumatriptan for presumed migraine
Correct answer: Perform a non-contrast CT of the head immediately
A 'thunderclap' headache (worst of life) requires immediate non-contrast CT to rule out subarachnoid hemorrhage.
Question 2: During a routine physical, a 55-year-old woman is found to have a blood pressure of 158/96 mmHg on two separate readings. She has no other symptoms. Which initial intervention is most appropriate?
- Start amlodipine immediately (Correct answer)
- Lifestyle modification and recheck in 1 month
- Refer to cardiology urgently
- Begin home blood pressure monitoring only
Correct answer: Start amlodipine immediately
Stage 2 hypertension (≥140/90 with confirmed readings) in adults without compelling indications warrants initiation of antihypertensive therapy alongside lifestyle changes.
Question 3: A physician is obtaining informed consent for an elective surgical procedure. The patient, who speaks limited English, nods and signs the form. What is the most appropriate action?
- Proceed with the signed consent form
- Use a trained medical interpreter to ensure comprehension (Correct answer)
- Ask a bilingual family member to translate
- Postpone the procedure indefinitely
Correct answer: Use a trained medical interpreter to ensure comprehension
Informed consent requires patient comprehension; a trained medical interpreter must be used when a language barrier exists.
Question 4: A 42-year-old man with diabetes mellitus presents with a painless foot ulcer. On examination, there is decreased sensation to monofilament testing bilaterally. Which pathophysiology best explains the painless nature of the ulcer?
- Peripheral arterial occlusion reducing blood flow
- Peripheral neuropathy impairing protective sensation (Correct answer)
- Central sensitization lowering pain threshold
- Venous insufficiency causing tissue hypoxia
Correct answer: Peripheral neuropathy impairing protective sensation
Diabetic peripheral neuropathy causes loss of protective sensation, allowing ulcers to develop and progress without pain.
Question 5: A 28-year-old woman at 32 weeks gestation presents with blood pressure 152/98 mmHg, 2+ proteinuria, and headache. Which diagnosis is most likely?
- Chronic hypertension
- Gestational hypertension
- Preeclampsia (Correct answer)
- HELLP syndrome
Correct answer: Preeclampsia
New-onset hypertension after 20 weeks with proteinuria and symptoms such as headache defines preeclampsia.
Question 6: A physician discovers that a colleague has been coming to work impaired by alcohol. What is the physician's most appropriate first action?
- Report the colleague directly to the state medical board
- Confront the colleague privately and encourage them to seek help
- Notify the chief of staff or designated hospital authority (Correct answer)
- Document observations and wait for further incidents
Correct answer: Notify the chief of staff or designated hospital authority
Patient safety requires immediate reporting to the appropriate institutional authority (e.g., chief of staff or physician health program) when a colleague is impaired.
Question 7: A 70-year-old man with end-stage COPD and a valid DNR order develops respiratory failure in the ED. His daughter insists on intubation. What should the physician do?
- Intubate the patient to avoid family conflict
- Explain that the DNR reflects the patient's own wishes and provide comfort care (Correct answer)
- Request an ethics committee consultation before any action
- Defer the decision to the attending pulmonologist
Correct answer: Explain that the DNR reflects the patient's own wishes and provide comfort care
A valid DNR order represents the patient's autonomous decision and must be honored; the physician should compassionately explain this to the family and transition to comfort care.
ECFMG Patient Care & Clinical Skills 2
A 68-year-old man presents with sudden onset of severe headache described as 'the worst of his life.' What is the most appropriate next step?