ECFMG Patient Care & Clinical Skills 2

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?

Accepted Answer

Perform a non-contrast CT of the head immediately

Answer

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?

Accepted Answer

Start amlodipine immediately

Answer

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?

Accepted Answer

Use a trained medical interpreter to ensure comprehension

Answer

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?

Accepted Answer

Peripheral neuropathy impairing protective sensation

Answer

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?

Accepted Answer

Preeclampsia

Answer

New-onset hypertension after 20 weeks with proteinuria and symptoms such as headache defines preeclampsia.

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

ECFMG Patient Care & Clinical Skills 2