ECFMG Patient Care & Clinical Skills 3

Question 1

A 35-year-old man presents with three weeks of productive cough, night sweats, and a 10-lb weight loss. He emigrated from Southeast Asia two years ago. Which diagnostic test is most important?

Accepted Answer

Sputum acid-fast bacilli smear and culture

Answer

The clinical picture strongly suggests pulmonary tuberculosis; sputum AFB smear and culture are essential for diagnosis and to guide infection control.

Question 2

An 8-year-old child is brought in by her mother for a routine visit. During the exam, you notice multiple bruises in various stages of healing on the child's back and buttocks. The mother states the child 'falls a lot.' What is the most appropriate next step?

Accepted Answer

Report suspicion of child abuse to child protective services

Answer

Patterned bruises in unusual locations at different healing stages are sentinel signs of abuse; mandatory reporting to child protective services is required by law.

Question 3

A patient taking warfarin for atrial fibrillation presents with a supratherapeutic INR of 8.5 and active GI bleeding. Which treatment is most urgently indicated?

Accepted Answer

Give 4-factor prothrombin complex concentrate (4F-PCC) plus IV vitamin K

Answer

Life-threatening bleeding with supratherapeutic INR requires immediate reversal with 4F-PCC (rapid onset) plus IV vitamin K (sustained reversal).

Question 4

A 60-year-old woman presents with crushing substernal chest pain radiating to her left arm, diaphoresis, and nausea for 45 minutes. ECG shows ST elevation in leads II, III, and aVF. What is the target time for reperfusion?

Accepted Answer

Within 90 minutes (door-to-balloon time)

Answer

Current ACC/AHA guidelines recommend primary PCI with a door-to-balloon time of ≤90 minutes for STEMI.

Question 5

A physician notices that a patient's electronic health record contains a billing code that does not match the services actually rendered. The physician suspects insurance fraud by a colleague. What is the most appropriate action?

Accepted Answer

Report the concern through appropriate institutional channels or compliance office

Answer

Suspected fraud must be reported through proper institutional compliance channels to protect patients, the institution, and the integrity of the health care system.

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

ECFMG Patient Care & Clinical Skills 3