ECFMG Patient Care & Clinical Skills 4

Question 1

A 45-year-old HIV-positive man with a CD4 count of 80 cells/µL presents with progressive dyspnea, dry cough, and bilateral interstitial infiltrates on chest X-ray. Which organism is the most likely cause?

Accepted Answer

Pneumocystis jirovecii

Answer

PCP (Pneumocystis jirovecii pneumonia) is the most common AIDS-defining pneumonia, typically occurring when CD4 count falls below 200 cells/µL.

Question 2

During a well-child visit, the parents of a 18-month-old ask about normal developmental milestones. Which skill would be expected at this age?

Accepted Answer

Building a tower of 2–4 cubes

Answer

By 18 months, children typically build a tower of 2–4 cubes as part of normal fine motor development.

Question 3

A 58-year-old woman with rheumatoid arthritis on long-term prednisone undergoes elective hip replacement. Perioperatively, she develops hypotension, tachycardia, and confusion despite adequate fluids. What is the most likely cause?

Accepted Answer

Adrenal insufficiency (adrenal crisis)

Answer

Chronic steroid use suppresses the HPA axis; surgical stress without stress-dose steroids can precipitate adrenal crisis.

Question 4

A 30-year-old man is brought to the ED after a high-speed motor vehicle collision. He is confused, has a GCS of 10, and CT shows a hyperdense lens-shaped (biconvex) lesion over the temporal lobe. What is the most likely diagnosis?

Accepted Answer

Epidural hematoma

Answer

A biconvex (lens-shaped) hyperdense lesion on CT after head trauma is the classic appearance of an epidural hematoma, typically from middle meningeal artery rupture.

Question 5

A physician is caring for a terminally ill patient who requests a higher dose of morphine for pain, knowing it may hasten death. The patient has decision-making capacity and a terminal prognosis. Which ethical principle supports honoring this request?

Accepted Answer

Autonomy and the doctrine of double effect

Answer

The doctrine of double effect permits administering palliative doses even if they may hasten death, when the intent is relief of suffering and the patient has made an autonomous, informed decision.

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

ECFMG Patient Care & Clinical Skills 4