ECFMG Patient Care & Clinical Skills 5 — Questions and Answers
Question 1: A 72-year-old woman is admitted for pneumonia. On day 2, she becomes agitated, confused, and has visual hallucinations. Her vitals are stable. She was oriented on admission. Which condition is most likely?
- New-onset dementia
- Hospital-acquired delirium (Correct answer)
- Schizophrenia exacerbation
- Wernicke's encephalopathy
Correct answer: Hospital-acquired delirium
Acute onset of fluctuating confusion in a hospitalized elderly patient with a precipitating illness is the hallmark of hospital-acquired delirium.
Question 2: A 17-year-old male presents to your office alone for STI testing. He requests confidentiality from his parents. In most US states, which statement is correct regarding adolescent confidentiality?
- Parental consent is always required for STI testing in minors
- Minors may consent to and receive confidential STI testing and treatment (Correct answer)
- The physician must notify parents unless the minor is emancipated
- Confidentiality cannot be maintained for patients under 18 years
Correct answer: Minors may consent to and receive confidential STI testing and treatment
Most US states allow minors to consent to testing and treatment for STIs without parental notification to encourage care-seeking.
Question 3: A 40-year-old woman with systemic lupus erythematosus develops worsening renal function, hematuria, and red cell casts on urinalysis. Which finding best confirms lupus nephritis?
- Positive antinuclear antibody (ANA)
- Elevated anti-double-stranded DNA antibodies with low complement
- Proteinuria greater than 500 mg/day
- Renal biopsy showing immune complex deposition (Correct answer)
Correct answer: Renal biopsy showing immune complex deposition
Renal biopsy demonstrating immune complex deposition (especially IgG, IgA, IgM, C3, C1q — 'full house' pattern) is the gold standard for diagnosing and classifying lupus nephritis.
Question 4: A 55-year-old man undergoes elective cholecystectomy under general anesthesia. Postoperatively, he develops fever, muscle rigidity, and his temperature rises to 41.5°C. CPK is markedly elevated. What is the most likely diagnosis?
- Neuroleptic malignant syndrome
- Malignant hyperthermia (Correct answer)
- Serotonin syndrome
- Thyroid storm
Correct answer: Malignant hyperthermia
Malignant hyperthermia is a rare, life-threatening pharmacogenetic disorder triggered by volatile anesthetic agents or succinylcholine, presenting with hyperthermia, muscle rigidity, and elevated CPK.
Question 5: A 33-year-old man with a history of IV drug use presents with fever, a new holosystolic murmur at the tricuspid area, and septic pulmonary emboli on CT. Which organism is most commonly responsible?
- Streptococcus viridans
- Staphylococcus aureus (Correct answer)
- Enterococcus faecalis
- Candida albicans
Correct answer: Staphylococcus aureus
Right-sided infective endocarditis in IV drug users is most commonly caused by Staphylococcus aureus affecting the tricuspid valve.
Question 6: A 48-year-old woman undergoing a history and physical mentions she drinks 'a couple of glasses of wine each night.' She denies any alcohol-related problems. Which validated screening tool is most appropriate for further assessment?
- CAGE questionnaire
- AUDIT (Alcohol Use Disorders Identification Test) (Correct answer)
- PHQ-9
- Beck Anxiety Inventory
Correct answer: AUDIT (Alcohol Use Disorders Identification Test)
The AUDIT is the WHO-recommended validated tool for identifying hazardous, harmful, and dependent alcohol use in primary care settings.
Question 7: A 19-year-old college student presents with a 3-day history of severe sore throat, fever, cervical lymphadenopathy, and palatal petechiae. Rapid strep test is negative. Which test should be ordered next?
- Throat culture for group A Streptococcus
- Monospot test (heterophile antibody test) (Correct answer)
- CT neck with contrast
- Blood cultures x2
Correct answer: Monospot test (heterophile antibody test)
The clinical presentation is classic for infectious mononucleosis (EBV); a monospot test should follow a negative rapid strep in this age group and setting.
ECFMG Patient Care & Clinical Skills 5
A 72-year-old woman is admitted for pneumonia.
On day 2, she becomes agitated, confused, and has visual hallucinations.
Her vitals are stable.
She was oriented on admission.
Which condition is most likely?