ECFMG Patient Care & Clinical Skills 5

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?

Accepted Answer

Hospital-acquired delirium

Answer

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?

Accepted Answer

Minors may consent to and receive confidential STI testing and treatment

Answer

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?

Accepted Answer

Renal biopsy showing immune complex deposition

Answer

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?

Accepted Answer

Malignant hyperthermia

Answer

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?

Accepted Answer

Staphylococcus aureus

Answer

Right-sided infective endocarditis in IV drug users is most commonly caused by Staphylococcus aureus affecting the tricuspid valve.

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

(ECFMG) Educational Commission for Foreign Medical Graduates Practice Test

ECFMG Patient Care & Clinical Skills 5