BESTLEC
ABFM KSA- CARE OF HOSPITALIZED PATIENTS EXAM
NEWEST ACTUAL ACCURATE EXAM COMPLETE QUESTIONS AND DETAILED
VERIFIED ANSWERS GRADED A+ | 100% VERIFIED| 2025
A 42-year-old construction worker with a 3-day history of cough, fever, chills, dyspnea, and
right posterolateral chest pain with inspiration is brought to the emergency department by his
wife. He has been in good health until this illness and has never been hospitalized. He does not
take any routine medications, does not smoke, and drinks alcohol only occasionally. On
examination he appears ill and in mild respiratory distress. His temperature is 40.3°C (104.5°F),
pulse rate 126 beats/min, respiratory rate 32/min, blood pressure 136/70 mm Hg, and oxygen
saturation 88% on room air. He has diminished breath sounds in the right posterolateral chest.
His Pneumonia Severity Index is 97. Based on the severity of his illness you recommend hospital
C
admission. Antibiotic choices recommended for empiric treatment in this patient include which
of the following?
LE
A. Ceftriaxone plus azithromycin (Zithromax)
B. Cefuroxime
C. Ciprofloxacin (Cipro) intravenously
ST
D. Piperacillin/tazobactam (Zosyn) plus vancomycin (Vancocin)
A
BE
Relative risk stratification should be performed for patients with community-acquired
pneumonia (CAP), using a clinical prediction tool such as the Pneumonia Severity Index (PSI)
or the CURB-65 (SOR A).
These tools can be used along with the judgment of the physician to decide whether or not a
patient can be treated as an outpatient or should be admitted to the hospital. This patient is
moderately ill and has a PSI score of 97 based on his age, heart rate, respiratory rate,
temperature, and oxygenation. This score indicates that he should
initially be treated in the hospital.A macrolide plus a β-lactam is recommended for combination
therapy in patients hospitalized with CAP who are at low risk (PSI score of 71–130) (SOR A). A
respiratory fluoroquinolone (levofloxacin or moxifloxacin) can also be used as monotherapy
(SOR A). Because of concerns about increasing levels of resistance, macrolides are not
recommended as monotherapy for a moderately ill patient (SOR C). Ciprofloxacin, a first-
generation quinolone, has poor potency against Streptococcus pneumoniae and is therefore not
appropriate treatment for CAP (SOR C). Treatment with piperacillin/tazobactam is not indicated
since there are no risk factors for Pseudomonas. Vancomycin is likewise not indicated since
there are no MRSA risk factors.Adults hospitalized with non-severe CAP who do not have risk
, BESTLEC
factors for MRSA can be treated by either of the following regimens:(1) combination therapy
with a β-lactam (ampicillin plus sulbactam, 1.5–3 g every 6 hours; cefotaxime, 1–2 g every 8
hours; ceftriaxone, 1–2 g daily; or ceftaroline, 600 mg every 12 hours) AND a macrolide
(azithromycin, 500 mg daily, or clarithromycin, 500 mg twice daily)(2) monotherapy with a
respiratory fluoroquinolone (levofloxacin, 750 mg daily, or moxifloxacin, 400 mg daily)A
combination of ceftriaxone and levofloxacin is not
recommended. It should be noted that β-lactam/macrolide therapy reduced mortality in patients
with CAP compared with patients
treated with β-lactam monotherapy, so monotherapy with a β-lactam for hospital-treated
pneumonia is not recommended. β- Lactam/macrolide combinations may decrease all-cause
death, but mainly for patients with severe CAP. The Infectious Diseases Society of America
recommends that monotherapy with a β-lactam not be used routinely for inpatient treatment of
pneumonia.
C
A 67-year-old male is hospitalized with altered mental status, jaundice, cirrhosis, and ascites
related to alcoholic liver disease. He develops a fever to 38.6°C (101.5°F). His abdomen is
LE
distended, with minimal tenderness but no rebound. The remainder of the physical examination is
normal.You perform ultrasound-guided paracentesis. Which one of the following would provide
the best evidence for a diagnosis of spontaneous bacterial peritonitis?
A. A peritoneal neutrophil count >250/mL
ST
B. An elevated amylase level in peritoneal fluid
C. A low serum-ascites albumin gradient
BE
D. Positive leukocyte esterase on urine testing strips
A
Spontaneous bacterial peritonitis is the most frequent bacterial infection in patients with
cirrhosis, followed by urinary tract infection,
pneumonia, skin and soft-tissue infections, and spontaneous bacteremia. A neutrophil count
>250/mL in ascitic fluid from paracentesis indicates a high risk for spontaneous bacterial
peritonitis (SBP) and is an indication for immediate empiric antibiotic therapy.
SBP is associated with a high mortality rate in patients with cirrhosis and ascites (SOR A), and
bacterial infections account for 25%-46% of hospitalizations due to acute decompensation
events in patients with cirrhosis. Bacterial cultures to identify the etiology of SBP may be
helpful in guiding antibiotic choices (SOR C) but cultures are negative in a significant
percentage of patients with SBP. Culture results may take 48-72 hours, and waiting on results
would delay treatment in high-risk patients.The serum-ascites albumin gradient (SAAG) helps
determine whether peritoneal fluid is a transudate or an exudate.
Theoretically, it might be expected that those with SBP would have higher protein levels and
, BESTLEC
thus a lower SAAG but this finding is not reliable. An elevated amylase level would be more
indicative of pancreatitis.A large multi-center study has shown that urine test strips are not a
reliable way to rule out infection in SBP.
A 32-year-old male is admitted to the hospital for management of a perirectal abscess. He
reports severe pain in the rectal area, and palpitations. His vital signs are normal, with the
exception of a heart rate of 132 beats/min and a temperature of 38.9°C (102.0°F). He rates his
pain as 8 out of 10. An EKG is shown below. Appropriate treatment of the patient's cardiac
arrhythmia would include intravenous adenosine
A. digoxin
B. diltiazem
C
C. ketorolac
D. labetalol
D
LE
ST
This patient has sinus tachycardia. Pain, fever, anxiety, hypoxia, tissue hypoperfusion, and
volume loss are common causes of sinus tachycardia in hospitalized patients. NSAIDs such as
ketorolac lower body temperature and relieve pain, which helps to decrease
sympathetic response to pain and therefore the heart rate (SOR B). β- Blockers are not indicated
BE
for sinus tachycardia resulting from pain and fever, as they do not address the underlying cause
of the tachycardia (SOR A). Intravenous digoxin and diltiazem are not indicated for sinus
tachycardia (SOR A). Adenosine is used for treatment of supraventricular tachycardia.
A 72-year-old female is undergoing total knee arthroplasty surgery. Which one of the following
is true regarding thromboprophylaxis for this patient?
A. Administration of low molecular weight heparin (LMWH) in the immediate
postoperative period is as effective as preoperative administration
B. Daily low-dose subcutaneous ultra fractionated heparin has been shown to be equivalent
to daily subcutaneous LMWH
C. Once-daily aspirin has been shown to be as effective as daily subcutaneous LMWH
D. Thromboprophylaxis should be discontinued on postoperative day 7
A
, BESTLEC
Low molecular weight heparin (LMWH) or direct oral anticoagulants (factor Xa inhibitors and
direct thrombin inhibitors) are the preferred agents for thromboprophylaxis in patients
hospitalized for orthopedic surgery who do not have an increased bleeding risk. There are slight
differences in bleeding risk and DVT and pulmonary embolism risk among the various agents.
The benefit of oral medications is obviously ease of administration and better compliance. There
are evidence-based studies that demonstrate that the administration of LMWH in the immediate
postoperative period is as effective as preoperative administration in patients undergoing major
orthopedic surgery (SOR A). Postoperative thromboprophylaxis is preferred in the United States
and has several advantages over preoperative administration. It allows for same-day admissions,
does not contribute to intraoperative bleeding, and does not interfere with decisions about the
use of regional anesthesia.
A 75-year-old female with dementia is admitted to the hospital with pneumonia. She has baseline
C
urinary incontinence and a urinary catheter was placed in the emergency department. Which one
of the following is true regarding this situation?
LE
A. Urinary catheters are commonly needed to assess fluid status and urine output in geriatric
patients hospitalized with pneumonia and for other problems
B. This patient should be screened halfway through her hospital stay for asymptomatic
bacteriuria
ST
C. Urinary catheter reminders and stop orders have been shown to decrease the
rate of catheter-associated urinary tract infections (CAUTIs)
D. CAUTIs acquired in the hospital will be covered by Medicare if they occur within the
BE
first 2 days of admission
C
Catheter-associated urinary tract infections (CAUTIs) are the leading cause of secondary
nosocomial bloodstream infections; about 17% of hospital-acquired bacteremias are from a
urinary source, with an associated mortality of approximately 10% (SOR B). An estimated 17%-
69% of CAUTIs may be preventable with recommended infection control measures, which
means that up to 380,000 infections and 9000 deaths per year related to CAUTI could be
prevented. In a study of 836 medical admissions evaluated over a 1-month period, 89 (10.7%)
had a urinary catheter placed within 24 hours; 34 placements (38%) had no justifiable
indication. The risk for inappropriate catheterization was independent of age, gender, functional
status, and mental status at admission.The CDC does not recommend routine screening of
asymptomatic patients for bacteriuria (SOR C).
Approximately 75%-90% of patients with asymptomatic bacteriuria do not develop a systemic
inflammatory response or other signs or symptoms to suggest infection. Monitoring and
treatment of
ABFM KSA- CARE OF HOSPITALIZED PATIENTS EXAM
NEWEST ACTUAL ACCURATE EXAM COMPLETE QUESTIONS AND DETAILED
VERIFIED ANSWERS GRADED A+ | 100% VERIFIED| 2025
A 42-year-old construction worker with a 3-day history of cough, fever, chills, dyspnea, and
right posterolateral chest pain with inspiration is brought to the emergency department by his
wife. He has been in good health until this illness and has never been hospitalized. He does not
take any routine medications, does not smoke, and drinks alcohol only occasionally. On
examination he appears ill and in mild respiratory distress. His temperature is 40.3°C (104.5°F),
pulse rate 126 beats/min, respiratory rate 32/min, blood pressure 136/70 mm Hg, and oxygen
saturation 88% on room air. He has diminished breath sounds in the right posterolateral chest.
His Pneumonia Severity Index is 97. Based on the severity of his illness you recommend hospital
C
admission. Antibiotic choices recommended for empiric treatment in this patient include which
of the following?
LE
A. Ceftriaxone plus azithromycin (Zithromax)
B. Cefuroxime
C. Ciprofloxacin (Cipro) intravenously
ST
D. Piperacillin/tazobactam (Zosyn) plus vancomycin (Vancocin)
A
BE
Relative risk stratification should be performed for patients with community-acquired
pneumonia (CAP), using a clinical prediction tool such as the Pneumonia Severity Index (PSI)
or the CURB-65 (SOR A).
These tools can be used along with the judgment of the physician to decide whether or not a
patient can be treated as an outpatient or should be admitted to the hospital. This patient is
moderately ill and has a PSI score of 97 based on his age, heart rate, respiratory rate,
temperature, and oxygenation. This score indicates that he should
initially be treated in the hospital.A macrolide plus a β-lactam is recommended for combination
therapy in patients hospitalized with CAP who are at low risk (PSI score of 71–130) (SOR A). A
respiratory fluoroquinolone (levofloxacin or moxifloxacin) can also be used as monotherapy
(SOR A). Because of concerns about increasing levels of resistance, macrolides are not
recommended as monotherapy for a moderately ill patient (SOR C). Ciprofloxacin, a first-
generation quinolone, has poor potency against Streptococcus pneumoniae and is therefore not
appropriate treatment for CAP (SOR C). Treatment with piperacillin/tazobactam is not indicated
since there are no risk factors for Pseudomonas. Vancomycin is likewise not indicated since
there are no MRSA risk factors.Adults hospitalized with non-severe CAP who do not have risk
, BESTLEC
factors for MRSA can be treated by either of the following regimens:(1) combination therapy
with a β-lactam (ampicillin plus sulbactam, 1.5–3 g every 6 hours; cefotaxime, 1–2 g every 8
hours; ceftriaxone, 1–2 g daily; or ceftaroline, 600 mg every 12 hours) AND a macrolide
(azithromycin, 500 mg daily, or clarithromycin, 500 mg twice daily)(2) monotherapy with a
respiratory fluoroquinolone (levofloxacin, 750 mg daily, or moxifloxacin, 400 mg daily)A
combination of ceftriaxone and levofloxacin is not
recommended. It should be noted that β-lactam/macrolide therapy reduced mortality in patients
with CAP compared with patients
treated with β-lactam monotherapy, so monotherapy with a β-lactam for hospital-treated
pneumonia is not recommended. β- Lactam/macrolide combinations may decrease all-cause
death, but mainly for patients with severe CAP. The Infectious Diseases Society of America
recommends that monotherapy with a β-lactam not be used routinely for inpatient treatment of
pneumonia.
C
A 67-year-old male is hospitalized with altered mental status, jaundice, cirrhosis, and ascites
related to alcoholic liver disease. He develops a fever to 38.6°C (101.5°F). His abdomen is
LE
distended, with minimal tenderness but no rebound. The remainder of the physical examination is
normal.You perform ultrasound-guided paracentesis. Which one of the following would provide
the best evidence for a diagnosis of spontaneous bacterial peritonitis?
A. A peritoneal neutrophil count >250/mL
ST
B. An elevated amylase level in peritoneal fluid
C. A low serum-ascites albumin gradient
BE
D. Positive leukocyte esterase on urine testing strips
A
Spontaneous bacterial peritonitis is the most frequent bacterial infection in patients with
cirrhosis, followed by urinary tract infection,
pneumonia, skin and soft-tissue infections, and spontaneous bacteremia. A neutrophil count
>250/mL in ascitic fluid from paracentesis indicates a high risk for spontaneous bacterial
peritonitis (SBP) and is an indication for immediate empiric antibiotic therapy.
SBP is associated with a high mortality rate in patients with cirrhosis and ascites (SOR A), and
bacterial infections account for 25%-46% of hospitalizations due to acute decompensation
events in patients with cirrhosis. Bacterial cultures to identify the etiology of SBP may be
helpful in guiding antibiotic choices (SOR C) but cultures are negative in a significant
percentage of patients with SBP. Culture results may take 48-72 hours, and waiting on results
would delay treatment in high-risk patients.The serum-ascites albumin gradient (SAAG) helps
determine whether peritoneal fluid is a transudate or an exudate.
Theoretically, it might be expected that those with SBP would have higher protein levels and
, BESTLEC
thus a lower SAAG but this finding is not reliable. An elevated amylase level would be more
indicative of pancreatitis.A large multi-center study has shown that urine test strips are not a
reliable way to rule out infection in SBP.
A 32-year-old male is admitted to the hospital for management of a perirectal abscess. He
reports severe pain in the rectal area, and palpitations. His vital signs are normal, with the
exception of a heart rate of 132 beats/min and a temperature of 38.9°C (102.0°F). He rates his
pain as 8 out of 10. An EKG is shown below. Appropriate treatment of the patient's cardiac
arrhythmia would include intravenous adenosine
A. digoxin
B. diltiazem
C
C. ketorolac
D. labetalol
D
LE
ST
This patient has sinus tachycardia. Pain, fever, anxiety, hypoxia, tissue hypoperfusion, and
volume loss are common causes of sinus tachycardia in hospitalized patients. NSAIDs such as
ketorolac lower body temperature and relieve pain, which helps to decrease
sympathetic response to pain and therefore the heart rate (SOR B). β- Blockers are not indicated
BE
for sinus tachycardia resulting from pain and fever, as they do not address the underlying cause
of the tachycardia (SOR A). Intravenous digoxin and diltiazem are not indicated for sinus
tachycardia (SOR A). Adenosine is used for treatment of supraventricular tachycardia.
A 72-year-old female is undergoing total knee arthroplasty surgery. Which one of the following
is true regarding thromboprophylaxis for this patient?
A. Administration of low molecular weight heparin (LMWH) in the immediate
postoperative period is as effective as preoperative administration
B. Daily low-dose subcutaneous ultra fractionated heparin has been shown to be equivalent
to daily subcutaneous LMWH
C. Once-daily aspirin has been shown to be as effective as daily subcutaneous LMWH
D. Thromboprophylaxis should be discontinued on postoperative day 7
A
, BESTLEC
Low molecular weight heparin (LMWH) or direct oral anticoagulants (factor Xa inhibitors and
direct thrombin inhibitors) are the preferred agents for thromboprophylaxis in patients
hospitalized for orthopedic surgery who do not have an increased bleeding risk. There are slight
differences in bleeding risk and DVT and pulmonary embolism risk among the various agents.
The benefit of oral medications is obviously ease of administration and better compliance. There
are evidence-based studies that demonstrate that the administration of LMWH in the immediate
postoperative period is as effective as preoperative administration in patients undergoing major
orthopedic surgery (SOR A). Postoperative thromboprophylaxis is preferred in the United States
and has several advantages over preoperative administration. It allows for same-day admissions,
does not contribute to intraoperative bleeding, and does not interfere with decisions about the
use of regional anesthesia.
A 75-year-old female with dementia is admitted to the hospital with pneumonia. She has baseline
C
urinary incontinence and a urinary catheter was placed in the emergency department. Which one
of the following is true regarding this situation?
LE
A. Urinary catheters are commonly needed to assess fluid status and urine output in geriatric
patients hospitalized with pneumonia and for other problems
B. This patient should be screened halfway through her hospital stay for asymptomatic
bacteriuria
ST
C. Urinary catheter reminders and stop orders have been shown to decrease the
rate of catheter-associated urinary tract infections (CAUTIs)
D. CAUTIs acquired in the hospital will be covered by Medicare if they occur within the
BE
first 2 days of admission
C
Catheter-associated urinary tract infections (CAUTIs) are the leading cause of secondary
nosocomial bloodstream infections; about 17% of hospital-acquired bacteremias are from a
urinary source, with an associated mortality of approximately 10% (SOR B). An estimated 17%-
69% of CAUTIs may be preventable with recommended infection control measures, which
means that up to 380,000 infections and 9000 deaths per year related to CAUTI could be
prevented. In a study of 836 medical admissions evaluated over a 1-month period, 89 (10.7%)
had a urinary catheter placed within 24 hours; 34 placements (38%) had no justifiable
indication. The risk for inappropriate catheterization was independent of age, gender, functional
status, and mental status at admission.The CDC does not recommend routine screening of
asymptomatic patients for bacteriuria (SOR C).
Approximately 75%-90% of patients with asymptomatic bacteriuria do not develop a systemic
inflammatory response or other signs or symptoms to suggest infection. Monitoring and
treatment of
