ABFM KSA CARE OF HOSPITALIZED PATIENTS ACTUAL 2025/2026 QUESTIONS AND 100% CORRECT ANSWERS

ABFM KSA CARE OF HOSPITALIZED PATIENTS ACTUAL 2025/2026 QUESTIONS AND 100% CORRECT ANSWERS CT would usually be indicated as the initial imaging study for which one of the following patients? An 8-year-old with a 2-day history of nausea, anorexia, and periumbilical pain that has migrated to the right lower quadrant with localized tenderness, guarding, and leukocytosis with a left shift A 43-year-old with a 1-day history of epigastric pain and nausea with vomiting, and elevated serum lipase A 66-year-old with diffuse abdominal pain, leukocytosis, and fever A 55-year-old with unrelenting severe low back pain associated with right leg pain and weakness A 68-year-old with crushing, retrosternal chest pain, an EKG showing sinus tachycardia with left bundle branch block, and a cardiac troponin I level of 14 ng/mL (N <0.04) CThe use of CT has increased significantly in recent years due to increased availability, better resolution, and faster scan times. However, there are rising concerns about cumulative radiation exposure and an increasing need to contain costs in medicine. To assist clinicians in making wise use of all imaging techniques, the American College of Radiology (ACR) has developed appropriateness criteria that recommend modalities for various clinical problems.Patients with undifferentiated abdominal pain often present a diagnostic challenge because of the wide range of pathology or organ involvement that can produce this symptom. Fever associated with abdominal pain increases the likelihood of intra-abdominal infection, abscess, or other conditions that may require an urgent definitive diagnosis or intervention. In one retrospective study, CT results changed the leading diagnosis in 51% of patients and the decision to admit patients presenting to the emergency department with abdominal pain in 25% of patients.In contrast, no imaging may be indicated when the diagnosis is straightforward based on other clinical indicators. Ultrasonography should be the first imaging study in a pediatric patient with a classic history and physical and laboratory findings of appendicitis. Similarly, while CT is unlikely to provide useful additional information in a patient with unequivocal, uncomplicated acute pancreatitis, ultrasonography is a reasonable first imaging study to evaluate for gallstones. Patients with suspected acute coronary syndrome should be taken for coronary angiography without delay. A patient with severe back pain and leg weakness should be evaluated with MRI.A 75-year-old male is hospitalized with new-onset atrial fibrillation and a rapid ventricular rate. His current medical problems include COPD, hypertension, coronary artery disease, and depression. A metabolic panel including a magnesium level is normal on admission.After a diltiazem continuous intravenous infusion his pulse rate is 85 beats/min and irregular. The following morning he converts to normal sinus rhythm.Which one of the following would be appropriate at this point? Administer a loading dose of warfarin, 10 mg orally Start apixaban (Eliquis), 5 mg twice daily Stop the diltiazem infusion and administer metoprolol intravenously Stop the diltiazem infusion and administer digoxin, 0.25 mg intravenously B It is generally not recommended to give a loading dose of warfarin, as the benefit is minimal, especially if treating atrial fibrillation. There is no benefit to administering digoxin or metoprolol intravenously once the patient has converted to sinus rhythm. Apixaban and other direct oral anticoagulants are recommended for stroke prophylaxis and should be initiated as soon as possible. This could have been started at the time of admission for this patient because there is no reason to wait until normal sinus rhythm is achieved. The dosage should be lowered to 2.5 mg twice daily for patients with two of the following: age ≥80, body weight ≤60 kg (130 lb), or serum creatinine ≥1.5 mg/dL.You admit a 74-year-old patient to the hospital with shortness of breath and bilateral pleural effusions seen on a chest radiograph. Which one of the following is true regarding pleural effusions? Noncontrast CT should be performed initially in all patients with pleural effusions if the cause is unknown Ultrasound-guided thoracentesis should be performed on admission in all patients with small bilateral pleural effusions In patients with heart failure who are treated with diuretics, pleural effusions may be misclassified as exudative rather than transudative Negative cytology on an adequate sample of pleural fluid (≥10 mL) effectively rules out malignancy as the cause of a unilateral pleural effusion