ABFM HOSPITAL MEDICINE QUESTIONS AND 100%
VERIFIED ANSWERS (2025) GRADED A+ /
GUARANTEED PASS!!
A 19-year-old male presents with a 2-day history of worsening headache,
photophobia, malaise, and fever. On examination the patient is alert but in mild
distress, and has a temperature of 38.3°C (100.9°F). The HEENT examination is
negative, including a funduscopic examination, but nuchal rigidity is present. You
perform a lumbar puncture to obtain a sample for cerebrospinal fluid (CSF)
analysis.True statements regarding interpretation of the test results include which
of the following? (Mark all that are true.)
Xanthochromia confirms that the patient has had a subarachnoid hemorrhage
A positive polymerase chain reaction test for enterovirus has high sensitivity and
specificity
Protein levels are typically normal in viral meningitis and elevated in bacterial
meningitis
A CSF glucose level of 80 mg/dL in a patient with a plasma glucose level of 120
mg/dL makes bacterial meningitis unlikely
A CSF WBC count <100/mm3 is r
- answer-B, C, E
Xanthochromia is yellow, red, or orange discoloration of the cerebrospinal fluid
(CSF) and can be an indication of subarachnoid hemorrhage (SOR B). It represents
the presence of free hemoglobin (or a byproduct) in the CSF as a result of red
blood cell (RBC) lysis, which occurs within a few hours of RBCs appearing in the
CSF. Xanthochromia can also be seen when the serum bilirubin concentration is
high, or when there is a traumatic lumbar puncture with >100,000
RBCs/mm3.Polymerase chain reaction (PCR) testing is rapid and highly sensitive
and specific for viral meningitis, particularly for Enterovirus infections. A positive
identification provides reassurance that the etiology is viral and allows for
discontinuation of antibacterial therapy and for earlier hospital discharge (SOR B).
PCR testing is also particularly helpful in identifying herpesvirus 1 CNS
infections. While there are fairly wide ranges for CSF protein concentrations with
various inflammatory conditions, infection raises the concentration (SOR B). This
increase is greater with bacterial infection than with viral meningitis, which is most
often associated with CSF protein in the normal range of 20-60 mg/dL.While the
normal CSF glucose concentration is usually two-thirds of the plasma glucose
level, it is classically lower in bacterial meningitis, and usually normal in viral
,meningitis. However, the CSF glucose level is normal in up to 50% of cases of
bacterial meningitis, so a normal level doesn't rule out bacterial infection (SOR B).
CSF WBC counts are >100/mm3 in 99% of cases of bacterial meningitis, and in
the vast majority of cases WBC counts are >1000/mm3 (SOR B).
A 32-year-old male is admitted to the hospital for management of a perirectal
abscess. When you examine him 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.
His EKG is shown below.Appropriate treatment of the patient's cardiac arrhythmia
would include which of the following? (Mark all that are true.)
Oral ibuprofen
Intravenous digoxin
Intravenous diltiazem
Intravenous labetalol
Intravenous morphine
Carotid sinus massage
- answer-A, E
This patient has sinus tachycardia. Pain, fever, anxiety, hypoxia, tissue
hypoperfusion, and volume loss are common causes of sinus tachycardia in
hospitalized patients. Ibuprofen lowers body temperature and relieves pain, helping
to decrease the heart rate (SOR B). Similarly, morphine helps lower the heart rate
by decreasing anxiety and relieving pain (SOR B). β-Blockers are not indicated 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,
as well as carotid sinus massage, are not indicated for sinus tachycardia (SOR A).
A 32-year-old nonpregnant female with a history of poorly controlled type 2
diabetes mellitus is admitted to the hospital for abdominal wall cellulitis. On
hospital day 2 she develops mild shortness of breath. Her physical examination is
normal, with the exception of a respiratory rate of 22/min and abdominal wall
erythema, warmth, and tenderness. Laboratory findings are normal with the
exception of a fasting blood glucose level of 268 mg/dL and mild leukocytosis.
Her D-dimer level is 250 ng/mL.True statements regarding the use of the D-dimer
assay for diagnosing pulmonary embolism in this situation include which of the
following? (Mark all that are true.)
It has good sensitivity
, It has good specificity
It has a good positive predictive value
It has a good negative predictive value
- answer-A, D
D-dimer is a degradation product of cross-linked fibrin. The PIOPED II
investigators recommend stratification of all patients with suspected pulmonary
embolism according to an objective clinical probability assessment. D-dimer
should be measured by a quantitative rapid enzyme-linked immunosorbent assay
(ELISA), and the combination of a negative D-dimer with a low or moderate
clinical probability can safely exclude pulmonary embolism in many patients. The
sensitivity of the D-dimer assay is 90%-95% for pulmonary embolus, but D-dimer
levels are normal in only 40%-68% of patients without pulmonary embolus (SOR
A). A D-dimer value >500 ng/mL is considered to be abnormal. Values ≤500
ng/mL have a high negative predictive value for pulmonary embolism in patients
with a low to moderate pretest probability (SOR A).
A 33-year-old male is hospitalized because of diabetic ketoacidosis, which is the
initial presentation of his diabetes mellitus. Initial laboratory testing reveals a
blood glucose level of 679 mg/dL, a venous pH of 7.11, a serum potassium level of
5.3 mEq/L (N 3.5-5.0), and a serum sodium level of 130 mEq/L (N 135-145). He is
initially treated with intravenous normal saline and a continuous insulin drip, and
intravenous potassium is added later. Four hours after treatment is started he has a
blood glucose level of 210 mg/dL, a venous pH of 7.28, a serum potassium level of
3.9 mEq/L, and a serum sodium level of 134 mEq/dL.Which one of the following
would be most appropriate at this time?
Stopping the insulin
Stopping the potassium
Switching to subcutaneous insulin
Changing the intravenous solution to ½-normal saline with dextrose and potassium
Administering sodium bicarbonate
- answer-D
In a patient being treated for ketoacidosis, once the serum glucose level goes below
about 250 mg/dL, dextrose should be added to the intravenous solution to decrease
the risk of hypoglycemia (SOR C). The fluid should be switched to ½-normal
saline when the sodium becomes normal (SOR C). Insulin should not be stopped
until the acidosis is cleared, and potassium should not be stopped until all values
are normal (SOR C). Continuous insulin infusion should be continued until
resolution of ketoacidosis as demonstrated by a blood glucose < 200 mg/dl and a
VERIFIED ANSWERS (2025) GRADED A+ /
GUARANTEED PASS!!
A 19-year-old male presents with a 2-day history of worsening headache,
photophobia, malaise, and fever. On examination the patient is alert but in mild
distress, and has a temperature of 38.3°C (100.9°F). The HEENT examination is
negative, including a funduscopic examination, but nuchal rigidity is present. You
perform a lumbar puncture to obtain a sample for cerebrospinal fluid (CSF)
analysis.True statements regarding interpretation of the test results include which
of the following? (Mark all that are true.)
Xanthochromia confirms that the patient has had a subarachnoid hemorrhage
A positive polymerase chain reaction test for enterovirus has high sensitivity and
specificity
Protein levels are typically normal in viral meningitis and elevated in bacterial
meningitis
A CSF glucose level of 80 mg/dL in a patient with a plasma glucose level of 120
mg/dL makes bacterial meningitis unlikely
A CSF WBC count <100/mm3 is r
- answer-B, C, E
Xanthochromia is yellow, red, or orange discoloration of the cerebrospinal fluid
(CSF) and can be an indication of subarachnoid hemorrhage (SOR B). It represents
the presence of free hemoglobin (or a byproduct) in the CSF as a result of red
blood cell (RBC) lysis, which occurs within a few hours of RBCs appearing in the
CSF. Xanthochromia can also be seen when the serum bilirubin concentration is
high, or when there is a traumatic lumbar puncture with >100,000
RBCs/mm3.Polymerase chain reaction (PCR) testing is rapid and highly sensitive
and specific for viral meningitis, particularly for Enterovirus infections. A positive
identification provides reassurance that the etiology is viral and allows for
discontinuation of antibacterial therapy and for earlier hospital discharge (SOR B).
PCR testing is also particularly helpful in identifying herpesvirus 1 CNS
infections. While there are fairly wide ranges for CSF protein concentrations with
various inflammatory conditions, infection raises the concentration (SOR B). This
increase is greater with bacterial infection than with viral meningitis, which is most
often associated with CSF protein in the normal range of 20-60 mg/dL.While the
normal CSF glucose concentration is usually two-thirds of the plasma glucose
level, it is classically lower in bacterial meningitis, and usually normal in viral
,meningitis. However, the CSF glucose level is normal in up to 50% of cases of
bacterial meningitis, so a normal level doesn't rule out bacterial infection (SOR B).
CSF WBC counts are >100/mm3 in 99% of cases of bacterial meningitis, and in
the vast majority of cases WBC counts are >1000/mm3 (SOR B).
A 32-year-old male is admitted to the hospital for management of a perirectal
abscess. When you examine him 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.
His EKG is shown below.Appropriate treatment of the patient's cardiac arrhythmia
would include which of the following? (Mark all that are true.)
Oral ibuprofen
Intravenous digoxin
Intravenous diltiazem
Intravenous labetalol
Intravenous morphine
Carotid sinus massage
- answer-A, E
This patient has sinus tachycardia. Pain, fever, anxiety, hypoxia, tissue
hypoperfusion, and volume loss are common causes of sinus tachycardia in
hospitalized patients. Ibuprofen lowers body temperature and relieves pain, helping
to decrease the heart rate (SOR B). Similarly, morphine helps lower the heart rate
by decreasing anxiety and relieving pain (SOR B). β-Blockers are not indicated 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,
as well as carotid sinus massage, are not indicated for sinus tachycardia (SOR A).
A 32-year-old nonpregnant female with a history of poorly controlled type 2
diabetes mellitus is admitted to the hospital for abdominal wall cellulitis. On
hospital day 2 she develops mild shortness of breath. Her physical examination is
normal, with the exception of a respiratory rate of 22/min and abdominal wall
erythema, warmth, and tenderness. Laboratory findings are normal with the
exception of a fasting blood glucose level of 268 mg/dL and mild leukocytosis.
Her D-dimer level is 250 ng/mL.True statements regarding the use of the D-dimer
assay for diagnosing pulmonary embolism in this situation include which of the
following? (Mark all that are true.)
It has good sensitivity
, It has good specificity
It has a good positive predictive value
It has a good negative predictive value
- answer-A, D
D-dimer is a degradation product of cross-linked fibrin. The PIOPED II
investigators recommend stratification of all patients with suspected pulmonary
embolism according to an objective clinical probability assessment. D-dimer
should be measured by a quantitative rapid enzyme-linked immunosorbent assay
(ELISA), and the combination of a negative D-dimer with a low or moderate
clinical probability can safely exclude pulmonary embolism in many patients. The
sensitivity of the D-dimer assay is 90%-95% for pulmonary embolus, but D-dimer
levels are normal in only 40%-68% of patients without pulmonary embolus (SOR
A). A D-dimer value >500 ng/mL is considered to be abnormal. Values ≤500
ng/mL have a high negative predictive value for pulmonary embolism in patients
with a low to moderate pretest probability (SOR A).
A 33-year-old male is hospitalized because of diabetic ketoacidosis, which is the
initial presentation of his diabetes mellitus. Initial laboratory testing reveals a
blood glucose level of 679 mg/dL, a venous pH of 7.11, a serum potassium level of
5.3 mEq/L (N 3.5-5.0), and a serum sodium level of 130 mEq/L (N 135-145). He is
initially treated with intravenous normal saline and a continuous insulin drip, and
intravenous potassium is added later. Four hours after treatment is started he has a
blood glucose level of 210 mg/dL, a venous pH of 7.28, a serum potassium level of
3.9 mEq/L, and a serum sodium level of 134 mEq/dL.Which one of the following
would be most appropriate at this time?
Stopping the insulin
Stopping the potassium
Switching to subcutaneous insulin
Changing the intravenous solution to ½-normal saline with dextrose and potassium
Administering sodium bicarbonate
- answer-D
In a patient being treated for ketoacidosis, once the serum glucose level goes below
about 250 mg/dL, dextrose should be added to the intravenous solution to decrease
the risk of hypoglycemia (SOR C). The fluid should be switched to ½-normal
saline when the sodium becomes normal (SOR C). Insulin should not be stopped
until the acidosis is cleared, and potassium should not be stopped until all values
are normal (SOR C). Continuous insulin infusion should be continued until
resolution of ketoacidosis as demonstrated by a blood glucose < 200 mg/dl and a
