ABFM KSA Care of Hospitalized Patients
Exam | Questions and Answers Rated A+ |
100% Correct | 2025/2026 Guide
An 82-year-old male is brought to the emergency department with
confusion after he passed out while getting up from the toilet. His wife
reports that for the past 3 days he had lower abdominal pain, nausea,
vomiting, and difficulty urinating. His chronic medical problems include
hypertension, hyperlipidemia, hypothyroidism, type 2 diabetes,
osteoarthritis, and benign prostatic hyperplasia. His daily medications
include the following: Hydrochlorothiazide Ibuprofen Lisinopril (Prinivil,
Zestril)Metformin (Glucophage)Simvastatin (Zocor)He has not been eating
or drinking much in the past several days, but his wife has made sure that
he has taken his medications as prescribed. His initial vital signs include a
temperature of 38.6°C (101.4°F), a blood pressure of 86/49 mm Hg, a heart
rate of 111 beats/min, and a respiratory rate of 22/min. His weight is 100 kg
(220 lb). He is obtunded and moaning, with dry mucous membranes, de
-Correct Answer-A
This patient's presentation is concerning for a diagnosis of sepsis, which is
defined as life-threatening organ dysfunction caused by a dysregulated
host response to infection. The patient's hypotension, tachycardia,
azotemia, elevated serum lactate, and metabolic encephalopathy are
markers of tissue hypoperfusion and organ dysfunction. In sepsis-induced
hypoperfusion, a crystalloid fluid bolus of 30 mL/kg within the first 3 hours
,of presentation is a critical first step recommended by the Surviving Sepsis
Campaign. Additional fluid orders should be guided by frequent
reassessment of hemodynamic status. In critically ill adults with sepsis,
giving a balanced crystalloid formulation instead of normal saline may
decrease in-hospital mortality and major adverse kidney events. Hypotonic
maintenance fluids such as 0.45% NaCl should not be given until adequate
fluid resuscitation has occurred. Both NSAIDs and ACE inhibitors reduce
glomerular filtration and can precipitate or exacerbate acute kidney injury,
especially in patients with pre-existing renal hypoperfusion. NSAIDs reduce
glomerular filtration by inducing vasoconstriction of the afferent arterioles
through inhibition of cyclooxygenase, which leads to increased levels of
thromboxane A2, a potent vasoconstrictor. ACE inhibitors reduce
glomerular filtration by reducing levels of angiotensin II, which allows
vasodilation of efferent arterioles and reduces glomerular hydrostatic
pressure.Although patients with non-oliguric renal failure fare better than
patients presenting with oliguria, the use of diuretics to stimulate urine
output actually increases mortality and does not promote recovery of renal
function (SOR B). Intravenous antibiotics should be administered as soon
as possible and within 1 hour of recognized sepsis, but levofloxacin is
cleared by the kidney and
A 62-year-old female with a history of diabetes mellitus and hypertension
presents to the emergency department of a rural hospital that is 2 hours via
ground transport from the nearest hospital with angiography capabilities.
She has a 2-hour history of 6/10 chest pain with bilateral arm radiation and
she is short of breath.On examination her blood pressure is 105/60 mm Hg,
,her pulse rate is 82/min, and her oxygen saturation is 93% on room air. An
EKG shows nonspecific ST-T wave abnormalities. Her initial high-sensitivity
troponin level is elevated at 26 ng/mL. Her serum creatinine level is 2.1
mg/dL (N 0.6-1.5). Her current medications are:Aspirin, 81 mg
dailyFurosemide (Lasix), 40 mg twice dailyInsulin, 70/30 twice daily before
mealsLisinopril (Prinivil, Zestril), 20 mg dailyMetoprolol succinate (Toprol-
XL), 25 mg dailyWhich one of the following would be appropriate at this
time?
Clopidogrel (Plavix), 150 mg orally
-Correct Answer-D
Unfractionated heparin should be given because anticoagulation is
indicated in acute coronary syndrome (SOR A). Aspirin, 162-325 mg
chewed, would be appropriate in this patient presenting with acute coronary
symptoms. She should also be given clopidogrel, 300-600 mg orally. A β-
blocker can be started unless it is contraindicated, which it is in this case
because of her relatively low blood pressure, and nitroglycerin would be a
better treatment in this setting initially before using a β-blocker. Intravenous
thrombolysis is indicated only if the patient has an ST-segment elevation
myocardial infarction (SOR A). Oxygen is not indicated unless the patient's
oxygen saturation is <90%.
A 52-year-old male is admitted to the hospital for an acute exacerbation of
COPD after several days of worsening dyspnea, cough, and purulent
sputum production. This is his fourth exacerbation in the past year. Home
oxygen has been prescribed but he only uses it sporadically and he
, continues to smoke.On examination the patient has a temperature of
37.0°C (98.6°F), a pulse rate of 100 beats/min, a respiratory rate of 32/min,
and a blood pressure of 148/90 mm Hg. His oxygen saturation is 88% on
room air, and diffuse bilateral wheezes are noted. A chest radiograph
shows hyperinflation with no distinct infiltrates.Which one of the following is
true regarding the use of antibiotics at this time?
Antibiotics should not be given until the infecting organisms are identified
on a sputum or blood culture
Penicillins with antipseudomonal activity are the initial treatment of choice
Intravenous antibiotics are superior to oral t
-Correct Answer-E
In patients with moderate to severe COPD, antibiotic treatment reduces the
rate of treatment failure and death (SOR B). Such patients often have
mixed bacterial growth from the lower respiratory tract,
including Streptococcus pneumoniae, Moraxella, Mycoplasma,
and Haemophilus species, so broad coverage is indicated based on local
microbial resistance patterns, prior antibiotic use, and the degree of the
patient’s symptoms. Cultures should be obtained before antibiotics are
started, but treatment should not be delayed until results are
available.Pseudomonas species are not common etiologic agents in COPD
exacerbations (SOR B). In patients who are able to take oral medications
and have a functioning alimentary tract, intravenous antibiotics are no
better than oral treatment (SOR B). Shorter courses of antibiotics, even <5
days, showed no difference in cure rates compared to longer courses of
treatment in one meta-analysis (SOR B). The optimal duration of antibiotic
therapy has not been determined (SOR C).
Exam | Questions and Answers Rated A+ |
100% Correct | 2025/2026 Guide
An 82-year-old male is brought to the emergency department with
confusion after he passed out while getting up from the toilet. His wife
reports that for the past 3 days he had lower abdominal pain, nausea,
vomiting, and difficulty urinating. His chronic medical problems include
hypertension, hyperlipidemia, hypothyroidism, type 2 diabetes,
osteoarthritis, and benign prostatic hyperplasia. His daily medications
include the following: Hydrochlorothiazide Ibuprofen Lisinopril (Prinivil,
Zestril)Metformin (Glucophage)Simvastatin (Zocor)He has not been eating
or drinking much in the past several days, but his wife has made sure that
he has taken his medications as prescribed. His initial vital signs include a
temperature of 38.6°C (101.4°F), a blood pressure of 86/49 mm Hg, a heart
rate of 111 beats/min, and a respiratory rate of 22/min. His weight is 100 kg
(220 lb). He is obtunded and moaning, with dry mucous membranes, de
-Correct Answer-A
This patient's presentation is concerning for a diagnosis of sepsis, which is
defined as life-threatening organ dysfunction caused by a dysregulated
host response to infection. The patient's hypotension, tachycardia,
azotemia, elevated serum lactate, and metabolic encephalopathy are
markers of tissue hypoperfusion and organ dysfunction. In sepsis-induced
hypoperfusion, a crystalloid fluid bolus of 30 mL/kg within the first 3 hours
,of presentation is a critical first step recommended by the Surviving Sepsis
Campaign. Additional fluid orders should be guided by frequent
reassessment of hemodynamic status. In critically ill adults with sepsis,
giving a balanced crystalloid formulation instead of normal saline may
decrease in-hospital mortality and major adverse kidney events. Hypotonic
maintenance fluids such as 0.45% NaCl should not be given until adequate
fluid resuscitation has occurred. Both NSAIDs and ACE inhibitors reduce
glomerular filtration and can precipitate or exacerbate acute kidney injury,
especially in patients with pre-existing renal hypoperfusion. NSAIDs reduce
glomerular filtration by inducing vasoconstriction of the afferent arterioles
through inhibition of cyclooxygenase, which leads to increased levels of
thromboxane A2, a potent vasoconstrictor. ACE inhibitors reduce
glomerular filtration by reducing levels of angiotensin II, which allows
vasodilation of efferent arterioles and reduces glomerular hydrostatic
pressure.Although patients with non-oliguric renal failure fare better than
patients presenting with oliguria, the use of diuretics to stimulate urine
output actually increases mortality and does not promote recovery of renal
function (SOR B). Intravenous antibiotics should be administered as soon
as possible and within 1 hour of recognized sepsis, but levofloxacin is
cleared by the kidney and
A 62-year-old female with a history of diabetes mellitus and hypertension
presents to the emergency department of a rural hospital that is 2 hours via
ground transport from the nearest hospital with angiography capabilities.
She has a 2-hour history of 6/10 chest pain with bilateral arm radiation and
she is short of breath.On examination her blood pressure is 105/60 mm Hg,
,her pulse rate is 82/min, and her oxygen saturation is 93% on room air. An
EKG shows nonspecific ST-T wave abnormalities. Her initial high-sensitivity
troponin level is elevated at 26 ng/mL. Her serum creatinine level is 2.1
mg/dL (N 0.6-1.5). Her current medications are:Aspirin, 81 mg
dailyFurosemide (Lasix), 40 mg twice dailyInsulin, 70/30 twice daily before
mealsLisinopril (Prinivil, Zestril), 20 mg dailyMetoprolol succinate (Toprol-
XL), 25 mg dailyWhich one of the following would be appropriate at this
time?
Clopidogrel (Plavix), 150 mg orally
-Correct Answer-D
Unfractionated heparin should be given because anticoagulation is
indicated in acute coronary syndrome (SOR A). Aspirin, 162-325 mg
chewed, would be appropriate in this patient presenting with acute coronary
symptoms. She should also be given clopidogrel, 300-600 mg orally. A β-
blocker can be started unless it is contraindicated, which it is in this case
because of her relatively low blood pressure, and nitroglycerin would be a
better treatment in this setting initially before using a β-blocker. Intravenous
thrombolysis is indicated only if the patient has an ST-segment elevation
myocardial infarction (SOR A). Oxygen is not indicated unless the patient's
oxygen saturation is <90%.
A 52-year-old male is admitted to the hospital for an acute exacerbation of
COPD after several days of worsening dyspnea, cough, and purulent
sputum production. This is his fourth exacerbation in the past year. Home
oxygen has been prescribed but he only uses it sporadically and he
, continues to smoke.On examination the patient has a temperature of
37.0°C (98.6°F), a pulse rate of 100 beats/min, a respiratory rate of 32/min,
and a blood pressure of 148/90 mm Hg. His oxygen saturation is 88% on
room air, and diffuse bilateral wheezes are noted. A chest radiograph
shows hyperinflation with no distinct infiltrates.Which one of the following is
true regarding the use of antibiotics at this time?
Antibiotics should not be given until the infecting organisms are identified
on a sputum or blood culture
Penicillins with antipseudomonal activity are the initial treatment of choice
Intravenous antibiotics are superior to oral t
-Correct Answer-E
In patients with moderate to severe COPD, antibiotic treatment reduces the
rate of treatment failure and death (SOR B). Such patients often have
mixed bacterial growth from the lower respiratory tract,
including Streptococcus pneumoniae, Moraxella, Mycoplasma,
and Haemophilus species, so broad coverage is indicated based on local
microbial resistance patterns, prior antibiotic use, and the degree of the
patient’s symptoms. Cultures should be obtained before antibiotics are
started, but treatment should not be delayed until results are
available.Pseudomonas species are not common etiologic agents in COPD
exacerbations (SOR B). In patients who are able to take oral medications
and have a functioning alimentary tract, intravenous antibiotics are no
better than oral treatment (SOR B). Shorter courses of antibiotics, even <5
days, showed no difference in cure rates compared to longer courses of
treatment in one meta-analysis (SOR B). The optimal duration of antibiotic
therapy has not been determined (SOR C).
