ABFM KSA - CARE OF HOSPITALIZED PATIENTS TEST BANK COMPLETE
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
WITH RATIONALES|ALREADY GRADED A+|
|BRAND NEW VERSION!!
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–40)
Question 1
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?
A. Administer a loading dose of warfarin, 10 mg orally
B. Start apixaban (Eliquis), 5 mg twice daily
C. Stop the diltiazem infusion and administer metoprolol intravenously
D. Stop the diltiazem infusion and administer digoxin, 0.25 mg intravenously
Correct Answer: B
Rationale: In patients with new-onset atrial fibrillation who convert to sinus
rhythm, anticoagulation is indicated based on the CHA₂DS₂‑VASc score. This
patient has hypertension, CAD, and is over 75 (score ≥2 in males), placing him at
high risk for stroke. Direct oral anticoagulants (DOACs) such as apixaban are
preferred over warfarin for nonvalvular atrial fibrillation due to fewer drug
interactions and no need for INR monitoring. Warfarin (A) requires bridging and
dose titration. Metoprolol or digoxin (C, D) are rate‑control agents; after
conversion, rhythm control may be considered, but anticoagulation is the
immediate priority.
Question 2
1
,A 68-year-old male presents to the emergency department with crushing
retrosternal chest pain radiating to the left arm. EKG shows sinus tachycardia with
left bundle branch block, and cardiac troponin I is 14 ng/mL (N <0.04). Which one
of the following is the most appropriate next step?
A. CT angiography of the chest
B. Immediate coronary angiography
C. Stress echocardiography
D. Medical management with aspirin and nitroglycerin
Correct Answer: B
Rationale: This patient has a STEMI equivalent: new LBBB with elevated troponin
and ischemic symptoms. Immediate coronary angiography with PCI is the
standard of
care (door‑to‑balloon <90 min). CT angiography (A) is for pulmonary embolism or
aortic dissection. Stress testing (C) is contraindicated in acute MI. Aspirin and
nitroglycerin (D) are temporizing but do not restore flow; they are adjuncts, not
definitive.
Question 3
A 55-year-old male with a history of heart failure with reduced ejection fraction
(HFrEF) is admitted with worsening shortness of breath and peripheral edema. He
is currently on lisinopril, carvedilol, and furosemide. His blood pressure is
110/70 mm Hg, heart rate 72 bpm, oxygen saturation 94% on room air. Which
one of the following medication adjustments is most appropriate?
A. Increase lisinopril
B. Add spironolactone
C. Increase carvedilol
D. Add digoxin
Correct Answer: B
Rationale: For HFrEF patients already on an ACE inhibitor (lisinopril) and a
2
,beta‑blocker (carvedilol), adding a mineralocorticoid receptor antagonist
(spironolactone) is a Class I guideline recommendation to reduce mortality and
hospitalizations (RALES and EMPHASIS‑HF trials). Increasing lisinopril or carvedilol
may be considered but is not the most urgent addition. Digoxin (D) can be added
for symptom control but does not offer the same mortality benefit as
spironolactone.
Question 4
A 72-year-old female with hypertension and diabetes is admitted with acute
decompensated heart failure. She has jugular venous distension, pulmonary
crackles, and severe peripheral edema. Serum creatinine is 1.8 mg/dL (baseline
1.2). Which diuretic regimen is most appropriate?
A. Oral furosemide 40 mg daily
B. Intravenous furosemide 40 mg bolus
C. Intravenous furosemide continuous infusion
D. Oral hydrochlorothiazide 25 mg daily
Correct Answer: C
Rationale: In acute decompensated heart failure with renal impairment,
continuous
IV furosemide infusion provides more predictable and effective diuresis than
intermittent boluses, especially when renal function is compromised. Oral
diuretics (A) are insufficient in acute settings. Thiazides (D) are not potent enough
as monotherapy for acute volume overload; they may be added later for
sequential nephron blockade.
Question 5
A 65-year-old male with known coronary artery disease is admitted with unstable
angina. He is started on aspirin, clopidogrel, and heparin. He develops acute
shortness of breath, hypotension, and muffled heart sounds. What is the most
likely diagnosis?
A. Anaphylaxis to aspirin
3
, B. Heparin‑induced thrombocytopenia
C. Cardiac tamponade
D. Pulmonary embolism
Correct Answer: C
Rationale: Beck's triad (hypotension, muffled heart sounds, distended neck veins)
is classic for cardiac tamponade. In the setting of ACS, tamponade can result from
myocardial rupture or post‑infarction pericarditis with effusion. Anaphylaxis (A)
would have wheezing/urticaria. HIT (B) typically causes thrombosis and
thrombocytopenia. PE (D) presents with tachypnea and hypoxia, not muffled
heart sounds.
Question 6
A 70-year-old male is admitted with syncope. He has hypertension and type 2
diabetes. EKG shows sinus bradycardia at 45 bpm and a prolonged PR interval of
280 ms. What is the most likely diagnosis?
A. Sick sinus syndrome
B. First‑degree AV block
C. Second‑degree AV block type I
D. Third‑degree AV block
Correct Answer: B
Rationale: First‑degree AV block is defined by a PR interval >200 ms (in adults)
with a constant 1:1 atrial‑ventricular relationship. It is often asymptomatic and
does not require treatment. Sick sinus syndrome (A) would show alternating
bradycardia/tachycardia. Type I (C) has progressive PR lengthening. Third‑degree
(D) has complete AV dissociation.
Question 7
A 60-year-old female with paroxysmal atrial fibrillation is admitted with
palpitations. She is on apixaban. EKG shows atrial fibrillation at 140 bpm.
4
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
WITH RATIONALES|ALREADY GRADED A+|
|BRAND NEW VERSION!!
SECTION 1: CARDIOVASCULAR DISORDERS (Questions 1–40)
Question 1
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?
A. Administer a loading dose of warfarin, 10 mg orally
B. Start apixaban (Eliquis), 5 mg twice daily
C. Stop the diltiazem infusion and administer metoprolol intravenously
D. Stop the diltiazem infusion and administer digoxin, 0.25 mg intravenously
Correct Answer: B
Rationale: In patients with new-onset atrial fibrillation who convert to sinus
rhythm, anticoagulation is indicated based on the CHA₂DS₂‑VASc score. This
patient has hypertension, CAD, and is over 75 (score ≥2 in males), placing him at
high risk for stroke. Direct oral anticoagulants (DOACs) such as apixaban are
preferred over warfarin for nonvalvular atrial fibrillation due to fewer drug
interactions and no need for INR monitoring. Warfarin (A) requires bridging and
dose titration. Metoprolol or digoxin (C, D) are rate‑control agents; after
conversion, rhythm control may be considered, but anticoagulation is the
immediate priority.
Question 2
1
,A 68-year-old male presents to the emergency department with crushing
retrosternal chest pain radiating to the left arm. EKG shows sinus tachycardia with
left bundle branch block, and cardiac troponin I is 14 ng/mL (N <0.04). Which one
of the following is the most appropriate next step?
A. CT angiography of the chest
B. Immediate coronary angiography
C. Stress echocardiography
D. Medical management with aspirin and nitroglycerin
Correct Answer: B
Rationale: This patient has a STEMI equivalent: new LBBB with elevated troponin
and ischemic symptoms. Immediate coronary angiography with PCI is the
standard of
care (door‑to‑balloon <90 min). CT angiography (A) is for pulmonary embolism or
aortic dissection. Stress testing (C) is contraindicated in acute MI. Aspirin and
nitroglycerin (D) are temporizing but do not restore flow; they are adjuncts, not
definitive.
Question 3
A 55-year-old male with a history of heart failure with reduced ejection fraction
(HFrEF) is admitted with worsening shortness of breath and peripheral edema. He
is currently on lisinopril, carvedilol, and furosemide. His blood pressure is
110/70 mm Hg, heart rate 72 bpm, oxygen saturation 94% on room air. Which
one of the following medication adjustments is most appropriate?
A. Increase lisinopril
B. Add spironolactone
C. Increase carvedilol
D. Add digoxin
Correct Answer: B
Rationale: For HFrEF patients already on an ACE inhibitor (lisinopril) and a
2
,beta‑blocker (carvedilol), adding a mineralocorticoid receptor antagonist
(spironolactone) is a Class I guideline recommendation to reduce mortality and
hospitalizations (RALES and EMPHASIS‑HF trials). Increasing lisinopril or carvedilol
may be considered but is not the most urgent addition. Digoxin (D) can be added
for symptom control but does not offer the same mortality benefit as
spironolactone.
Question 4
A 72-year-old female with hypertension and diabetes is admitted with acute
decompensated heart failure. She has jugular venous distension, pulmonary
crackles, and severe peripheral edema. Serum creatinine is 1.8 mg/dL (baseline
1.2). Which diuretic regimen is most appropriate?
A. Oral furosemide 40 mg daily
B. Intravenous furosemide 40 mg bolus
C. Intravenous furosemide continuous infusion
D. Oral hydrochlorothiazide 25 mg daily
Correct Answer: C
Rationale: In acute decompensated heart failure with renal impairment,
continuous
IV furosemide infusion provides more predictable and effective diuresis than
intermittent boluses, especially when renal function is compromised. Oral
diuretics (A) are insufficient in acute settings. Thiazides (D) are not potent enough
as monotherapy for acute volume overload; they may be added later for
sequential nephron blockade.
Question 5
A 65-year-old male with known coronary artery disease is admitted with unstable
angina. He is started on aspirin, clopidogrel, and heparin. He develops acute
shortness of breath, hypotension, and muffled heart sounds. What is the most
likely diagnosis?
A. Anaphylaxis to aspirin
3
, B. Heparin‑induced thrombocytopenia
C. Cardiac tamponade
D. Pulmonary embolism
Correct Answer: C
Rationale: Beck's triad (hypotension, muffled heart sounds, distended neck veins)
is classic for cardiac tamponade. In the setting of ACS, tamponade can result from
myocardial rupture or post‑infarction pericarditis with effusion. Anaphylaxis (A)
would have wheezing/urticaria. HIT (B) typically causes thrombosis and
thrombocytopenia. PE (D) presents with tachypnea and hypoxia, not muffled
heart sounds.
Question 6
A 70-year-old male is admitted with syncope. He has hypertension and type 2
diabetes. EKG shows sinus bradycardia at 45 bpm and a prolonged PR interval of
280 ms. What is the most likely diagnosis?
A. Sick sinus syndrome
B. First‑degree AV block
C. Second‑degree AV block type I
D. Third‑degree AV block
Correct Answer: B
Rationale: First‑degree AV block is defined by a PR interval >200 ms (in adults)
with a constant 1:1 atrial‑ventricular relationship. It is often asymptomatic and
does not require treatment. Sick sinus syndrome (A) would show alternating
bradycardia/tachycardia. Type I (C) has progressive PR lengthening. Third‑degree
(D) has complete AV dissociation.
Question 7
A 60-year-old female with paroxysmal atrial fibrillation is admitted with
palpitations. She is on apixaban. EKG shows atrial fibrillation at 140 bpm.
4
