ABFM KSA - Care Of Hospitalized Patients Questions And Answers Latest Update (2025)!!

ABFM KSA - Care Of Hospitalized Patients Questions And Answers Latest Update (2025)!!




ABFM KSA - Care Of Hospitalized Patients
Questions And Answers Latest Update
(2025)!!

1. CT would usually be indicated as the initial imaging study for which one of the
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nfollowing patients? n




An 8-year-old with a 2-day history of nausea, anorexia, and periumbilical pain
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that has migrated to the right lower quadrant with localized tenderness,
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guarding, and leukocytosis with a left shift
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A43-year-old witha 1-day history ofepigastric painandnausea withvomiting, and
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elevated serum lipase
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A 66-year-old with diffuse abdominal pain,leukocytosis,and fever
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A 55-year-old with unrelenting severe low back pain associated with right leg pain
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and weakness
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A 68-year-old with crushing, retrosternal chest pain, an EKG showing sinus
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tachycardia with left bundle branch block,and a cardiac troponin I level of 14 ng/m
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(N <0.04)ANS: C
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The use of CT has increased significantly in recent years due to increased avail- ability,
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better resolution, and faster scan times.However, there are rising concerns about
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cumulative radiation exposure and an increasing need to contain costs in medicine.To
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assist clinicians in making wise use of all imaging techniques, the American College of
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Radiology (ACR) has developed appropriateness criteria that recommend modalities
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for various clinical problems.Patients with undifferentiated abdominal pain often
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present a diagnostic challenge because of the wide range of pathology or organ
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involvement that can produce this symptom. Fever associated with abdominal pain
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increases the likelihood of intra-abdominal infection, abscess, orotherconditionsthat
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,mayrequireanurgentdefinitivediagnosisorintervention.In oneretrospectivestudy,CT
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resultschangedtheleadingdiagnosisin51%ofpatients and the decision to admit
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patients presenting to the emergency department with abdominal pain in 25% of
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patients.In contrast, no imaging may be indicated when the diagnosis is
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straightforward based on other clinical indicators.Ultrasonography should be the first
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imaging study in a pediatric patient with a classic history and physical and laboratory
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findings of appendicitis.Similarly, while CT is unlikely to provide useful additional
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information in a patient with unequivocal, uncomplicated acute pancreatitis,
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ultrasonography is a reasonable first imaging study to evaluate for gallstones. Patients
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with suspected acute coronary syndrome should be taken for coronary angiography
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without delay.A patient with severe back pain and leg weakness should be evaluated
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with MRI.
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2. A 75-year-old male is hospitalized with new-onset atrial fibrillation and a
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rapid ventricularrate.His current medical problems include COPD,hyperten-
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sion, coronary artery disease, and depression. A metabolic panel including a
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magnesium level is normal on admission.After a diltiazem continuous in-
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,travenous infusion his pulse rate is 85 beats/min and irregular. The following n n n n n n n n n n n




morning he converts to normal sinus rhythm.Which one of the following would be
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appropriate at this point?
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Administer a loading dose of warfarin,10 mg orally Start n n n n n n n n n




apixaban (Eliquis), 5 mg twice daily
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Stop the diltiazem infusion and administer metoprolol intravenously
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Stop the diltiazem infusion and administer digoxin,0.25 mg intravenously ANS: B
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It is generally not recommended to give a loading dose of warfarin, as the benefit is
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minimal, especially if treating atrial fibrillation.There is no benefit to administering
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digoxin ormetoprolol intravenously once the patienthasconverted to sinus rhythm.
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Apixaban and other direct oral anticoagulants are recommended for stroke prophy-
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laxis and should be initiated as soon as possible.This could have been started at the
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time ofadmission for thispatient because there isnoreason to waituntilnormal sinus
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rhythm is achieved.The dosage should be lowered to 2.5 mg twice daily for patients
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with two of the following: age e80, body weight d60 kg (130 lb), or serum creatinine e1.5
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mg/dL.
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3. You admit a 74-year-old patient to the hospital with shortness of breath and
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bilateral pleural effusions seen on a chest radiograph.Which one of the
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following is true regarding pleural effusions?
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Noncontrast CT should be performed initially in all patients with pleural effu- n n n n n n n n n n n




sions if the cause is unknown
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Ultrasound-guided thoracentesis should be performed on admission in all n n n n n n n n




patients with small bilateral pleural effusions
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In patients with heart failure who are treated with diuretics,pleural effusions may
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be misclassified as exudative rather than transudative
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Negativecytologyonanadequatesampleofpleuralfluid( e1 0 mL)effectively rules
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out malignancy as the cause of a unilateral pleural effusion
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ANS: C n




CT can detect effusions not apparent on plain radiographs, distinguish between
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, n pleural fluid and pleural thickening, and provide clues to the underlying cause.
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Contrast CT is recommended to provide additional information that can be used in
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making the diagnosis.Thoracentesis should not be performed in patients with
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bilateraleffusionsiftheclinicalfindingsstronglysuggestapleuraltransudate,unless there
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are atypical features (fever, pleuritic chest pain, or widely asymmetric effusion size) or
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the effusion fails to respond to therapy (SOR C).Thoracentesis should
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be performed with ultrasound guidance, when possible, to improve the likelihood of
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successful aspiration and decrease the risk of organ puncture, especially when
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effusions are small.About 20% of patients with a pleural effusion caused by heart
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