ABFM KSA - CARE OF HOSPITALIZED PATIENTS QUESTIONS AND ANSWERS LATEST UPDATES 2025/2026

ABFM KSA - CARE OF HOSPITALIZED PATIENTS QUESTIONS AND ANSWERS LATEST UPDATES 2025/2026

1. 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, guard-
ing, 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) answer >> C

The 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
unditterentiated 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.

2. 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 mag-






,nesium 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 answe
>> 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 answer >> age 8e0 , body weight 6d0 kg (130 lb), or serum creatinine 1e. 5 mg/dL.

3. 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 effu-
sions if the cause is unknown

Ultrasound-guided thoracentesis should be performed on admission in all
patients with small bilateral pleural effusions

3 n/ n107

, In patients with heart failure who are treated with diuretics, pleural effusions
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nmay be misclassified as exudative rather than transudative
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Negative cytology on an adequate sample of pleural fluid ( e1 0 mL)
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effectively rules out malignancy as the cause of a unilateral pleural effusion
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answer >> C
n n n n




CT can detect ettusions not apparent on plain radiographs, distinguish between pleural fluid and pleural thickening,
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and provide clues to the underlying cause. Contrast CT is recommended to provide additional information that can be
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used in making the diagnosis. Thoracentesis should not be performed in patients with bilateral ettusions if the clinical
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findings strongly suggest a pleural transudate, unless there are atypical features (fever, pleuritic chest pain, or widely
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asymmetric ettusion size) or the ettusion fails to respond to therapy (SOR C). Thoracentesis should be performed with
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4 n/ n107