ABFM KSA Care of Hospitalized Patients Exam Questions With Complete Solutions - Latest Update 2026/2027 | Graded A+.

ABFM KSA Care of Hospitalized Patients Exam Questions With Complete Solutions - Latest Update 2026/2027 | Graded A+. Clostridioides (Clostridium) difficile colitis is one of the more common diseases, usually affecting patients recently treated with antibiotics, and often requiring hospital admission. Initial management of a patient with C. difficile –associated diarrhea should include discontinuation of offending antimicrobials when possible, routine supportive care including fluid and electrolyte management, and treatment with oral vancomycin or fidaxomicin. In a meta-analysis and systematic review, fidaxomicin outperformed oral vancomycin and was cost effective despite higher per dose costs. Oral metronidazole is no longer to be used for treatment of C. difficile infection as the rate of treatment failure with metronidazole is increasing with rates of nonresponse now 20%. However, in more acutely ill patients, combination therapy with intravenous metronidazole and oral vancomycin is recommended. The antibiotics most commonly implicated in the development of C. difficile colitis include clindamycin, broad-spectrum penicillins, and cephalosporins and are not effective against the infection. Fluoroquinolones also have not been effective. There is no evidence to support the routine use of antimotility agents such as loperamide; the increased risks of toxin-related disease warrant against its usage (SOR B). Intravenous vancomycin has no effect against C. difficile, inhibiting only oral vancomycin's efficacy in eradicating C. difficile from the colon. A new order set was recently implemented at your hospital for the treatment of sepsis. While the order set seems successful in standardizing treatment, there has been an uptick in acute kidney injuries in the intensive-care unit since the order set was implemented. Which of the following would NOT be helpful in decreasing medication-related nephrotoxicity? Reviewing the medications on the order set for similarly effective but less toxic alternatives Implementing strategies to identify high-risk clients before receiving a potentially nephrotoxic medication Maintaining the patient's fluid volume at a minimum during the course of a potentially nephrotoxic medication Closely monitoring serum creatinine levels during a course of nephrotoxic medications Utilization of the Modification of Diet in Renal Disease Study equation to assess renal function C When a new order set is associated with increased acute kidney injury, the new order set likely contains a medication that is more nephrotoxic than the one used previously. That drug should be replaced, if possible, with an equally effective but less nephrotoxic medication. Also, being able to identify risk factors before the administration of nephrotoxic drugs can reduce nephrotoxicity. SOR C. The common risk factors for nephroxic reactions to medications include advanced age, depleted fluid status, underlying chronic renal disease, and concurrent use of medications that can impact renal function such as NSAIDs, other anti-inflammatory drugs, or ACE inhibitors. Whether or not ACE inhibitors should be stopped in these settings, and what criteria should be used to make that decision is not clear in the medical literature. Most other medications such as NSAIDs should be stopped immediately. Medications that are renally excreted can build up to toxic levels if not appropriately dosed based on renal function. Generally, the use of the Modification of Diet in Renal Disease [MDRD] Study equation is not appropriate because it uses race as a determinant in establishing the estimated GFR. Because this calculation yields a different GFR for a given level of creatinine and age in Black patients, it can lead to inappropriate dosing of medications and will miss Black patients with significant renal disease. Furthermore, it is suggested that potentially nephrotoxic medications are given with adequate hydration and that the patient be well hydrated before a potentially nephrotoxic medication is begun (SOR C). An observational study has also shown that poor monitoring of serum creatinine contributes to adverse drug events (SOR B). A 78-year-old man is admitted to the medical floor to be treated for a large ischemic stroke. He has been unable to eat and has been receiving his nutrition through a nasogastric tube. The morning laboratory values on his fourth hospital day show that this patient has a serum sodium value of 129 mEq/L (N 135- 145).Which one of the following values would be useful for determining the reason for this patient's hyponatremia? Total 24-hour urine output 24-hour urine sodium Spot urine sodium Urine protein C The cause of the hyponatremia can be determined in part by how the patient's kidneys are responding to the condition. This is based on the serum osmolality. The next step is assessing volume status. This can be tricky on clinical examination. A spot urine sodium level and urine osmolality are recommended. If appropriately dilute with a sodium 20 mEq/L, then hyponatremia is secondary to excessive water intake or inadequate solute intake. If urine is concentrated with a spot urine sodium 20 mEq/L, then patient may be hypovolemic, or may have the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). This is typically manifested by a low serum osmolality, a urinary osmolality above 100 mOsm/kg, normal renal function, euvolemia, and a random urinary sodium level above 20 mEq/L, with no thyroid disorders or the use of diuretics. If the serum osmolality is normal or high, no treatment of the hyponatremia itself is necessary. Both the iso-osmolar hyponatremia and the hyperosmolar hyponatremia result from an excess of another osmole such as glucose, mannitol, or contrast dye. A urine protein level is also useless in evaluating hyponatremia. The urine sodium and urine chloride concentrations can be helpful in differentiating hypovolemic from euvolemic hyponatremia. In hypovolemic hyponatremic patients with metabolic alkalosis from vomiting, the urine sodium may be 20 mEq/L, but the urine chloride will be 20 mEq/L. Which one of the following is true regarding the transfusion of PRBCs? Most patients with previous coronary artery disease who are admitted to the hospital for a noncardiovascular problem and whose admitting hemoglobin is 8.0-9.0 g/dL should be transfused because their hospital stay will more than likely continue to lower their hemoglobin . Anemia, as manifested by a decline in the hemoglobin from an admission value of 11.0 g/dL to 8.0 g/dL during a 3-day hospital stay, is an absolute indication for transfusion Generally, transfusion of 1 unit of PRBCs should increase hemoglobin by 2 g/dL and hematocrit by 6 percentage points Restrictive transfusion practices limiting transfusion to only patients with hemoglobin 7.0 g/dL have been associated with lower 30-day mortality rates compared to more liberal transfusion practices In spite of aggressive screening the risk of infection from a blood transfusion has continued to rise annually since the 1980s D Transfusion of blood products can be a lifesaving intervention for properly selected patients. In the past, fairly liberal transfusion policies often resulted in transfusion based upon the "10/30" rule; any patient with a hemoglobin level 10 mg/dL or a hematocrit 30% would be considered for transfusion, regardless of clinical condition. There is now support for more restrictive transfusion rules that recommend the limitation of transfusion to patients with hemoglobin levels below 7.0 g/dL with a target range of 7.0-9.0 g/dL. In general, in average-sized adults, one unit of packed red blood cells leads to an increment in hemoglobin of 1 g/dL or an increment of 3 percentage points in hematocrit. This more restrictive strategy, as compared to more liberal transfusion practices, significantly reduces the number of units transfused, resulting in a reduction in 30-day mortality. Other indications for transfusion include sickle-cell crisis and an acute loss of 1500 mL of blood or 30% of blood volume (SOR C).Transfusion is also indicated for patients with acute symptoms related to their anemia -ie, shortness of breath, weakness, altered cognition, angina, and severe heart failure-who are unable to function as a result of their symptoms (SOR C). Overall, the risk of transfusion-related complications is small. Although there continues to be some risk of noninfectious complications, the risk of transfusion-transmitted infections has decreased 10,000-fold since the 1980s due to vigorous screening of potential donors and the supply of donor blood (SOR C).