ABFM KSA CARE OF HOSPITALIZED PATIENTS
QUESTIONS AND ANSWERS LATEST 2025-2026
UPDATE |GRADE A+ GUARANTEE
A 78-year-old male lives alone with no known relatives or friends. A
social worker performing a routine welfare check finds him down on the
floor and he is hospitalized for several days with Wernicke-Korsakoff
syndrome. He is medically optimized, and discharge planning is now
being discussed. His cognitive assessment scores are abnormal. There is
no advance care plan document or health care power of attorney. The
patient states that he wants to return home, but you have significant
concerns about that decision and do not feel it would be safe. When you
discuss your concerns with the patient and ask about his plans for
obtaining and preparing food and other instrumental activities of daily
living, he simply asserts that he'll be "fine." He is not able to provide any
further explanation of his thoughts, and he becomes upset and refuses to
answer further questions.Reasonable strategies for managing this
situation includ - Answer-D
As with any medical procedure, discharge planning should be done with
the consent of the patient involved. Because this patient does not appear
to have the capacity to consent to any plan, a surrogate decision maker
should be sought. Capacity is not the same as competence. It is
important to distinguish the terms precisely in clinical practice.
Competence is a legal term that is determined by the court system,
whereas capacity is a medical term that is determined by the treating
,physician. According to their strict definitions, lack of competence refers
to impairment of global decision-making regarding matters such as
finances, property, and wills, whereas lack of capacity refers to the
inability to make decisions about proposed medical treatments and other
aspects of care. Capacity can vary with circumstance and the relative
complexity of the decision that is being made.Once the physician has
determined that no communication barriers exist, such as hearing loss,
language barriers, or dysarthria, and that no medically reversible causes
are present, medical decision-making capacity should be assessed. The
patient should be able to demonstrate understanding of the situation,
appreciation of the consequences of the decision, and reasoning in the
thought process. They also must be able to communicate their wishes. If
it is still unclear whether the patient has the capacity to make decisions,
a structured interview should be done using a validated tool. Common
assessment tools include the Aid to Capacity Evaluation (ACE), the
Hopkins Competency Assessment Test (HCAT), the Understanding
Treatment Disclosure, and the MacArthur Competence Assessment Tool
for Treatment. Assessing cognition with a mental status examination is
not always necessary to determine medical decision-making capacity.If
there is no valid medical power
A 64-year-old female presents to the emergency department with 3-4
days of worsening abdominal pain, nonbloody diarrhea, a subjective
fever, and chills. She has not had any vomiting or urinary symptoms.
Her abdominal pain is somewhat localized to the entire left side of her
abdomen, but she reports that her whole abdomen feels tender. She has
not eaten anything for at least 36 hours. She tried to drink some water
earlier today but says it made her abdominal pain worse. Her previous
medical history includes hypertension, uncontrolled diabetes mellitus
treated with insulin, and COPD.On examination the patient appears
uncomfortable and ill. Her vital signs include a temperature of 38.2°C
,(100.8°F), a blood pressure of 140/91 mm Hg, a heart rate of 102
beats/min, a respiratory rate of 16/min, and an oxygen saturation of 94%
on room air. A cardiopulmonary examination is unremarkable except for
mild tachycardia. An abdomin - Answer-B
This patient has acute complicated diverticulitis. Given that she has a
small diverticular abscess, the initial management should be intravenous
antibiotics that cover gram-negative and anaerobic bacteria, such as
piperacillin/tazobactam. There are no randomized, controlled trials that
delineate the best antibiotic course. Patients presenting with a
diverticular abscess <3 cm or sometimes even 4 cm in diameter often
respond to antibiotics alone and do not need surgery or percutaneous
drainage. This patient should be hospitalized, given her uncontrolled
diabetes mellitus, fever, and inability to eat or drink. Outpatient
management with antibiotics and bowel stimulation with magnesium
citrate may be appropriate for patients with mild uncomplicated disease.
Oral antibiotics can be used in cases with small abscesses, as they have
been shown to be as effective as intravenous antibiotics, and some
patients may not require any antibiotics. Surgery is not indicated in the
acute management of diverticulitis unless pneumoperitoneum or
peritonitis is present.
A 58-year-old male with type 2 diabetes has undergone elective knee
surgery. After the surgery all of his usual medications were restarted,
with intensive glucose monitoring. The next morning he is found to be
confused and lethargic with a blood glucose level of 32 mg/dL.When
used alone, which one of the following diabetes medications is most
likely to cause hypoglycemia?
Glipizide (Glucotrol)
Metformin (Glucophage)
, Pioglitazone (Actos)
Sitagliptin (Januvia) - Answer-A
Some diabetes medications can lead to hypoglycemia in hospitalized
patients, including glipizide, which stimulates insulin production (SOR
B). Metformin and pioglitazone both help control diabetes by sensitizing
the body to the effects of insulin. Sitagliptin is a DPP-4 inhibitor and
works by blocking the enzyme that releases GLP-1. Its greatest effect is
reducing postprandial hyperglycemia. These medications are not a direct
cause of hypoglycemia when given at usual dosages in most situations
(SOR B).
Which one of the following is an advantage of a durable power of
attorney for health care compared to a living will?
It is not legally binding
It is the only advance directive that satisfies the Patient Self-
Determination Act
It is applicable in more clinical scenarios than a living will
It allows first responders to avoid cardiopulmonary resuscitation
It allows the person designated to make health care decisions to manage
the patient's finances and legal matters as well - Answer-C
The durable power of attorney for health care (DPOA-HC) is a type of
advance directive in which a competent person designates someone to
make health care decisions if the person becomes unable to do so. A
living will is a different type of advance directive in which a person
writes down instructions to avoid or receive specific medical care in the
QUESTIONS AND ANSWERS LATEST 2025-2026
UPDATE |GRADE A+ GUARANTEE
A 78-year-old male lives alone with no known relatives or friends. A
social worker performing a routine welfare check finds him down on the
floor and he is hospitalized for several days with Wernicke-Korsakoff
syndrome. He is medically optimized, and discharge planning is now
being discussed. His cognitive assessment scores are abnormal. There is
no advance care plan document or health care power of attorney. The
patient states that he wants to return home, but you have significant
concerns about that decision and do not feel it would be safe. When you
discuss your concerns with the patient and ask about his plans for
obtaining and preparing food and other instrumental activities of daily
living, he simply asserts that he'll be "fine." He is not able to provide any
further explanation of his thoughts, and he becomes upset and refuses to
answer further questions.Reasonable strategies for managing this
situation includ - Answer-D
As with any medical procedure, discharge planning should be done with
the consent of the patient involved. Because this patient does not appear
to have the capacity to consent to any plan, a surrogate decision maker
should be sought. Capacity is not the same as competence. It is
important to distinguish the terms precisely in clinical practice.
Competence is a legal term that is determined by the court system,
whereas capacity is a medical term that is determined by the treating
,physician. According to their strict definitions, lack of competence refers
to impairment of global decision-making regarding matters such as
finances, property, and wills, whereas lack of capacity refers to the
inability to make decisions about proposed medical treatments and other
aspects of care. Capacity can vary with circumstance and the relative
complexity of the decision that is being made.Once the physician has
determined that no communication barriers exist, such as hearing loss,
language barriers, or dysarthria, and that no medically reversible causes
are present, medical decision-making capacity should be assessed. The
patient should be able to demonstrate understanding of the situation,
appreciation of the consequences of the decision, and reasoning in the
thought process. They also must be able to communicate their wishes. If
it is still unclear whether the patient has the capacity to make decisions,
a structured interview should be done using a validated tool. Common
assessment tools include the Aid to Capacity Evaluation (ACE), the
Hopkins Competency Assessment Test (HCAT), the Understanding
Treatment Disclosure, and the MacArthur Competence Assessment Tool
for Treatment. Assessing cognition with a mental status examination is
not always necessary to determine medical decision-making capacity.If
there is no valid medical power
A 64-year-old female presents to the emergency department with 3-4
days of worsening abdominal pain, nonbloody diarrhea, a subjective
fever, and chills. She has not had any vomiting or urinary symptoms.
Her abdominal pain is somewhat localized to the entire left side of her
abdomen, but she reports that her whole abdomen feels tender. She has
not eaten anything for at least 36 hours. She tried to drink some water
earlier today but says it made her abdominal pain worse. Her previous
medical history includes hypertension, uncontrolled diabetes mellitus
treated with insulin, and COPD.On examination the patient appears
uncomfortable and ill. Her vital signs include a temperature of 38.2°C
,(100.8°F), a blood pressure of 140/91 mm Hg, a heart rate of 102
beats/min, a respiratory rate of 16/min, and an oxygen saturation of 94%
on room air. A cardiopulmonary examination is unremarkable except for
mild tachycardia. An abdomin - Answer-B
This patient has acute complicated diverticulitis. Given that she has a
small diverticular abscess, the initial management should be intravenous
antibiotics that cover gram-negative and anaerobic bacteria, such as
piperacillin/tazobactam. There are no randomized, controlled trials that
delineate the best antibiotic course. Patients presenting with a
diverticular abscess <3 cm or sometimes even 4 cm in diameter often
respond to antibiotics alone and do not need surgery or percutaneous
drainage. This patient should be hospitalized, given her uncontrolled
diabetes mellitus, fever, and inability to eat or drink. Outpatient
management with antibiotics and bowel stimulation with magnesium
citrate may be appropriate for patients with mild uncomplicated disease.
Oral antibiotics can be used in cases with small abscesses, as they have
been shown to be as effective as intravenous antibiotics, and some
patients may not require any antibiotics. Surgery is not indicated in the
acute management of diverticulitis unless pneumoperitoneum or
peritonitis is present.
A 58-year-old male with type 2 diabetes has undergone elective knee
surgery. After the surgery all of his usual medications were restarted,
with intensive glucose monitoring. The next morning he is found to be
confused and lethargic with a blood glucose level of 32 mg/dL.When
used alone, which one of the following diabetes medications is most
likely to cause hypoglycemia?
Glipizide (Glucotrol)
Metformin (Glucophage)
, Pioglitazone (Actos)
Sitagliptin (Januvia) - Answer-A
Some diabetes medications can lead to hypoglycemia in hospitalized
patients, including glipizide, which stimulates insulin production (SOR
B). Metformin and pioglitazone both help control diabetes by sensitizing
the body to the effects of insulin. Sitagliptin is a DPP-4 inhibitor and
works by blocking the enzyme that releases GLP-1. Its greatest effect is
reducing postprandial hyperglycemia. These medications are not a direct
cause of hypoglycemia when given at usual dosages in most situations
(SOR B).
Which one of the following is an advantage of a durable power of
attorney for health care compared to a living will?
It is not legally binding
It is the only advance directive that satisfies the Patient Self-
Determination Act
It is applicable in more clinical scenarios than a living will
It allows first responders to avoid cardiopulmonary resuscitation
It allows the person designated to make health care decisions to manage
the patient's finances and legal matters as well - Answer-C
The durable power of attorney for health care (DPOA-HC) is a type of
advance directive in which a competent person designates someone to
make health care decisions if the person becomes unable to do so. A
living will is a different type of advance directive in which a person
writes down instructions to avoid or receive specific medical care in the
