ABFM Hospital Medicine Certified Exam Q&A with Rationales 2025 Verified Prep for
Guaranteed Success
A 42-year-old construction worker with a 3-day history of cough, fever, chills, dyspnea, and right
posterolateral chest pain with inspiration is brought to the emergency department by his wife. He has
been in good health until this illness, and has never been hospitalized. He does not take any routine
medications, does not smoke, and drinks alcohol only occasionally.On examination he appears ill and in
mild respiratory distress. His temperature is 40.3°C (104.5°F), pulse rate 130 beats/min, respiratory rate
32/min, blood pressure 136/70 mm Hg, and oxygen saturation 88% on room air. He has diminished
breath sounds in the right posterolateral chest. His Pneumonia Severity Index is 97. Based on the
severity of his illness you recommend hospital admission.Antibiotic choices recommended for empiric
treatment in this patient include which of the following? (Mark all that are true.)
Ceftriaxone (Rocephin) plus azithromycin A, B, E
Relative risk stratification should be performed for patients with community-acquired pneumonia, using
a clinical prediction tool such as the Pneumonia Severity Index (PSI) or the CURB-65 (SOR A). These tools
can be used along with the judgment of the physician to decide whether or not a patient can be treated
as an outpatient or should be admitted to the hospital. This patient is moderately ill and, based on his
presentation, has a PSI score of 97 (based on his age, respiratory rate, temperature, and pulse oximetry).
This score indicates that he should initially be treated in the hospital.A macrolide plus a β-lactam is
recommended for combination therapy in patients hospitalized with community-acquired pneumonia
who are at low risk (PSI score of 71-130) (SOR A). In addition to a β-lactam, doxycycline can be used as
an alternative to a macrolide (SOR B). A respiratory fluoroquinolone (levofloxacin, gemifloxacin,
moxifloxacin) can be used as monotherapy (SOR A). Because of concerns about increasing levels of
resistance, macrolides are not recommended as monotherapy for a moderately ill patient (SOR C).
Ciprofloxacin, a first-generation quinolone, has no antimicrobial activity against Streptococcus
pneumoniae and is therefore not appropriate treatment for community-acquired pneumonia (SOR C) <<
correct answer >>A 32-year-old nonpregnant female with a history of poorly controlled type 2 diabetes
mellitus is admitted to the hospital for abdominal wall cellulitis. On hospital day 2 she develops mild
shortness of breath. Her physical examination is normal, with the exception of a respiratory rate of
22/min and abdominal wall erythema, warmth, and tenderness. Laboratory findings are normal with the
exception of a fasting blood glucose level of 268 mg/dL and mild leukocytosis. Her D-dimer level is 250
ng/mL.True statements regarding the use of the D-dimer assay for diagnosing pulmonary embolism in
this situation include which of the following? (Mark all that are true.)
It has good sensitivity
It has good specificity
It has a good positive predictive value
, It has a good negative predictive value A, D
D-dimer is a degradation product of cross-linked fibrin. The PIOPED II investigators recommend
stratification of all patients with suspected pulmonary embolism according to an objective clinical
probability assessment. D-dimer should be measured by a quantitative rapid enzyme-linked
immunosorbent assay (ELISA), and the combination of a negative D-dimer with a low or moderate
clinical probability can safely exclude pulmonary embolism in many patients. The sensitivity of the D-
dimer assay is 90%-95% for pulmonary embolus, but D-dimer levels are normal in only 40%-68% of
patients without pulmonary embolus (SOR A). A D-dimer value >500 ng/mL is considered to be
abnormal. Values ≤500 ng/mL have a high negative predictive value for pulmonary embolism in patients
with a low to moderate pretest probability (SOR A) << correct answer >>A 58-year-old male with type 2
diabetes mellitus undergoes elective knee surgery. After the surgery he is restarted on all of his usual
medications with intensive glucose monitoring. On his first postoperative day he is found to be confused
and lethargic with a blood glucose level of 32 mg/dL.When used alone, which of the following diabetes
medications can cause this problem? (Mark all that are true.)
Nateglinide (Starlix)
Glipizide (Glucotrol)
Insulin glargine (Lantus)
Metformin (Glucophage)
Pioglitazone (Actos) A, B, C
Some diabetes medications can lead to hypoglycemia in hospitalized patients. Both nateglinide and
glipizide stimulate insulin production, which can lead to hypoglycemia (SOR B). All insulin products lower
blood glucose directly, with hypoglycemia as a known side effect (SOR B). Metformin and pioglitazone
both help control diabetes by sensitizing the body to the effects of insulin. These medications are not a
direct cause of hypoglycemia when given at usual dosages in most situations (SOR B) << correct answer
>>An 82-year-old female is hospitalized with acute pancreatitis and intestinal ileus, and you determine
that she will require total parenteral nutrition through a central venous catheter. Which of the following
will decrease the likelihood of catheter-related complications in this patient? (Mark all that are true.)
Placement of the catheter in the femoral vein
Ultrasound-guided placement of the catheter into the internal jugular vein
Routinely changing the catheter over a wire every 3-5 days
Routinely moving the catheter to a different insertion site every 3-5 days
Using chlorhexidine gluconate-impregnated sponges in the catheter dressings B, E
Guaranteed Success
A 42-year-old construction worker with a 3-day history of cough, fever, chills, dyspnea, and right
posterolateral chest pain with inspiration is brought to the emergency department by his wife. He has
been in good health until this illness, and has never been hospitalized. He does not take any routine
medications, does not smoke, and drinks alcohol only occasionally.On examination he appears ill and in
mild respiratory distress. His temperature is 40.3°C (104.5°F), pulse rate 130 beats/min, respiratory rate
32/min, blood pressure 136/70 mm Hg, and oxygen saturation 88% on room air. He has diminished
breath sounds in the right posterolateral chest. His Pneumonia Severity Index is 97. Based on the
severity of his illness you recommend hospital admission.Antibiotic choices recommended for empiric
treatment in this patient include which of the following? (Mark all that are true.)
Ceftriaxone (Rocephin) plus azithromycin A, B, E
Relative risk stratification should be performed for patients with community-acquired pneumonia, using
a clinical prediction tool such as the Pneumonia Severity Index (PSI) or the CURB-65 (SOR A). These tools
can be used along with the judgment of the physician to decide whether or not a patient can be treated
as an outpatient or should be admitted to the hospital. This patient is moderately ill and, based on his
presentation, has a PSI score of 97 (based on his age, respiratory rate, temperature, and pulse oximetry).
This score indicates that he should initially be treated in the hospital.A macrolide plus a β-lactam is
recommended for combination therapy in patients hospitalized with community-acquired pneumonia
who are at low risk (PSI score of 71-130) (SOR A). In addition to a β-lactam, doxycycline can be used as
an alternative to a macrolide (SOR B). A respiratory fluoroquinolone (levofloxacin, gemifloxacin,
moxifloxacin) can be used as monotherapy (SOR A). Because of concerns about increasing levels of
resistance, macrolides are not recommended as monotherapy for a moderately ill patient (SOR C).
Ciprofloxacin, a first-generation quinolone, has no antimicrobial activity against Streptococcus
pneumoniae and is therefore not appropriate treatment for community-acquired pneumonia (SOR C) <<
correct answer >>A 32-year-old nonpregnant female with a history of poorly controlled type 2 diabetes
mellitus is admitted to the hospital for abdominal wall cellulitis. On hospital day 2 she develops mild
shortness of breath. Her physical examination is normal, with the exception of a respiratory rate of
22/min and abdominal wall erythema, warmth, and tenderness. Laboratory findings are normal with the
exception of a fasting blood glucose level of 268 mg/dL and mild leukocytosis. Her D-dimer level is 250
ng/mL.True statements regarding the use of the D-dimer assay for diagnosing pulmonary embolism in
this situation include which of the following? (Mark all that are true.)
It has good sensitivity
It has good specificity
It has a good positive predictive value
, It has a good negative predictive value A, D
D-dimer is a degradation product of cross-linked fibrin. The PIOPED II investigators recommend
stratification of all patients with suspected pulmonary embolism according to an objective clinical
probability assessment. D-dimer should be measured by a quantitative rapid enzyme-linked
immunosorbent assay (ELISA), and the combination of a negative D-dimer with a low or moderate
clinical probability can safely exclude pulmonary embolism in many patients. The sensitivity of the D-
dimer assay is 90%-95% for pulmonary embolus, but D-dimer levels are normal in only 40%-68% of
patients without pulmonary embolus (SOR A). A D-dimer value >500 ng/mL is considered to be
abnormal. Values ≤500 ng/mL have a high negative predictive value for pulmonary embolism in patients
with a low to moderate pretest probability (SOR A) << correct answer >>A 58-year-old male with type 2
diabetes mellitus undergoes elective knee surgery. After the surgery he is restarted on all of his usual
medications with intensive glucose monitoring. On his first postoperative day he is found to be confused
and lethargic with a blood glucose level of 32 mg/dL.When used alone, which of the following diabetes
medications can cause this problem? (Mark all that are true.)
Nateglinide (Starlix)
Glipizide (Glucotrol)
Insulin glargine (Lantus)
Metformin (Glucophage)
Pioglitazone (Actos) A, B, C
Some diabetes medications can lead to hypoglycemia in hospitalized patients. Both nateglinide and
glipizide stimulate insulin production, which can lead to hypoglycemia (SOR B). All insulin products lower
blood glucose directly, with hypoglycemia as a known side effect (SOR B). Metformin and pioglitazone
both help control diabetes by sensitizing the body to the effects of insulin. These medications are not a
direct cause of hypoglycemia when given at usual dosages in most situations (SOR B) << correct answer
>>An 82-year-old female is hospitalized with acute pancreatitis and intestinal ileus, and you determine
that she will require total parenteral nutrition through a central venous catheter. Which of the following
will decrease the likelihood of catheter-related complications in this patient? (Mark all that are true.)
Placement of the catheter in the femoral vein
Ultrasound-guided placement of the catheter into the internal jugular vein
Routinely changing the catheter over a wire every 3-5 days
Routinely moving the catheter to a different insertion site every 3-5 days
Using chlorhexidine gluconate-impregnated sponges in the catheter dressings B, E
