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
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
