ABFM HOSPITAL MEDICINE
QUESTIONS WITH CORRECT
ANSWERS GRADED A+ FOR 2025-
2026 ASSURED EXCEL!!
Ag42-year-oldgconstructiongworkergwithgag3-
dayghistorygofgcough,gfever,gchills,gdyspnea,gandgrightgposterolateralgchestgpaingwithginspirationgisg
broughtgtogthegemergencygdepartmentgbyghisgwife.gHeghasgbeenginggoodghealthguntilgthisgillness,ga
ndghasgnevergbeenghospitalized.gHegdoesgnotgtakeganygroutinegmedications,gdoesgnotgsmoke,gandg
drinksgalcoholgonlygoccasionally.Ongexaminationghegappearsgillgandgingmildgrespiratorygdistress.gHis
gtemperaturegisg40.3°Cg(104.5°F),gpulsegrateg130gbeats/min,grespiratorygrateg32/min,gbloodgpressu
reg136/70gmmgHg,gandgoxygengsaturationg88%gongroomgair.gHeghasgdiminishedgbreathgsoundsgingth
egrightgposterolateralgchest.gHisgPneumoniagSeveritygIndexgisg97.gBasedgongthegseveritygofghisgillnes
sgyougrecommendghospitalgadmission.Antibioticgchoicesgrecommendedgforgempiricgtreatmentgingt
hisgpatientgincludegwhichgofgthegfollowing?g(Markgallgthatgaregtrue.)
Ceftriaxoneg(Rocephin)gplusgazithromycing-ggCORRECTgANSWERSA,gB,gE
Relativegriskgstratificationgshouldgbegperformedgforgpatientsgwithgcommunity-
acquiredgpneumonia,gusinggagclinicalgpredictiongtoolgsuchgasgthegPneumoniagSeveritygIndexg(PSI)go
rgthegCURB-
65g(SORgA).gThesegtoolsgcangbegusedgalonggwithgthegjudgmentgofgthegphysiciangtogdecidegwhetherg
orgnotgagpatientgcangbegtreatedgasgangoutpatientgorgshouldgbegadmittedgtogtheghospital.gThisgpatien
tgisgmoderatelygillgand,gbasedgonghisgpresentation,ghasgagPSIgscoregofg97g(basedgonghisgage,grespirat
orygrate,gtemperature,gandgpulsegoximetry).gThisgscoregindicatesgthatghegshouldginitiallygbegtreated
gingtheghospital.Agmacrolidegplusgagβ-
lactamgisgrecommendedgforgcombinationgtherapygingpatientsghospitalizedgwithgcommunity-
acquiredgpneumoniagwhogaregatglowgriskg(PSIgscoregofg71-130)g(SORgA).gIngadditiongtogagβ-
lactam,gdoxycyclinegcangbegusedgasgangalternativegtogagmacrolideg(SORgB).gAgrespiratorygfluoroquin
oloneg(levofloxacin,ggemifloxacin,gmoxifloxacin)gcangbegusedgasgmonotherapyg(SORgA).gBecausegofg
concernsgaboutgincreasingglevelsgofgresistance,gmacrolidesgaregnotgrecommendedgasgmonotherap
ygforgagmoderatelygillgpatientg(SORgC).gCiprofloxacin,gagfirst-
generationgquinolone,ghasgnogantimicrobialgactivitygagainstgStreptococcusgpneumoniaegandgisgthe
reforegnotgappropriategtreatmentgforgcommunity-acquiredgpneumoniag(SORgC).
,Ag32-year-
oldgnonpregnantgfemalegwithgaghistorygofgpoorlygcontrolledgtypeg2gdiabetesgmellitusgisgadmittedgt
ogtheghospitalgforgabdominalgwallgcellulitis.gOnghospitalgdayg2gshegdevelopsgmildgshortnessgofgbrea
th.gHergphysicalgexaminationgisgnormal,gwithgthegexceptiongofgagrespiratorygrategofg22/mingandgab
dominalgwallgerythema,gwarmth,gandgtenderness.gLaboratorygfindingsgaregnormalgwithgthegexcept
iongofgagfastinggbloodgglucoseglevelgofg268gmg/dLgandgmildgleukocytosis.gHergD-
dimerglevelgisg250gng/mL.TruegstatementsgregardinggthegusegofgthegD-
dimergassaygforgdiagnosinggpulmonarygembolismgingthisgsituationgincludegwhichgofgthegfollowing?g
(Markgallgthatgaregtrue.)
Itghasggoodgsensitivity
Itghasggoodgspecificity
Itghasgaggoodgpositivegpredictivegvalue
Itghasgaggoodgnegativegpredictivegvalueg-ggCORRECTgANSWERSA,gD
D-dimergisgagdegradationgproductgofgcross-
linkedgfibrin.gThegPIOPEDgIIginvestigatorsgrecommendgstratificationgofgallgpatientsgwithgsuspectedg
pulmonarygembolismgaccordinggtogangobjectivegclinicalgprobabilitygassessment.gD-
dimergshouldgbegmeasuredgbygagquantitativegrapidgenzyme-
linkedgimmunosorbentgassayg(ELISA),gandgthegcombinationgofgagnegativegD-
dimergwithgaglowgorgmoderategclinicalgprobabilitygcangsafelygexcludegpulmonarygembolismgingman
ygpatients.gThegsensitivitygofgthegD-dimergassaygisg90%-95%gforgpulmonarygembolus,gbutgD-
dimerglevelsgaregnormalgingonlyg40%-68%gofgpatientsgwithoutgpulmonarygembolusg(SORgA).gAgD-
dimergvalueg>500gng/mLgisgconsideredgtogbegabnormal.gValuesg≤500gng/mLghavegaghighgnegativegp
redictivegvaluegforgpulmonarygembolismgingpatientsgwithgaglowgtogmoderategpretestgprobabilityg(S
ORgA).
Ag58-year-
oldgmalegwithgtypeg2gdiabetesgmellitusgundergoesgelectivegkneegsurgery.gAftergthegsurgeryghegisgre
startedgongallgofghisgusualgmedicationsgwithgintensivegglucosegmonitoring.gOnghisgfirstgpostoperativ
egdayghegisgfoundgtogbegconfusedgandglethargicgwithgagbloodgglucoseglevelgofg32gmg/dL.Whengusedg
alone,gwhichgofgthegfollowinggdiabetesgmedicationsgcangcausegthisgproblem?g(Markgallgthatgaregtru
e.)
, Nateglinideg(Starlix)
Glipizideg(Glucotrol)
Insulingglargineg(Lantus)
Metforming(Glucophage)
Pioglitazoneg(Actos)g-ggCORRECTgANSWERSA,gB,gC
Somegdiabetesgmedicationsgcangleadgtoghypoglycemiaginghospitalizedgpatients.gBothgnateglinidega
ndgglipizidegstimulateginsulingproduction,gwhichgcangleadgtoghypoglycemiag(SORgB).gAllginsulingprod
uctsglowergbloodgglucosegdirectly,gwithghypoglycemiagasgagknowngsidegeffectg(SORgB).gMetforminga
ndgpioglitazonegbothghelpgcontrolgdiabetesgbygsensitizinggthegbodygtogthegeffectsgofginsulin.gTheseg
medicationsgaregnotgagdirectgcausegofghypoglycemiagwhenggivengatgusualgdosagesgingmostgsituatio
nsg(SORgB).
Ang82-year-
oldgfemalegisghospitalizedgwithgacutegpancreatitisgandgintestinalgileus,gandgyougdeterminegthatgshe
gwillgrequiregtotalgparenteralgnutritiongthroughgagcentralgvenousgcatheter.gWhichgofgthegfollowingg
willgdecreasegtheglikelihoodgofgcatheter-
relatedgcomplicationsgingthisgpatient?g(Markgallgthatgaregtrue.)
Placementgofgthegcathetergingthegfemoralgvein
Ultrasound-guidedgplacementgofgthegcathetergintogtheginternalgjugulargvein
Routinelygchanginggthegcathetergovergagwiregeveryg3-5gdays
Routinelygmovinggthegcathetergtogagdifferentginsertiongsitegeveryg3-5gdays
Usinggchlorhexidineggluconate-impregnatedgspongesgingthegcathetergdressingsg-
ggCORRECTgANSWERSB,gE
Studiesgshowgthatgultrasound-
guidedgplacementgofgthegcathetergintogtheginternalgjugulargveingisgassociatedgwithgaghighergsucces
sgrategandgaglowergcomplicationgrategduringginsertion,gevengamonggphysiciansghighlygexperiencedgi
ngthegprocedureg(SORgA).gPlacementgofgthegcathetergingthegfemoralgveingisgassociatedgwithgaghighe
rgrategofgpost-
insertiongcomplicationsg(SORgA).gRoutinelygchanginggthegcathetergovergagwiregeveryg3-
QUESTIONS WITH CORRECT
ANSWERS GRADED A+ FOR 2025-
2026 ASSURED EXCEL!!
Ag42-year-oldgconstructiongworkergwithgag3-
dayghistorygofgcough,gfever,gchills,gdyspnea,gandgrightgposterolateralgchestgpaingwithginspirationgisg
broughtgtogthegemergencygdepartmentgbyghisgwife.gHeghasgbeenginggoodghealthguntilgthisgillness,ga
ndghasgnevergbeenghospitalized.gHegdoesgnotgtakeganygroutinegmedications,gdoesgnotgsmoke,gandg
drinksgalcoholgonlygoccasionally.Ongexaminationghegappearsgillgandgingmildgrespiratorygdistress.gHis
gtemperaturegisg40.3°Cg(104.5°F),gpulsegrateg130gbeats/min,grespiratorygrateg32/min,gbloodgpressu
reg136/70gmmgHg,gandgoxygengsaturationg88%gongroomgair.gHeghasgdiminishedgbreathgsoundsgingth
egrightgposterolateralgchest.gHisgPneumoniagSeveritygIndexgisg97.gBasedgongthegseveritygofghisgillnes
sgyougrecommendghospitalgadmission.Antibioticgchoicesgrecommendedgforgempiricgtreatmentgingt
hisgpatientgincludegwhichgofgthegfollowing?g(Markgallgthatgaregtrue.)
Ceftriaxoneg(Rocephin)gplusgazithromycing-ggCORRECTgANSWERSA,gB,gE
Relativegriskgstratificationgshouldgbegperformedgforgpatientsgwithgcommunity-
acquiredgpneumonia,gusinggagclinicalgpredictiongtoolgsuchgasgthegPneumoniagSeveritygIndexg(PSI)go
rgthegCURB-
65g(SORgA).gThesegtoolsgcangbegusedgalonggwithgthegjudgmentgofgthegphysiciangtogdecidegwhetherg
orgnotgagpatientgcangbegtreatedgasgangoutpatientgorgshouldgbegadmittedgtogtheghospital.gThisgpatien
tgisgmoderatelygillgand,gbasedgonghisgpresentation,ghasgagPSIgscoregofg97g(basedgonghisgage,grespirat
orygrate,gtemperature,gandgpulsegoximetry).gThisgscoregindicatesgthatghegshouldginitiallygbegtreated
gingtheghospital.Agmacrolidegplusgagβ-
lactamgisgrecommendedgforgcombinationgtherapygingpatientsghospitalizedgwithgcommunity-
acquiredgpneumoniagwhogaregatglowgriskg(PSIgscoregofg71-130)g(SORgA).gIngadditiongtogagβ-
lactam,gdoxycyclinegcangbegusedgasgangalternativegtogagmacrolideg(SORgB).gAgrespiratorygfluoroquin
oloneg(levofloxacin,ggemifloxacin,gmoxifloxacin)gcangbegusedgasgmonotherapyg(SORgA).gBecausegofg
concernsgaboutgincreasingglevelsgofgresistance,gmacrolidesgaregnotgrecommendedgasgmonotherap
ygforgagmoderatelygillgpatientg(SORgC).gCiprofloxacin,gagfirst-
generationgquinolone,ghasgnogantimicrobialgactivitygagainstgStreptococcusgpneumoniaegandgisgthe
reforegnotgappropriategtreatmentgforgcommunity-acquiredgpneumoniag(SORgC).
,Ag32-year-
oldgnonpregnantgfemalegwithgaghistorygofgpoorlygcontrolledgtypeg2gdiabetesgmellitusgisgadmittedgt
ogtheghospitalgforgabdominalgwallgcellulitis.gOnghospitalgdayg2gshegdevelopsgmildgshortnessgofgbrea
th.gHergphysicalgexaminationgisgnormal,gwithgthegexceptiongofgagrespiratorygrategofg22/mingandgab
dominalgwallgerythema,gwarmth,gandgtenderness.gLaboratorygfindingsgaregnormalgwithgthegexcept
iongofgagfastinggbloodgglucoseglevelgofg268gmg/dLgandgmildgleukocytosis.gHergD-
dimerglevelgisg250gng/mL.TruegstatementsgregardinggthegusegofgthegD-
dimergassaygforgdiagnosinggpulmonarygembolismgingthisgsituationgincludegwhichgofgthegfollowing?g
(Markgallgthatgaregtrue.)
Itghasggoodgsensitivity
Itghasggoodgspecificity
Itghasgaggoodgpositivegpredictivegvalue
Itghasgaggoodgnegativegpredictivegvalueg-ggCORRECTgANSWERSA,gD
D-dimergisgagdegradationgproductgofgcross-
linkedgfibrin.gThegPIOPEDgIIginvestigatorsgrecommendgstratificationgofgallgpatientsgwithgsuspectedg
pulmonarygembolismgaccordinggtogangobjectivegclinicalgprobabilitygassessment.gD-
dimergshouldgbegmeasuredgbygagquantitativegrapidgenzyme-
linkedgimmunosorbentgassayg(ELISA),gandgthegcombinationgofgagnegativegD-
dimergwithgaglowgorgmoderategclinicalgprobabilitygcangsafelygexcludegpulmonarygembolismgingman
ygpatients.gThegsensitivitygofgthegD-dimergassaygisg90%-95%gforgpulmonarygembolus,gbutgD-
dimerglevelsgaregnormalgingonlyg40%-68%gofgpatientsgwithoutgpulmonarygembolusg(SORgA).gAgD-
dimergvalueg>500gng/mLgisgconsideredgtogbegabnormal.gValuesg≤500gng/mLghavegaghighgnegativegp
redictivegvaluegforgpulmonarygembolismgingpatientsgwithgaglowgtogmoderategpretestgprobabilityg(S
ORgA).
Ag58-year-
oldgmalegwithgtypeg2gdiabetesgmellitusgundergoesgelectivegkneegsurgery.gAftergthegsurgeryghegisgre
startedgongallgofghisgusualgmedicationsgwithgintensivegglucosegmonitoring.gOnghisgfirstgpostoperativ
egdayghegisgfoundgtogbegconfusedgandglethargicgwithgagbloodgglucoseglevelgofg32gmg/dL.Whengusedg
alone,gwhichgofgthegfollowinggdiabetesgmedicationsgcangcausegthisgproblem?g(Markgallgthatgaregtru
e.)
, Nateglinideg(Starlix)
Glipizideg(Glucotrol)
Insulingglargineg(Lantus)
Metforming(Glucophage)
Pioglitazoneg(Actos)g-ggCORRECTgANSWERSA,gB,gC
Somegdiabetesgmedicationsgcangleadgtoghypoglycemiaginghospitalizedgpatients.gBothgnateglinidega
ndgglipizidegstimulateginsulingproduction,gwhichgcangleadgtoghypoglycemiag(SORgB).gAllginsulingprod
uctsglowergbloodgglucosegdirectly,gwithghypoglycemiagasgagknowngsidegeffectg(SORgB).gMetforminga
ndgpioglitazonegbothghelpgcontrolgdiabetesgbygsensitizinggthegbodygtogthegeffectsgofginsulin.gTheseg
medicationsgaregnotgagdirectgcausegofghypoglycemiagwhenggivengatgusualgdosagesgingmostgsituatio
nsg(SORgB).
Ang82-year-
oldgfemalegisghospitalizedgwithgacutegpancreatitisgandgintestinalgileus,gandgyougdeterminegthatgshe
gwillgrequiregtotalgparenteralgnutritiongthroughgagcentralgvenousgcatheter.gWhichgofgthegfollowingg
willgdecreasegtheglikelihoodgofgcatheter-
relatedgcomplicationsgingthisgpatient?g(Markgallgthatgaregtrue.)
Placementgofgthegcathetergingthegfemoralgvein
Ultrasound-guidedgplacementgofgthegcathetergintogtheginternalgjugulargvein
Routinelygchanginggthegcathetergovergagwiregeveryg3-5gdays
Routinelygmovinggthegcathetergtogagdifferentginsertiongsitegeveryg3-5gdays
Usinggchlorhexidineggluconate-impregnatedgspongesgingthegcathetergdressingsg-
ggCORRECTgANSWERSB,gE
Studiesgshowgthatgultrasound-
guidedgplacementgofgthegcathetergintogtheginternalgjugulargveingisgassociatedgwithgaghighergsucces
sgrategandgaglowergcomplicationgrategduringginsertion,gevengamonggphysiciansghighlygexperiencedgi
ngthegprocedureg(SORgA).gPlacementgofgthegcathetergingthegfemoralgveingisgassociatedgwithgaghighe
rgrategofgpost-
insertiongcomplicationsg(SORgA).gRoutinelygchanginggthegcathetergovergagwiregeveryg3-
