ABFM KSA – Care of Hospitalized Patients
STUDY GUIDE 2026 COMPLETE QUESTIONS
WITH CORRECT DETAILED ANSWERS || 100%
GUARANTEED PASS <RECENT VERSION>
Sample Educational Questions: Care of Hospitalized Patients Core Topics
1. Sepsis Management
Q: A 68-year-old patient with diabetes presents with altered mental status, fever (102.5°F), and
hypotension (88/50 mmHg). Suspecting sepsis, you order labs and cultures. According to
Surviving Sepsis Campaign guidelines, what is the single most critical action to initiate within the
FIRST HOUR (Hour-1 bundle)?
A: a) Administer broad-spectrum antibiotics.
b) Obtain a full set of blood cultures.
c) Begin rapid IV fluid resuscitation with 30 mL/kg crystalloid.
d) Start vasopressors to maintain MAP >65 mmHg.
Correct Answer: c) Begin rapid IV fluid resuscitation with 30 mL/kg crystalloid.
*While antibiotics and cultures are crucial and should be obtained promptly, the cornerstone of
the *Hour-1* bundle is the immediate initiation of fluid resuscitation for hypotension or lactate
≥4 mmol/L.*
2. Acute COPD Exacerbation
Q: You are admitting a patient with a severe COPD exacerbation. They are on 4L home O2 and
are now on 6L via nasal cannula to maintain SpO2 90%. Initial ABG on 6L shows pH 7.28, pCO2
65, pO2 62. Which of the following is the most appropriate next step in respiratory
management?
A: a) Intubate for mechanical ventilation immediately.
b) Initiate non-invasive positive pressure ventilation (BiPAP).
c) Increase FiO2 via non-rebreather mask to achieve SpO2 >94%.
d) Administer IV corticosteroids and continue current O2.
Correct Answer: b) Initiate non-invasive positive pressure ventilation (BiPAP).
This patient has acute respiratory acidosis (low pH, high pCO2) and is a clear candidate for BiPAP
to improve ventilation, avoid intubation, and manage hypercapnia. Increasing oxygen further
can suppress respiratory drive.
, 3. Community-Acquired Pneumonia (CAP)
Q: A previously healthy 45-year-old is admitted with CAP (CURB-65 score 1). They have a
penicillin allergy (hives). Chest X-ray shows a right lower lobe consolidation. What is the most
appropriate initial IV antibiotic regimen?
A: a) Ceftriaxone + Azithromycin
b) Levofloxacin monotherapy
c) Vancomycin + Piperacillin-Tazobactam
d) Azithromycin monotherapy
Correct Answer: b) Levofloxacin monotherapy.
For inpatient CAP, a respiratory fluoroquinolone (levofloxacin or moxifloxacin) is recommended
monotherapy, especially with a penicillin allergy. Combination therapy with a beta-lactam
(ceftriaxone) is standard but contraindicated here.
4. Hypertensive Urgency/Emergency
Q: A patient presents to the ED with a blood pressure of 220/120 mmHg and a complaint of a
severe, new-onset occipital headache. Fundoscopic exam reveals papilledema. What is the most
appropriate initial management?
A: a) Administer oral labetalol and observe for 1 hour.
b) Start a continuous IV infusion of nicardipine with goal of lowering MAP by 10-15% in the first
hour.
c) Give 40 mg IV furosemide for presumed volume overload.
d) Prescribe amlodipine 10 mg PO and arrange PCP follow-up in 1 week.
Correct Answer: b) Start a continuous IV infusion of nicardipine...
The presence of papilledema defines hypertensive emergency (end-organ damage). This requires
controlled reduction of BP using a titratable IV agent in an ICU/stepdown setting to avoid
precipitous drops that can cause ischemia.
5. GI Bleed - Risk Stratification
Q: An 80-year-old on aspirin and clopidogrel for recent stent presents with melena. HR 110, BP
100/60, which improves to 115/70 after 1L NS. Hb on arrival is 9.0 g/dL. What is the most
important predictor of the need for urgent intervention and poor outcome in this patient?
A: a) The use of dual antiplatelet therapy.
b) The presence of tachycardia.
c) A low hemoglobin level on admission.
d) Recurrent hematemesis in the ED.
Correct Answer: b) The presence of tachycardia.
Vital signs (especially persistent tachycardia after initial resuscitation) are key components of
clinical risk scores (e.g., Glasgow-Blatchford). They are more dynamic and immediate indicators
of ongoing significant blood loss than a single hemoglobin value.
STUDY GUIDE 2026 COMPLETE QUESTIONS
WITH CORRECT DETAILED ANSWERS || 100%
GUARANTEED PASS <RECENT VERSION>
Sample Educational Questions: Care of Hospitalized Patients Core Topics
1. Sepsis Management
Q: A 68-year-old patient with diabetes presents with altered mental status, fever (102.5°F), and
hypotension (88/50 mmHg). Suspecting sepsis, you order labs and cultures. According to
Surviving Sepsis Campaign guidelines, what is the single most critical action to initiate within the
FIRST HOUR (Hour-1 bundle)?
A: a) Administer broad-spectrum antibiotics.
b) Obtain a full set of blood cultures.
c) Begin rapid IV fluid resuscitation with 30 mL/kg crystalloid.
d) Start vasopressors to maintain MAP >65 mmHg.
Correct Answer: c) Begin rapid IV fluid resuscitation with 30 mL/kg crystalloid.
*While antibiotics and cultures are crucial and should be obtained promptly, the cornerstone of
the *Hour-1* bundle is the immediate initiation of fluid resuscitation for hypotension or lactate
≥4 mmol/L.*
2. Acute COPD Exacerbation
Q: You are admitting a patient with a severe COPD exacerbation. They are on 4L home O2 and
are now on 6L via nasal cannula to maintain SpO2 90%. Initial ABG on 6L shows pH 7.28, pCO2
65, pO2 62. Which of the following is the most appropriate next step in respiratory
management?
A: a) Intubate for mechanical ventilation immediately.
b) Initiate non-invasive positive pressure ventilation (BiPAP).
c) Increase FiO2 via non-rebreather mask to achieve SpO2 >94%.
d) Administer IV corticosteroids and continue current O2.
Correct Answer: b) Initiate non-invasive positive pressure ventilation (BiPAP).
This patient has acute respiratory acidosis (low pH, high pCO2) and is a clear candidate for BiPAP
to improve ventilation, avoid intubation, and manage hypercapnia. Increasing oxygen further
can suppress respiratory drive.
, 3. Community-Acquired Pneumonia (CAP)
Q: A previously healthy 45-year-old is admitted with CAP (CURB-65 score 1). They have a
penicillin allergy (hives). Chest X-ray shows a right lower lobe consolidation. What is the most
appropriate initial IV antibiotic regimen?
A: a) Ceftriaxone + Azithromycin
b) Levofloxacin monotherapy
c) Vancomycin + Piperacillin-Tazobactam
d) Azithromycin monotherapy
Correct Answer: b) Levofloxacin monotherapy.
For inpatient CAP, a respiratory fluoroquinolone (levofloxacin or moxifloxacin) is recommended
monotherapy, especially with a penicillin allergy. Combination therapy with a beta-lactam
(ceftriaxone) is standard but contraindicated here.
4. Hypertensive Urgency/Emergency
Q: A patient presents to the ED with a blood pressure of 220/120 mmHg and a complaint of a
severe, new-onset occipital headache. Fundoscopic exam reveals papilledema. What is the most
appropriate initial management?
A: a) Administer oral labetalol and observe for 1 hour.
b) Start a continuous IV infusion of nicardipine with goal of lowering MAP by 10-15% in the first
hour.
c) Give 40 mg IV furosemide for presumed volume overload.
d) Prescribe amlodipine 10 mg PO and arrange PCP follow-up in 1 week.
Correct Answer: b) Start a continuous IV infusion of nicardipine...
The presence of papilledema defines hypertensive emergency (end-organ damage). This requires
controlled reduction of BP using a titratable IV agent in an ICU/stepdown setting to avoid
precipitous drops that can cause ischemia.
5. GI Bleed - Risk Stratification
Q: An 80-year-old on aspirin and clopidogrel for recent stent presents with melena. HR 110, BP
100/60, which improves to 115/70 after 1L NS. Hb on arrival is 9.0 g/dL. What is the most
important predictor of the need for urgent intervention and poor outcome in this patient?
A: a) The use of dual antiplatelet therapy.
b) The presence of tachycardia.
c) A low hemoglobin level on admission.
d) Recurrent hematemesis in the ED.
Correct Answer: b) The presence of tachycardia.
Vital signs (especially persistent tachycardia after initial resuscitation) are key components of
clinical risk scores (e.g., Glasgow-Blatchford). They are more dynamic and immediate indicators
of ongoing significant blood loss than a single hemoglobin value.
