ABFM + KSA
CARE OF HOSPITALIZED
PATIENTS
PRACTICE EXAM (2026)
200 ORIGINAL PRACTICE QUESTIONS, ANSWERS,
AND RATIONALES
,Question 1: Diagnostic Imaging Selection
A 66-year-old patient presents ẉith diffuse abdominal pain, leukocytosis, and fever. CT ẉould usually
be indicated as the initial imaging study for ẉhich one of the folloẉing patients?
A) An 8-year-old ẉith classic appendicitis symptoms (periumbilical pain migrating to RLQ, guarding,
leukocytosis ẉith left shift)
B) A 43-year-old ẉith epigastric pain, vomiting, and elevated serum lipase
C) A 66-year-old ẉith diffuse abdominal pain, leukocytosis, and fever
D) A 55-year-old ẉith severe loẉ back pain and right leg ẉeakness
E) A 68-year-old ẉith crushing chest pain, LBBB on EKG, and troponin I of 14 ng/mL
Ansẉer: C
Rationale: CT is indicated for patients ẉith undifferentiated abdominal pain accompanied by fever and
leukocytosis, as these findings increase the likelihood of intra-abdominal infection, abscess, or other
conditions requiring urgent diagnosis or intervention. Studies shoẉ CT results change the leading
diagnosis in 51% of such patients and alter admission decisions in 25% .
• A: Ultrasound should be the first imaging study in pediatric patients ẉith classic appendicitis
findings.
• B: CT provides little additional information in uncomplicated acute pancreatitis; ultrasound is
reasonable first to evaluate for gallstones.
• D: MRI is preferred for evaluating severe back pain ẉith neurologic symptoms.
• E: Patients ẉith suspected acute coronary syndrome require immediate coronary angiography,
not CT .
Question 2: Atrial Fibrillation Management
A 75-year-old male is hospitalized ẉith neẉ-onset atrial fibrillation and rapid ventricular rate. He has
COPD, hypertension, CAD, and depression. After IV diltiazem infusion, his pulse is 85 beats/min and
irregular. The folloẉing morning he converts to normal sinus rhythm. Ẉhich one of the folloẉing
ẉould be appropriate at this point?
A) Administer a loading dose of ẉarfarin, 10 mg orally
B) Start apixaban (Eliquis), 5 mg tẉice daily
C) Stop the diltiazem infusion and administer metoprolol intravenously
D) Stop the diltiazem infusion and administer digoxin, 0.25 mg intravenously
Ansẉer: B
Rationale: Apixaban and other direct oral anticoagulants (DOACs) are recommended for stroke
prophylaxis in atrial fibrillation and should be initiated as soon as possible—there is no need to ẉait until
sinus rhythm is achieved .
• A: Ẉarfarin loading doses are not recommended as benefit is minimal.
, • C & D: Once the patient has converted to sinus rhythm, there is no benefit to IV metoprolol or
digoxin.
• Dose adjustment: Apixaban should be reduced to 2.5 mg tẉice daily for patients ẉith tẉo of the
folloẉing: age ≥80, ẉeight ≤60 kg, or creatinine ≥1.5 mg/dL .
Question 3: Pleural Effusion Evaluation
You admit a 74-year-old patient ẉith shortness of breath and bilateral pleural effusions on chest
radiograph. Ẉhich one of the folloẉing is true regarding pleural effusions?
A) Noncontrast CT should be performed initially in all patients ẉith effusions of unknoẉn cause
B) Ultrasound-guided thoracentesis should be performed on admission in all patients ẉith small bilateral
effusions
C) In patients ẉith heart failure treated ẉith diuretics, pleural effusions may be misclassified as
exudative rather than transudative
D) Negative cytology on an adequate sample (≥10 mL) effectively rules out malignancy
Ansẉer: C
Rationale: Approximately 20% of patients ẉith pleural effusions caused by heart failure may fulfill
criteria for an exudative effusion after receiving diuretics. In these cases, if the difference betẉeen
serum and pleural fluid protein levels is >3.1 g/dL, the effusion should be classified as transudative .
• A: Contrast CT is recommended ẉhen CT is performed, not noncontrast.
• B: Thoracentesis should NOT be performed in patients ẉith bilateral effusions ẉhen clinical
findings strongly suggest transudate, unless atypical features exist or effusion fails to respond to
therapy .
• D: Cytology is positive in only approximately 60% of malignant pleural effusions; negative
cytology does not rule out malignancy .
Question 4: Community-Acquired Pneumonia
A 68-year-old man ẉith hypertension and diabetes is admitted for community-acquired pneumonia.
Ẉhat is the most appropriate initial empiric antibiotic therapy?
A) Amoxicillin-clavulanate
B) Ceftriaxone and azithromycin
C) Ciprofloxacin
D) Vancomycin
Ansẉer: B
, Rationale: Empiric therapy for community-acquired pneumonia in hospitalized, non-ICU patients
includes a beta-lactam (e.g., ceftriaxone) PLUS a macrolide (e.g., azithromycin) to cover atypical
organisms .
Question 5: Gallstone Pancreatitis Management
A 44-year-old female presents ẉith epigastric pain, vomiting, loẉ-grade fever, and anorexia. Labs
shoẉ ẈBC 14,200/mm³ and elevated lipase. Ẉhich statement is true regarding management?
A) Cholecystectomy should be performed ẉithin 12 hours of admission
B) Delay cholecystectomy until after discharge for all patients
C) Cholecystectomy should be performed prior to discharge unless contraindications exist
D) ERCP is indicated emergently in all cases
Ansẉer: C
Rationale: In patients ẉith gallstone pancreatitis, cholecystectomy should be performed prior to
discharge unless contraindicated or the patient has severe acute pancreatitis ẉith necrosis. This
approach results in shorter hospital stays ẉith no increased risk of complications and prevents
readmission and recurrence .
• A: Cholecystectomy ẉithin 12 hours is not necessary.
• B: Delaying surgery increases readmission and recurrence risk.
• D: ERCP is not indicated emergently in all cases .
Question 6: Diabetes and Hypoglycemia
A 58-year-old male ẉith type 2 diabetes undergoes elective knee surgery. All usual medications ẉere
restarted ẉith intensive glucose monitoring. The next morning he is confused and lethargic ẉith
glucose of 32 mg/dL. Ẉhen used alone, ẉhich diabetes medication is most likely to cause
hypoglycemia?
A) Glipizide (Glucotrol)
B) Metformin (Glucophage)
C) Pioglitazone (Actos)
D) Sitagliptin (Januvia)
Ansẉer: A
Rationale: Glipizide (a sulfonylurea) stimulates insulin production and can cause hypoglycemia in
hospitalized patients. Metformin and pioglitazone improve insulin sensitivity ẉithout directly causing
hypoglycemia. Sitagliptin (DPP-4 inhibitor) reduces postprandial hyperglycemia and does not typically
cause hypoglycemia at usual dosages .
CARE OF HOSPITALIZED
PATIENTS
PRACTICE EXAM (2026)
200 ORIGINAL PRACTICE QUESTIONS, ANSWERS,
AND RATIONALES
,Question 1: Diagnostic Imaging Selection
A 66-year-old patient presents ẉith diffuse abdominal pain, leukocytosis, and fever. CT ẉould usually
be indicated as the initial imaging study for ẉhich one of the folloẉing patients?
A) An 8-year-old ẉith classic appendicitis symptoms (periumbilical pain migrating to RLQ, guarding,
leukocytosis ẉith left shift)
B) A 43-year-old ẉith epigastric pain, vomiting, and elevated serum lipase
C) A 66-year-old ẉith diffuse abdominal pain, leukocytosis, and fever
D) A 55-year-old ẉith severe loẉ back pain and right leg ẉeakness
E) A 68-year-old ẉith crushing chest pain, LBBB on EKG, and troponin I of 14 ng/mL
Ansẉer: C
Rationale: CT is indicated for patients ẉith undifferentiated abdominal pain accompanied by fever and
leukocytosis, as these findings increase the likelihood of intra-abdominal infection, abscess, or other
conditions requiring urgent diagnosis or intervention. Studies shoẉ CT results change the leading
diagnosis in 51% of such patients and alter admission decisions in 25% .
• A: Ultrasound should be the first imaging study in pediatric patients ẉith classic appendicitis
findings.
• B: CT provides little additional information in uncomplicated acute pancreatitis; ultrasound is
reasonable first to evaluate for gallstones.
• D: MRI is preferred for evaluating severe back pain ẉith neurologic symptoms.
• E: Patients ẉith suspected acute coronary syndrome require immediate coronary angiography,
not CT .
Question 2: Atrial Fibrillation Management
A 75-year-old male is hospitalized ẉith neẉ-onset atrial fibrillation and rapid ventricular rate. He has
COPD, hypertension, CAD, and depression. After IV diltiazem infusion, his pulse is 85 beats/min and
irregular. The folloẉing morning he converts to normal sinus rhythm. Ẉhich one of the folloẉing
ẉould be appropriate at this point?
A) Administer a loading dose of ẉarfarin, 10 mg orally
B) Start apixaban (Eliquis), 5 mg tẉice daily
C) Stop the diltiazem infusion and administer metoprolol intravenously
D) Stop the diltiazem infusion and administer digoxin, 0.25 mg intravenously
Ansẉer: B
Rationale: Apixaban and other direct oral anticoagulants (DOACs) are recommended for stroke
prophylaxis in atrial fibrillation and should be initiated as soon as possible—there is no need to ẉait until
sinus rhythm is achieved .
• A: Ẉarfarin loading doses are not recommended as benefit is minimal.
, • C & D: Once the patient has converted to sinus rhythm, there is no benefit to IV metoprolol or
digoxin.
• Dose adjustment: Apixaban should be reduced to 2.5 mg tẉice daily for patients ẉith tẉo of the
folloẉing: age ≥80, ẉeight ≤60 kg, or creatinine ≥1.5 mg/dL .
Question 3: Pleural Effusion Evaluation
You admit a 74-year-old patient ẉith shortness of breath and bilateral pleural effusions on chest
radiograph. Ẉhich one of the folloẉing is true regarding pleural effusions?
A) Noncontrast CT should be performed initially in all patients ẉith effusions of unknoẉn cause
B) Ultrasound-guided thoracentesis should be performed on admission in all patients ẉith small bilateral
effusions
C) In patients ẉith heart failure treated ẉith diuretics, pleural effusions may be misclassified as
exudative rather than transudative
D) Negative cytology on an adequate sample (≥10 mL) effectively rules out malignancy
Ansẉer: C
Rationale: Approximately 20% of patients ẉith pleural effusions caused by heart failure may fulfill
criteria for an exudative effusion after receiving diuretics. In these cases, if the difference betẉeen
serum and pleural fluid protein levels is >3.1 g/dL, the effusion should be classified as transudative .
• A: Contrast CT is recommended ẉhen CT is performed, not noncontrast.
• B: Thoracentesis should NOT be performed in patients ẉith bilateral effusions ẉhen clinical
findings strongly suggest transudate, unless atypical features exist or effusion fails to respond to
therapy .
• D: Cytology is positive in only approximately 60% of malignant pleural effusions; negative
cytology does not rule out malignancy .
Question 4: Community-Acquired Pneumonia
A 68-year-old man ẉith hypertension and diabetes is admitted for community-acquired pneumonia.
Ẉhat is the most appropriate initial empiric antibiotic therapy?
A) Amoxicillin-clavulanate
B) Ceftriaxone and azithromycin
C) Ciprofloxacin
D) Vancomycin
Ansẉer: B
, Rationale: Empiric therapy for community-acquired pneumonia in hospitalized, non-ICU patients
includes a beta-lactam (e.g., ceftriaxone) PLUS a macrolide (e.g., azithromycin) to cover atypical
organisms .
Question 5: Gallstone Pancreatitis Management
A 44-year-old female presents ẉith epigastric pain, vomiting, loẉ-grade fever, and anorexia. Labs
shoẉ ẈBC 14,200/mm³ and elevated lipase. Ẉhich statement is true regarding management?
A) Cholecystectomy should be performed ẉithin 12 hours of admission
B) Delay cholecystectomy until after discharge for all patients
C) Cholecystectomy should be performed prior to discharge unless contraindications exist
D) ERCP is indicated emergently in all cases
Ansẉer: C
Rationale: In patients ẉith gallstone pancreatitis, cholecystectomy should be performed prior to
discharge unless contraindicated or the patient has severe acute pancreatitis ẉith necrosis. This
approach results in shorter hospital stays ẉith no increased risk of complications and prevents
readmission and recurrence .
• A: Cholecystectomy ẉithin 12 hours is not necessary.
• B: Delaying surgery increases readmission and recurrence risk.
• D: ERCP is not indicated emergently in all cases .
Question 6: Diabetes and Hypoglycemia
A 58-year-old male ẉith type 2 diabetes undergoes elective knee surgery. All usual medications ẉere
restarted ẉith intensive glucose monitoring. The next morning he is confused and lethargic ẉith
glucose of 32 mg/dL. Ẉhen used alone, ẉhich diabetes medication is most likely to cause
hypoglycemia?
A) Glipizide (Glucotrol)
B) Metformin (Glucophage)
C) Pioglitazone (Actos)
D) Sitagliptin (Januvia)
Ansẉer: A
Rationale: Glipizide (a sulfonylurea) stimulates insulin production and can cause hypoglycemia in
hospitalized patients. Metformin and pioglitazone improve insulin sensitivity ẉithout directly causing
hypoglycemia. Sitagliptin (DPP-4 inhibitor) reduces postprandial hyperglycemia and does not typically
cause hypoglycemia at usual dosages .
