ABFM\ American Board of Family Medicine KSA
Care of Hospitalized Patients | Correct Questions
and Answers Rated A+ | 2026\2027 Latest Guide
A 72-year-old male is admitted to the hospital with abdominal pain. His
chronic medical problems include hypertension and hyperlipidemia. On
examination his lungs are clear and no cardiac murmurs are noted but an
S4 gallop is present. An EKG and a basic metabolic panel are both normal.
Further workup indicates that he has acute cholecystitis. While he is on a
cardiac monitor, multifocal PVCs are noted.Which one of the following
would be appropriate for evaluation of the cardiac arrhythmia?
Electrophysiologic testing
CT angiography
Echocardiography
Dobutamine stress echocardiography
Cardiac catheterization
-Correct Answer-C
Echocardiography is indicated in patients with ventricular arrhythmias and
suspected structural heart disease (SOR B). Electrophysiologic testing is
recommended for evaluation of patients with a history of a remote
myocardial infarction and symptoms that suggest malignant ventricular
tachyarrhythmias (SOR B). In addition, a magnesium level should be
ordered in addition to a standard electrolyte panel, which should have been
obtained routinely. An S4 is the sound of active ventricular filling in late
ventricular diastole produced by forceful atrial contraction in patients with
decreased ventricular compliance. Although it may be physiologic in elderly
patients, an S4 is usually a marker of pathologic diastolic dysfunction.
Cardiac catheterization would not be indicated with a normal EKG. This
patient does not have symptoms of current ischemia and his EKG is
normal, so CT angiography or stress echocardiography would not be
indicated before proceeding with surgery.
,A 58-year-old male presents to the emergency department with alcohol
withdrawal symptoms. He has a score of 10 on the Clinical Institute
Withdrawal Assessment Scale for Alcohol, Revised (CIWA-Ar). He has
been hospitalized multiple times for alcohol withdrawal and 5 years ago
developed delirium tremens.Which one of the following is true regarding the
management of alcohol withdrawal and dependence in this patient?
A past history of delirium tremens places the patient at a high risk for
severe alcohol withdrawal
Outpatient detoxification and management of alcohol withdrawal syndrome
is preferred over inpatient treatment for this patient
Acamprosate should not be used in patients with a history of liver
dysfunction
Symptom-triggered administration is not as effective as a fixed-dose
schedule for withdrawal
Lorazepam (Ativan) would be a good choice for long-term anxiolytic
therapy, and would reduce his risk for relapse a
-Correct Answer-A
Management of alcohol abuse and dependence is a complex and
challenging task for physicians. Use of a standardized assessment tool,
such as the Clinical Institute Withdrawal Assessment Scale for Alcohol,
Revised (CIWA-Ar) provides an objective means of evaluating a patient for
withdrawal symptoms and guiding treatment decisions. Patients with
minimal symptoms (CIWA-Ar score <8) may not require any medication.
Patients with moderate symptoms (CIWA-Ar score 8-15) will require
medication but could potentially be treated on an outpatient basis. Those
with severe symptoms (CIWA-Ar score >15), a history of withdrawal
seizures or delirium tremens, or other significant comorbidities are not
eligible for outpatient treatment (SOR C). Of the individual findings that can
be obtained from a clinical evaluation, a history of delirium tremens is the
most significant for identifying a risk for developing severe alcohol
withdrawal (summary likelihood ratio 2.9, 95% confidence interval 1.7-
5.2).Outpatient management of alcohol withdrawal is a safe, effective, and
cost-effective option for some patients with mild symptoms, no history of
delirium tremens or withdrawal seizures, reliable supervision, and
,transportation to daily outpatient follow-up appointments (SOR C).
Symptom-triggered self-medication is as safe as fixed-schedule medication
in treating outpatients with alcohol dependence and mild to moderate
symptoms of alcohol withdrawal syndrome.In patients with no history of
liver disease, the use of long-acting benzodiazepines is preferred for
management of acute alcohol withdrawal syndrome and is associated with
a lower incidence of delirium and seizures (SOR A). In a Cochrane review
of 24 different trials, acamprosate was associated with a significant (14%)
reduction in return to drinking and an 11% increase in abstinence maint
A previously healthy, active 75-year-old female is admitted to the hospital
after tripping on a rug at home and sustaining a femur fracture requiring
open fixation. She does well on the medical floor postoperatively, but on the
second day after the fracture repair she develops a fever and a productive
cough.Findings on examination include a temperature of 38.3°C (100.9°F),
an oxygen saturation of 90% on room air, a heart rate of 85 beats/min, and
a blood pressure of 121/88 mm Hg. Rhonchi are noted in the right lower
lung field posteriorly. Laboratory testing reveals a WBC count of
17,000/mm3 (N 4300-10,800) with 12% bands. A chest radiograph shows a
right lower lobe infiltrate.Which one of the following is true regarding the
diagnosis and management of this patient?
A broad-spectrum combination intravenous antibiotic that covers anaerobic
species should be initiated due to the patient's increased risk for aspiration
-Correct Answer-E
Patients with hospital-associated pneumonia (HAP), defined as pneumonia
that occurs more than 48 hours after hospital admission, should be treated
with guidance of the local hospital antibiogram or may be treated
empirically with a regimen that covers methicillin-susceptible
Staphylococcus aureus and possibly gram-negative bacilli such as
Pseudomonas aeruginosa if the patient recently received intravenous
antibiotics or is at high risk of death. Piperacillin/tazobactam, cefepime,
levofloxacin, imipenem, or meropenem are all acceptable choices.
Vancomycin or linezolid should be initiated only in those who received
intravenous antibiotics in the last 90 days.Identification of the causative
, organism generally requires a sputum culture, which allows antibiotic
therapy to be tailored to the organism that is isolated (SOR C). PCR testing
has been increasingly employed to diagnose pathogens responsible for
HAP and ventilator-associated pneumonia and to guide antibiotic
stewardship measures. Blood cultures are recommended for all patients
diagnosed with HAP. Blood cultures from this group may demonstrate
pathogens reflective of a secondary, nonpulmonary source of infection.If
patients receive an initially appropriate antibiotic regimen, efforts should be
made to shorten the duration of therapy from the traditional 14-21 days to
periods as short as 7 days, provided that the etiologic pathogen is not P.
aeruginosa or Acinetobacter, and that the patient has a good clinical
response with resolution of the clinical features of infection (SOR B). Chest
radiographs are of limited value for defining clinical improvement in severe
pneumonia, and initial radiographic deterioration is common, especially
among patients who are bacteremic or who are infected with highly virulent
organisms (SOR C). In addition, radiographic improvement o
You are treating an 84-year-old male who was admitted overnight because
of a COPD exacerbation. The patient has a previous history of dementia,
and on morning rounds you note that he is confused and picking at things
in the air. The nurse attempted to give him his morning medications but he
refused to take them. He is alert and responds when asked a question, but
his answers are nonsensical. On examination he is afebrile and his oxygen
saturation is 92% on 2 L/min of oxygen. He also has mild expiratory
wheezes. A basic metabolic panel and procalcitonin levels are normal.If
nonpharmacologic measures for managing his delirium are unsuccessful,
which one of the following would be most appropriate?
Gabapentin (Neurontin), 300 mg
Haloperidol, 0.5 mg
Lorazepam (Ativan), 1 mg
Quetiapine (Seroquel), 25 mg
-Correct Answer-B
The best strategy for managing delirium is to prevent it by using orientation
methods and assuring a consistent wake/sleep cycle. If it develops the
Care of Hospitalized Patients | Correct Questions
and Answers Rated A+ | 2026\2027 Latest Guide
A 72-year-old male is admitted to the hospital with abdominal pain. His
chronic medical problems include hypertension and hyperlipidemia. On
examination his lungs are clear and no cardiac murmurs are noted but an
S4 gallop is present. An EKG and a basic metabolic panel are both normal.
Further workup indicates that he has acute cholecystitis. While he is on a
cardiac monitor, multifocal PVCs are noted.Which one of the following
would be appropriate for evaluation of the cardiac arrhythmia?
Electrophysiologic testing
CT angiography
Echocardiography
Dobutamine stress echocardiography
Cardiac catheterization
-Correct Answer-C
Echocardiography is indicated in patients with ventricular arrhythmias and
suspected structural heart disease (SOR B). Electrophysiologic testing is
recommended for evaluation of patients with a history of a remote
myocardial infarction and symptoms that suggest malignant ventricular
tachyarrhythmias (SOR B). In addition, a magnesium level should be
ordered in addition to a standard electrolyte panel, which should have been
obtained routinely. An S4 is the sound of active ventricular filling in late
ventricular diastole produced by forceful atrial contraction in patients with
decreased ventricular compliance. Although it may be physiologic in elderly
patients, an S4 is usually a marker of pathologic diastolic dysfunction.
Cardiac catheterization would not be indicated with a normal EKG. This
patient does not have symptoms of current ischemia and his EKG is
normal, so CT angiography or stress echocardiography would not be
indicated before proceeding with surgery.
,A 58-year-old male presents to the emergency department with alcohol
withdrawal symptoms. He has a score of 10 on the Clinical Institute
Withdrawal Assessment Scale for Alcohol, Revised (CIWA-Ar). He has
been hospitalized multiple times for alcohol withdrawal and 5 years ago
developed delirium tremens.Which one of the following is true regarding the
management of alcohol withdrawal and dependence in this patient?
A past history of delirium tremens places the patient at a high risk for
severe alcohol withdrawal
Outpatient detoxification and management of alcohol withdrawal syndrome
is preferred over inpatient treatment for this patient
Acamprosate should not be used in patients with a history of liver
dysfunction
Symptom-triggered administration is not as effective as a fixed-dose
schedule for withdrawal
Lorazepam (Ativan) would be a good choice for long-term anxiolytic
therapy, and would reduce his risk for relapse a
-Correct Answer-A
Management of alcohol abuse and dependence is a complex and
challenging task for physicians. Use of a standardized assessment tool,
such as the Clinical Institute Withdrawal Assessment Scale for Alcohol,
Revised (CIWA-Ar) provides an objective means of evaluating a patient for
withdrawal symptoms and guiding treatment decisions. Patients with
minimal symptoms (CIWA-Ar score <8) may not require any medication.
Patients with moderate symptoms (CIWA-Ar score 8-15) will require
medication but could potentially be treated on an outpatient basis. Those
with severe symptoms (CIWA-Ar score >15), a history of withdrawal
seizures or delirium tremens, or other significant comorbidities are not
eligible for outpatient treatment (SOR C). Of the individual findings that can
be obtained from a clinical evaluation, a history of delirium tremens is the
most significant for identifying a risk for developing severe alcohol
withdrawal (summary likelihood ratio 2.9, 95% confidence interval 1.7-
5.2).Outpatient management of alcohol withdrawal is a safe, effective, and
cost-effective option for some patients with mild symptoms, no history of
delirium tremens or withdrawal seizures, reliable supervision, and
,transportation to daily outpatient follow-up appointments (SOR C).
Symptom-triggered self-medication is as safe as fixed-schedule medication
in treating outpatients with alcohol dependence and mild to moderate
symptoms of alcohol withdrawal syndrome.In patients with no history of
liver disease, the use of long-acting benzodiazepines is preferred for
management of acute alcohol withdrawal syndrome and is associated with
a lower incidence of delirium and seizures (SOR A). In a Cochrane review
of 24 different trials, acamprosate was associated with a significant (14%)
reduction in return to drinking and an 11% increase in abstinence maint
A previously healthy, active 75-year-old female is admitted to the hospital
after tripping on a rug at home and sustaining a femur fracture requiring
open fixation. She does well on the medical floor postoperatively, but on the
second day after the fracture repair she develops a fever and a productive
cough.Findings on examination include a temperature of 38.3°C (100.9°F),
an oxygen saturation of 90% on room air, a heart rate of 85 beats/min, and
a blood pressure of 121/88 mm Hg. Rhonchi are noted in the right lower
lung field posteriorly. Laboratory testing reveals a WBC count of
17,000/mm3 (N 4300-10,800) with 12% bands. A chest radiograph shows a
right lower lobe infiltrate.Which one of the following is true regarding the
diagnosis and management of this patient?
A broad-spectrum combination intravenous antibiotic that covers anaerobic
species should be initiated due to the patient's increased risk for aspiration
-Correct Answer-E
Patients with hospital-associated pneumonia (HAP), defined as pneumonia
that occurs more than 48 hours after hospital admission, should be treated
with guidance of the local hospital antibiogram or may be treated
empirically with a regimen that covers methicillin-susceptible
Staphylococcus aureus and possibly gram-negative bacilli such as
Pseudomonas aeruginosa if the patient recently received intravenous
antibiotics or is at high risk of death. Piperacillin/tazobactam, cefepime,
levofloxacin, imipenem, or meropenem are all acceptable choices.
Vancomycin or linezolid should be initiated only in those who received
intravenous antibiotics in the last 90 days.Identification of the causative
, organism generally requires a sputum culture, which allows antibiotic
therapy to be tailored to the organism that is isolated (SOR C). PCR testing
has been increasingly employed to diagnose pathogens responsible for
HAP and ventilator-associated pneumonia and to guide antibiotic
stewardship measures. Blood cultures are recommended for all patients
diagnosed with HAP. Blood cultures from this group may demonstrate
pathogens reflective of a secondary, nonpulmonary source of infection.If
patients receive an initially appropriate antibiotic regimen, efforts should be
made to shorten the duration of therapy from the traditional 14-21 days to
periods as short as 7 days, provided that the etiologic pathogen is not P.
aeruginosa or Acinetobacter, and that the patient has a good clinical
response with resolution of the clinical features of infection (SOR B). Chest
radiographs are of limited value for defining clinical improvement in severe
pneumonia, and initial radiographic deterioration is common, especially
among patients who are bacteremic or who are infected with highly virulent
organisms (SOR C). In addition, radiographic improvement o
You are treating an 84-year-old male who was admitted overnight because
of a COPD exacerbation. The patient has a previous history of dementia,
and on morning rounds you note that he is confused and picking at things
in the air. The nurse attempted to give him his morning medications but he
refused to take them. He is alert and responds when asked a question, but
his answers are nonsensical. On examination he is afebrile and his oxygen
saturation is 92% on 2 L/min of oxygen. He also has mild expiratory
wheezes. A basic metabolic panel and procalcitonin levels are normal.If
nonpharmacologic measures for managing his delirium are unsuccessful,
which one of the following would be most appropriate?
Gabapentin (Neurontin), 300 mg
Haloperidol, 0.5 mg
Lorazepam (Ativan), 1 mg
Quetiapine (Seroquel), 25 mg
-Correct Answer-B
The best strategy for managing delirium is to prevent it by using orientation
methods and assuring a consistent wake/sleep cycle. If it develops the
