ABFM + KSA
Care of Hospitalized Patients
Certification Exam
Actual Questions and Answers
100% Guarantee Pass.
This Exam contains:
100% Guarantee Pass.
Actual Questions and Answers
Multiple choice (single best answer)
Case Studies/Scenario-Based Questions
Verified Rationales
,CT would usually be indicated as the initial imaging study for which
one of the following patients?
A. An 8-year-old with a 2-day history of nausea, anorexia, and periumbilical
pain that has migrated to the right lower quadrant with localized
tenderness, guarding, and leukocytosis with a left shift
B. A 43-year-old with a 1-day history of epigastric pain and nausea with
vomiting, and elevated serum lipase
C. A 66-year-old with diffuse abdominal pain, leukocytosis, and fever
D. A 55-year-old with unrelenting severe low back pain associated with right
leg pain and weakness
E. A 68-year-old with crushing, retrosternal chest pain, an EKG showing
sinus tachycardia with left bundle branch block, and a cardiac troponin I
level of 14 ng/mL (N <0.04)
Answer: C
Rationale:
The use of CT has increased significantly in recent years due to increased
availability, better resolution, and faster scan times. However, there are
rising concerns about cumulative radiation exposure and an increasing
need to contain costs in medicine. To assist clinicians in making wise use of
all imaging techniques, the American College of Radiology (ACR) has
developed appropriateness criteria that recommend modalities for various
clinical problems. Patients with undifferentiated abdominal pain often
present a diagnostic challenge because of the wide range of pathology or
organ involvement that can produce this symptom. Fever associated with
abdominal pain increases the likelihood of intra-abdominal infection,
abscess, or other conditions that may require an urgent definitive diagnosis
or intervention. In one retrospective study, CT results changed the leading
,diagnosis in 51% of patients and the decision to admit patients presenting
to the emergency department with abdominal pain in 25% of patients. In
contrast, no imaging may be indicated when the diagnosis is
straightforward based on other clinical indicators. Ultrasonography should
be the first imaging study in a pediatric patient with a classic history and
physical and laboratory findings of appendicitis. Similarly, while CT is
unlikely to provide useful additional information in a patient with
unequivocal, uncomplicated acute pancreatitis, ultrasonography is a
reasonable first imaging study to evaluate for gallstones. Patients with
suspected acute coronary syndrome should be taken for coronary
angiography without delay. A patient with severe back pain and leg
weakness should be evaluated with MRI.
---
A 75-year-old male is hospitalized with new-onset atrial fibrillation and a
rapid ventricular rate. His current medical problems include COPD,
hypertension, coronary artery disease, and depression. A metabolic panel
including a magnesium level is normal on admission. After a diltiazem
continuous intravenous infusion his pulse rate is 85 beats/min and irregular.
The following morning he converts to normal sinus rhythm.
Which one of the following would be appropriate at this point?
A. Administer a loading dose of warfarin, 10 mg orally
B. Start apixaban (Eliquis), 5 mg twice daily
C. Stop the diltiazem infusion and administer metoprolol intravenously
D. Stop the diltiazem infusion and administer digoxin, 0.25 mg
intravenously
, Answer: B
Rationale:
It is generally not recommended to give a loading dose of warfarin, as the
benefit is minimal, especially if treating atrial fibrillation. There is no benefit
to administering digoxin or metoprolol intravenously once the patient has
converted to sinus rhythm. Apixaban and other direct oral anticoagulants
are recommended for stroke prophylaxis and should be initiated as soon as
possible. This could have been started at the time of admission for this
patient because there is no reason to wait until normal sinus rhythm is
achieved. The dosage should be lowered to 2.5 mg twice daily for patients
with two of the following: age ≥80, body weight ≤60 kg (130 lb), or serum
creatinine ≥1.5 mg/dL.
---
You admit a 74-year-old patient to the hospital with shortness of
breath and bilateral pleural effusions seen on a chest radiograph.
Which one of the following is true regarding pleural effusions?
A. Noncontrast CT should be performed initially in all patients with pleural
effusions if the cause is unknown
B. Ultrasound-guided thoracentesis should be performed on admission in
all patients with small bilateral pleural effusions
C. In patients with heart failure who are treated with diuretics, pleural
effusions may be misclassified as exudative rather than transudative
D. Negative cytology on an adequate sample of pleural fluid (≥10 mL)
effectively rules out malignancy as the cause of a unilateral pleural effusion
Care of Hospitalized Patients
Certification Exam
Actual Questions and Answers
100% Guarantee Pass.
This Exam contains:
100% Guarantee Pass.
Actual Questions and Answers
Multiple choice (single best answer)
Case Studies/Scenario-Based Questions
Verified Rationales
,CT would usually be indicated as the initial imaging study for which
one of the following patients?
A. An 8-year-old with a 2-day history of nausea, anorexia, and periumbilical
pain that has migrated to the right lower quadrant with localized
tenderness, guarding, and leukocytosis with a left shift
B. A 43-year-old with a 1-day history of epigastric pain and nausea with
vomiting, and elevated serum lipase
C. A 66-year-old with diffuse abdominal pain, leukocytosis, and fever
D. A 55-year-old with unrelenting severe low back pain associated with right
leg pain and weakness
E. A 68-year-old with crushing, retrosternal chest pain, an EKG showing
sinus tachycardia with left bundle branch block, and a cardiac troponin I
level of 14 ng/mL (N <0.04)
Answer: C
Rationale:
The use of CT has increased significantly in recent years due to increased
availability, better resolution, and faster scan times. However, there are
rising concerns about cumulative radiation exposure and an increasing
need to contain costs in medicine. To assist clinicians in making wise use of
all imaging techniques, the American College of Radiology (ACR) has
developed appropriateness criteria that recommend modalities for various
clinical problems. Patients with undifferentiated abdominal pain often
present a diagnostic challenge because of the wide range of pathology or
organ involvement that can produce this symptom. Fever associated with
abdominal pain increases the likelihood of intra-abdominal infection,
abscess, or other conditions that may require an urgent definitive diagnosis
or intervention. In one retrospective study, CT results changed the leading
,diagnosis in 51% of patients and the decision to admit patients presenting
to the emergency department with abdominal pain in 25% of patients. In
contrast, no imaging may be indicated when the diagnosis is
straightforward based on other clinical indicators. Ultrasonography should
be the first imaging study in a pediatric patient with a classic history and
physical and laboratory findings of appendicitis. Similarly, while CT is
unlikely to provide useful additional information in a patient with
unequivocal, uncomplicated acute pancreatitis, ultrasonography is a
reasonable first imaging study to evaluate for gallstones. Patients with
suspected acute coronary syndrome should be taken for coronary
angiography without delay. A patient with severe back pain and leg
weakness should be evaluated with MRI.
---
A 75-year-old male is hospitalized with new-onset atrial fibrillation and a
rapid ventricular rate. His current medical problems include COPD,
hypertension, coronary artery disease, and depression. A metabolic panel
including a magnesium level is normal on admission. After a diltiazem
continuous intravenous infusion his pulse rate is 85 beats/min and irregular.
The following morning he converts to normal sinus rhythm.
Which one of the following would be appropriate at this point?
A. Administer a loading dose of warfarin, 10 mg orally
B. Start apixaban (Eliquis), 5 mg twice daily
C. Stop the diltiazem infusion and administer metoprolol intravenously
D. Stop the diltiazem infusion and administer digoxin, 0.25 mg
intravenously
, Answer: B
Rationale:
It is generally not recommended to give a loading dose of warfarin, as the
benefit is minimal, especially if treating atrial fibrillation. There is no benefit
to administering digoxin or metoprolol intravenously once the patient has
converted to sinus rhythm. Apixaban and other direct oral anticoagulants
are recommended for stroke prophylaxis and should be initiated as soon as
possible. This could have been started at the time of admission for this
patient because there is no reason to wait until normal sinus rhythm is
achieved. The dosage should be lowered to 2.5 mg twice daily for patients
with two of the following: age ≥80, body weight ≤60 kg (130 lb), or serum
creatinine ≥1.5 mg/dL.
---
You admit a 74-year-old patient to the hospital with shortness of
breath and bilateral pleural effusions seen on a chest radiograph.
Which one of the following is true regarding pleural effusions?
A. Noncontrast CT should be performed initially in all patients with pleural
effusions if the cause is unknown
B. Ultrasound-guided thoracentesis should be performed on admission in
all patients with small bilateral pleural effusions
C. In patients with heart failure who are treated with diuretics, pleural
effusions may be misclassified as exudative rather than transudative
D. Negative cytology on an adequate sample of pleural fluid (≥10 mL)
effectively rules out malignancy as the cause of a unilateral pleural effusion
