Page 1 of 423
American Board of Family Medicine (ABFM)Hospital
Medicine Exam WITH 600 QUESTIONS AND CORRECT
DETAILED RATIONALISED SOLUTIONS LATEST UPDATED
VERSION JUST RELEASED NEWEST!!
Question: An 82-year-old female is hospitalized with acute pancreatitis and intestinal ileus, and
you determine that she will require total parenteral nutrition through a central venous catheter.
Which of the following will decrease the likelihood of catheter-related complications in this
patient? (Mark all that are true.)
Placement of the catheter in the femoral vein
Ultrasound-guided placement of the catheter into the internal jugular vein
Routinely changing the catheter over a wire every 3-5 days
Routinely moving the catheter to a different insertion site every 3-5 days
Using chlorhexidine gluconate-impregnated sponges in the catheter dressings - ANSWER✔✔B, E
Studies show that ultrasound-guided placement of the catheter into the internal jugular vein is
associated with a higher success rate and a lower complication rate during insertion, even
among physicians highly experienced in the procedure (SOR A). Placement of the catheter in the
femoral vein is associated with a higher rate of post-insertion complications (SOR A). Routinely
changing the catheter over a wire every 3-5 days has been shown to increase the rate of
catheter-associated infections (SOR A). Evidence has shown no benefit from moving the
catheter in terms of reducing infections, and making multiple insertions has been shown to lead
to an increase in infections (SOR A). Evidence from a large, well-done, randomized, controlled
, Page 2 of 423
trial shows a significant decrease in major catheter-related infections when chlorhexidine
gluconate-impregnated sponges are used in the catheter dressing (hazard ratio 0.39) (SOR A). In
this study, a major infection was avoided for every 117 catheters treated.
Question: A 68-year-old female is admitted to the hospital with pneumonia. She is penicillin-
allergic and receives a dose of ampicillin/sulbactam (Unasyn). She has an anaphylactic reaction
and is transferred to the intensive-care unit, where her condition stabilizes with mechanical
ventilation, pressor agents, and corticosteroids.True statements regarding disclosure of the
unanticipated outcome to the patient and her family include which of the following? (Mark all
that are true.)
Federal law requires disclosure of all medical errors or unanticipated outcomes regardless of
harm
Disclosure of unanticipated outcomes or medical errors is a standard of the Joint Commission
The majority of states have laws that legally protect apologies for medical errors from being
used as evidence of liability
Most physicians believe that disclosure of serious errors reduces the risk of a lawsuit
Disclosure of unanticipated outcomes and medical e - ANSWER✔✔B,C,D
In 2005, the National Medical Errors Disclosure and Compensation (MEDiC) Act of 2005 was
introduced in the U.S. Senate. The bill emphasized open disclosure of medical errors to patients,
apology and early compensation, and a comprehensive analysis of the events. Congress did not
pass the legislation, but in the meantime at least 34 states have passed laws requiring disclosure
of medical errors, generally with limited protections regarding the use of apologies or
expressions of regret as evidence of liability. Since 2001, disclosure to patients and their families
, Page 3 of 423
of the outcomes of treatment, including unanticipated outcomes, has been a standard of the
Joint Commission.Some studies suggest that disclosure results in fewer lawsuits or lower total
payouts, but others show the opposite. It is not yet known what the net effect will ultimately be
on lawsuits related to disclosure of medical errors as such disclosure becomes the norm, but
one study found that two-thirds of American and Canadian physicians believe that disclosure
reduces the risk of a lawsuit. That same study, however, found that 98% of those physicians
believed that disclosure of serious errors was the right thing to do, whether or not they believed
it lowered the risk of litigation. In a study regarding physicians' attitudes toward disclosing
errors to patients, there were several factors associated with an increased willingness to tell
patients about medical errors. These factors include the belief that doing so made patients less
likely to sue, not being in private practice, being Canadian rather than a U.S. citizen, and being a
surgeon.
Question: An 82-year-old male is admitted to the intensive-care unit with a 3-day history of
abdominal pain, nausea, vomiting, and bloody diarrhea. He has a fever and meets clinical
criteria for sepsis. His chronic medical problems include hypertension, hyperlipidemia, coronary
artery disease, heart failure, type 2 diabetes mellitus, and osteoarthritis. His daily medications
include lisinopril (Prinivil, Zestril), furosemide (Lasix), metformin (Glucophage), simvastatin
(Zocor), and ibuprofen. He has not been eating or drinking much in the past several days, but his
wife has made sure that he has taken his medications as prescribed.His initial laboratory results
include a BUN of 72 mg/dL (N 8-25) and a serum creatinine level of 3.2 mg/dL (baseline 1.3; N
0.6-1.5). Despite aggressive fluid resuscitation, his urine output is only 100 mL in the first 8
hours. A general surgeon is consulted and orders abdominal CT with contrast.Whi -
ANSWER✔✔A
Most cases of acute kidney injury (AKI, formerly called acute renal failure) occur as a result of
decreased renal perfusion or decreased glomerular filtration. Common etiologies include
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dehydration from gastrointestinal fluid loss, overaggressive diuresis, and conditions that reduce
effective arterial volume, such as heart failure, liver failure, and nephrotic syndrome (SOR C).
Restoration of renal perfusion and glomerular filtration are the cornerstones of treatment for
acute prerenal renal failure. Expansion of the circulating intravascular volume with intravenous
fluids and withholding medications known to affect glomerular function are important first
steps in this patient's treatment.Both NSAIDs and ACE inhibitors reduce glomerular filtration
and can precipitate AKI, especially in patients with other contributing factors, such as
dehydration. NSAIDs reduce glomerular filtration by inducing vasoconstriction of the afferent
arterioles through inhibition of cyclooxygenase, which leads to increased levels of thromboxane
A2, a potent vasoconstrictor. ACE inhibitors reduce glomerular filtration by reducing levels of
angiotensin II, which allows vasodilation of efferent arterioles and reduces glomerular
hydrostatic pressure.Radiocontrast media are known to be potentially nephrotoxic and are best
avoided in patients with, or at risk for, AKI. Administering sodium bicarbonate is no longer
recommended.Although patients with nonoliguric renal failure fare better than patients
presenting with oliguria, the use of diuretics to stimulate urine output actually increases
mortality and does not promote recovery of renal function (SOR B). A placebo-controlled
randomized trial of low-dose dopamine in critically ill ICU patients who met criteria for sepsis
with early renal dysfunction showed no benefit with regard to preventing AK
Question: CT is usually indicated for which of the following? (Mark all that are true.)
Suspected aortic dissection
Head trauma from a fall in a 67-year-old patient
Chronic neck pain
Persistent, recurrent, or chronic sinusitis in children
American Board of Family Medicine (ABFM)Hospital
Medicine Exam WITH 600 QUESTIONS AND CORRECT
DETAILED RATIONALISED SOLUTIONS LATEST UPDATED
VERSION JUST RELEASED NEWEST!!
Question: An 82-year-old female is hospitalized with acute pancreatitis and intestinal ileus, and
you determine that she will require total parenteral nutrition through a central venous catheter.
Which of the following will decrease the likelihood of catheter-related complications in this
patient? (Mark all that are true.)
Placement of the catheter in the femoral vein
Ultrasound-guided placement of the catheter into the internal jugular vein
Routinely changing the catheter over a wire every 3-5 days
Routinely moving the catheter to a different insertion site every 3-5 days
Using chlorhexidine gluconate-impregnated sponges in the catheter dressings - ANSWER✔✔B, E
Studies show that ultrasound-guided placement of the catheter into the internal jugular vein is
associated with a higher success rate and a lower complication rate during insertion, even
among physicians highly experienced in the procedure (SOR A). Placement of the catheter in the
femoral vein is associated with a higher rate of post-insertion complications (SOR A). Routinely
changing the catheter over a wire every 3-5 days has been shown to increase the rate of
catheter-associated infections (SOR A). Evidence has shown no benefit from moving the
catheter in terms of reducing infections, and making multiple insertions has been shown to lead
to an increase in infections (SOR A). Evidence from a large, well-done, randomized, controlled
, Page 2 of 423
trial shows a significant decrease in major catheter-related infections when chlorhexidine
gluconate-impregnated sponges are used in the catheter dressing (hazard ratio 0.39) (SOR A). In
this study, a major infection was avoided for every 117 catheters treated.
Question: A 68-year-old female is admitted to the hospital with pneumonia. She is penicillin-
allergic and receives a dose of ampicillin/sulbactam (Unasyn). She has an anaphylactic reaction
and is transferred to the intensive-care unit, where her condition stabilizes with mechanical
ventilation, pressor agents, and corticosteroids.True statements regarding disclosure of the
unanticipated outcome to the patient and her family include which of the following? (Mark all
that are true.)
Federal law requires disclosure of all medical errors or unanticipated outcomes regardless of
harm
Disclosure of unanticipated outcomes or medical errors is a standard of the Joint Commission
The majority of states have laws that legally protect apologies for medical errors from being
used as evidence of liability
Most physicians believe that disclosure of serious errors reduces the risk of a lawsuit
Disclosure of unanticipated outcomes and medical e - ANSWER✔✔B,C,D
In 2005, the National Medical Errors Disclosure and Compensation (MEDiC) Act of 2005 was
introduced in the U.S. Senate. The bill emphasized open disclosure of medical errors to patients,
apology and early compensation, and a comprehensive analysis of the events. Congress did not
pass the legislation, but in the meantime at least 34 states have passed laws requiring disclosure
of medical errors, generally with limited protections regarding the use of apologies or
expressions of regret as evidence of liability. Since 2001, disclosure to patients and their families
, Page 3 of 423
of the outcomes of treatment, including unanticipated outcomes, has been a standard of the
Joint Commission.Some studies suggest that disclosure results in fewer lawsuits or lower total
payouts, but others show the opposite. It is not yet known what the net effect will ultimately be
on lawsuits related to disclosure of medical errors as such disclosure becomes the norm, but
one study found that two-thirds of American and Canadian physicians believe that disclosure
reduces the risk of a lawsuit. That same study, however, found that 98% of those physicians
believed that disclosure of serious errors was the right thing to do, whether or not they believed
it lowered the risk of litigation. In a study regarding physicians' attitudes toward disclosing
errors to patients, there were several factors associated with an increased willingness to tell
patients about medical errors. These factors include the belief that doing so made patients less
likely to sue, not being in private practice, being Canadian rather than a U.S. citizen, and being a
surgeon.
Question: An 82-year-old male is admitted to the intensive-care unit with a 3-day history of
abdominal pain, nausea, vomiting, and bloody diarrhea. He has a fever and meets clinical
criteria for sepsis. His chronic medical problems include hypertension, hyperlipidemia, coronary
artery disease, heart failure, type 2 diabetes mellitus, and osteoarthritis. His daily medications
include lisinopril (Prinivil, Zestril), furosemide (Lasix), metformin (Glucophage), simvastatin
(Zocor), and ibuprofen. He has not been eating or drinking much in the past several days, but his
wife has made sure that he has taken his medications as prescribed.His initial laboratory results
include a BUN of 72 mg/dL (N 8-25) and a serum creatinine level of 3.2 mg/dL (baseline 1.3; N
0.6-1.5). Despite aggressive fluid resuscitation, his urine output is only 100 mL in the first 8
hours. A general surgeon is consulted and orders abdominal CT with contrast.Whi -
ANSWER✔✔A
Most cases of acute kidney injury (AKI, formerly called acute renal failure) occur as a result of
decreased renal perfusion or decreased glomerular filtration. Common etiologies include
, Page 4 of 423
dehydration from gastrointestinal fluid loss, overaggressive diuresis, and conditions that reduce
effective arterial volume, such as heart failure, liver failure, and nephrotic syndrome (SOR C).
Restoration of renal perfusion and glomerular filtration are the cornerstones of treatment for
acute prerenal renal failure. Expansion of the circulating intravascular volume with intravenous
fluids and withholding medications known to affect glomerular function are important first
steps in this patient's treatment.Both NSAIDs and ACE inhibitors reduce glomerular filtration
and can precipitate AKI, especially in patients with other contributing factors, such as
dehydration. NSAIDs reduce glomerular filtration by inducing vasoconstriction of the afferent
arterioles through inhibition of cyclooxygenase, which leads to increased levels of thromboxane
A2, a potent vasoconstrictor. ACE inhibitors reduce glomerular filtration by reducing levels of
angiotensin II, which allows vasodilation of efferent arterioles and reduces glomerular
hydrostatic pressure.Radiocontrast media are known to be potentially nephrotoxic and are best
avoided in patients with, or at risk for, AKI. Administering sodium bicarbonate is no longer
recommended.Although patients with nonoliguric renal failure fare better than patients
presenting with oliguria, the use of diuretics to stimulate urine output actually increases
mortality and does not promote recovery of renal function (SOR B). A placebo-controlled
randomized trial of low-dose dopamine in critically ill ICU patients who met criteria for sepsis
with early renal dysfunction showed no benefit with regard to preventing AK
Question: CT is usually indicated for which of the following? (Mark all that are true.)
Suspected aortic dissection
Head trauma from a fall in a 67-year-old patient
Chronic neck pain
Persistent, recurrent, or chronic sinusitis in children
