ABFM KSA - Care Of Hospitalized Patients Questions And Answers Latest Update (2025)!!

ABFM KSA - Care Of Hospitalized Patients
Questions And Answers Latest Update
(2025)!!


1. CT would usually be indicated as the initial imaging study for which one of the
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following patients?
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An 8-year-old with a 2-day history of nausea, anorexia, and periumbilical pain
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that has migrated to the right lower quadrant with localized tenderness,
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guarding, and leukocytosis with a left shift
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A43-year-oldwitha1-dayhistoryofepigastricpainandnauseawithvomiting, and
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elevated serum lipase
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A 66-year-old with diffuse abdominal pain,leukocytosis,and fever
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A 55-year-oldwithunrelenting severe low back painassociated with right leg pain
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and weakness
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A 68-year-old with crushing, retrosternal chest pain, an EKG showing sinus
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tachycardia withleft bundle branchblock,anda cardiac troponin I level of 14 ng/mL
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(N <0.04)ANS: C
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The use of CT has increased significantly in recent years due to increased avail- ability,
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better resolution, and faster scan times.However, there are rising concerns about
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cumulative radiation exposure and an increasing need to contain costs in medicine.To
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assist clinicians in making wise use of all imaging techniques, the American College of
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Radiology (ACR) has developed appropriateness criteria that recommend modalities
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for various clinical problems.Patients with undifferentiated abdominal pain often
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present a diagnostic challenge because of the wide range of pathology or organ
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involvement that can produce this symptom.Fever associated with abdominal pain
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increases the likelihood of intra-abdominal infection, abscess, orotherconditionsthat
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,mayrequireanurgentdefinitivediagnosisorintervention.In oneretrospectivestudy,CT
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resultschangedtheleadingdiagnosisin51%ofpatients and the decision to admit patients
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presenting to the emergency department with abdominal pain in 25% of patients.In
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contrast, no imaging may be indicated when the diagnosis is straightforward based on
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other clinical indicators.Ultrasonography should be the first imaging study in a pediatric
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patient with a classic history and physical and laboratory findings of appendicitis.
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Similarly, while CT is unlikely to provide useful additional information in a patient with
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unequivocal, uncomplicated acute pancreatitis, ultrasonography is a reasonable first
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imaging study to evaluate for gallstones.Patients with suspected acute coronary
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syndrome should be taken for coronary angiography without delay.A patient with
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severe back pain and leg weakness should be evaluated with MRI.
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2. A 75-year-old male is hospitalized with new-onset atrial fibrillation and a
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rapidventricularrate.HiscurrentmedicalproblemsincludeCOPD,hyperten-
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sion, coronary artery disease, and depression. A metabolic panel including a
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magnesium level is normal on admission.After a diltiazem continuous in-
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,travenous infusion his pulse rate is 85 beats/min and irregular. The following ji ji ji ji ji ji ji ji ji ji ji




morning he converts to normal sinus rhythm.Which one of the following would be
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appropriate at this point?
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Administer a loading dose of warfarin,10 mg orally Start ji ji ji ji ji ji ji ji ji




apixaban (Eliquis), 5 mg twice daily
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Stop the diltiazem infusion and administer metoprolol intravenously
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Stop the diltiazem infusion and administer digoxin,0.25 mg intravenously ANS:B
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Itisgenerallynotrecommendedtogivealoadingdoseofwarfarin,asthebenefitis
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minimal, especially if treating atrial fibrillation.There is no benefit to administering
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digoxinormetoprololintravenouslyoncethepatienthasconvertedtosinusrhythm.
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Apixabanandotherdirectoralanticoagulantsarerecommendedforstrokeprophy- laxis
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and should be initiated as soon as possible.This could have been started at thetimeof
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admissionforthispatientbecausethereisnoreasontowaituntilnormal sinus rhythm is
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achieved.The dosage should be lowered to 2.5 mg twice daily for patients with two of the
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following:age e80, body weight d60 kg (130 lb), or serum creatinine e1.5 mg/dL.
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3. You admit a 74-year-old patient to the hospital with shortness of breath and
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bilateral pleural effusions seen on a chest radiograph.Which one of the
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following is true regarding pleural effusions?
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Noncontrast CT should be performed initially in all patients with pleural effu- ji ji ji ji ji ji ji ji ji ji ji




sions if the cause is unknown
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Ultrasound-guided thoracentesis should be performed on admission in all ji ji ji ji ji ji ji ji




patients with small bilateral pleural effusions
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In patients with heart failure who are treated with diuretics,pleural effusions may
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be misclassified as exudative rather than transudative
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Negativecytologyonanadequatesampleofpleuralfluid( e1 0 mL)effectively rules ji ji ji ji ji ji ji ji ji ji ji ji




out malignancy as the cause of a unilateral pleural effusion
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ANS: C ji




CT can detect effusions not apparent on plain radiographs, distinguish between
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pleural fluid and pleural thickening, and provide clues to the underlying cause.
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, Contrast CT is recommended to provide additional information that can be used in
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making the diagnosis.Thoracentesis should not be performed in patients with
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bilateraleffusionsiftheclinicalfindingsstronglysuggestapleuraltransudate,unless there
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areatypicalfeatures(fever,pleuriticchestpain,orwidelyasymmetriceffusion size) or the
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effusion fails to respond to therapy (SOR C).Thoracentesis should
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be performed with ultrasound guidance, when possible, to improve the likelihood of
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successful aspiration and decrease the risk of organ puncture, especially when
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effusions are small.About 20% of patients with a pleural effusion caused by heart
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