Page 1 of 422
ABFM-American Board of Family Medicine -Hospital
Medicine Exam NEWEST VERSION ALL 600 QUESTIONS
AND CORRECT VERIFIED ANSWERS WITH RATIONALES
LATEST UPDATE JUST RELEASED THIS YEAR
Question: A 32-year-old nonpregnant female with a history of poorly controlled type 2
diabetes mellitus is admitted to the hospital for abdominal wall cellulitis. On hospital day 2 she
develops mild shortness of breath. Her physical examination is normal, with the exception of a
respiratory rate of 22/min and abdominal wall erythema, warmth, and tenderness. Laboratory
findings are normal with the exception of a fasting blood glucose level of 268 mg/dL and mild
leukocytosis. Her D-dimer level is 250 ng/mL.True statements regarding the use of the D-dimer
assay for diagnosing pulmonary embolism in this situation include which of the following?
(Mark all that are true.)
It has good sensitivity
It has good specificity
It has a good positive predictive value
It has a good negative predictive value - ANSWER✔✔A, D
D-dimer is a degradation product of cross-linked fibrin. The PIOPED II investigators recommend
stratification of all patients with suspected pulmonary embolism according to an objective
clinical probability assessment. D-dimer should be measured by a quantitative rapid enzyme-
linked immunosorbent assay (ELISA), and the combination of a negative D-dimer with a low or
moderate clinical probability can safely exclude pulmonary embolism in many patients. The
sensitivity of the D-dimer assay is 90%-95% for pulmonary embolus, but D-dimer levels are
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normal in only 40%-68% of patients without pulmonary embolus (SOR A). A D-dimer value >500
ng/mL is considered to be abnormal. Values ≤500 ng/mL have a high negative predictive value
for pulmonary embolism in patients with a low to moderate pretest probability (SOR A).
Question: A 58-year-old male with type 2 diabetes mellitus undergoes elective knee surgery.
After the surgery he is restarted on all of his usual medications with intensive glucose
monitoring. On his first postoperative day he is found to be confused and lethargic with a blood
glucose level of 32 mg/dL.When used alone, which of the following diabetes medications can
cause this problem? (Mark all that are true.)
Nateglinide (Starlix)
Glipizide (Glucotrol)
Insulin glargine (Lantus)
Metformin (Glucophage)
Pioglitazone (Actos) - ANSWER✔✔A, B, C
Some diabetes medications can lead to hypoglycemia in hospitalized patients. Both nateglinide
and glipizide stimulate insulin production, which can lead to hypoglycemia (SOR B). All insulin
products lower blood glucose directly, with hypoglycemia as a known side effect (SOR B).
Metformin and pioglitazone both help control diabetes by sensitizing the body to the effects of
insulin. These medications are not a direct cause of hypoglycemia when given at usual dosages
in most situations (SOR B).
2
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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
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
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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
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
4
SUCCESS!
ABFM-American Board of Family Medicine -Hospital
Medicine Exam NEWEST VERSION ALL 600 QUESTIONS
AND CORRECT VERIFIED ANSWERS WITH RATIONALES
LATEST UPDATE JUST RELEASED THIS YEAR
Question: A 32-year-old nonpregnant female with a history of poorly controlled type 2
diabetes mellitus is admitted to the hospital for abdominal wall cellulitis. On hospital day 2 she
develops mild shortness of breath. Her physical examination is normal, with the exception of a
respiratory rate of 22/min and abdominal wall erythema, warmth, and tenderness. Laboratory
findings are normal with the exception of a fasting blood glucose level of 268 mg/dL and mild
leukocytosis. Her D-dimer level is 250 ng/mL.True statements regarding the use of the D-dimer
assay for diagnosing pulmonary embolism in this situation include which of the following?
(Mark all that are true.)
It has good sensitivity
It has good specificity
It has a good positive predictive value
It has a good negative predictive value - ANSWER✔✔A, D
D-dimer is a degradation product of cross-linked fibrin. The PIOPED II investigators recommend
stratification of all patients with suspected pulmonary embolism according to an objective
clinical probability assessment. D-dimer should be measured by a quantitative rapid enzyme-
linked immunosorbent assay (ELISA), and the combination of a negative D-dimer with a low or
moderate clinical probability can safely exclude pulmonary embolism in many patients. The
sensitivity of the D-dimer assay is 90%-95% for pulmonary embolus, but D-dimer levels are
1
SUCCESS!
,Page 2 of 422
normal in only 40%-68% of patients without pulmonary embolus (SOR A). A D-dimer value >500
ng/mL is considered to be abnormal. Values ≤500 ng/mL have a high negative predictive value
for pulmonary embolism in patients with a low to moderate pretest probability (SOR A).
Question: A 58-year-old male with type 2 diabetes mellitus undergoes elective knee surgery.
After the surgery he is restarted on all of his usual medications with intensive glucose
monitoring. On his first postoperative day he is found to be confused and lethargic with a blood
glucose level of 32 mg/dL.When used alone, which of the following diabetes medications can
cause this problem? (Mark all that are true.)
Nateglinide (Starlix)
Glipizide (Glucotrol)
Insulin glargine (Lantus)
Metformin (Glucophage)
Pioglitazone (Actos) - ANSWER✔✔A, B, C
Some diabetes medications can lead to hypoglycemia in hospitalized patients. Both nateglinide
and glipizide stimulate insulin production, which can lead to hypoglycemia (SOR B). All insulin
products lower blood glucose directly, with hypoglycemia as a known side effect (SOR B).
Metformin and pioglitazone both help control diabetes by sensitizing the body to the effects of
insulin. These medications are not a direct cause of hypoglycemia when given at usual dosages
in most situations (SOR B).
2
SUCCESS!
,Page 3 of 422
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
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
3
SUCCESS!
, Page 4 of 422
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
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
4
SUCCESS!
