ABFM HOSPITAL MEDICINE EXAM LATEST
2024 WITH 120+ EXPERT CERTIFIED
QUESTIONS AND ANSWERS I ALREADY
GRADED A+
Relative risk stratification should be performed for patients with community-
acquired pneumonia, using a clinical prediction tool such as the Pneumonia
Severity Index (PSI) or the CURB-65 (SOR A). These tools can be used along with
the judgment of the physician to decide whether or not a patient can be treated
as an outpatient or should be admitted to the hospital. This patient is moderately
ill and, based on his presentation, has a PSI score of 97 (based on his age,
respiratory rate, temperature, and pulse oximetry). This score indicates that he
should initially be treated in the hospital.A macrolide plus a β-lactam is
recommended for combination therapy in patients hospitalized with community-
acquired pneumonia who are at low risk (PSI score of 71-130) (SOR A). In addition
to a β-lactam, doxycycline can be used as an alternative to a macrolide (SOR B). A
respiratory fluoroquinolone (levofloxacin, gemifloxacin, moxifloxacin) can be used
as monotherapy (SOR A). Because of concerns about increasing levels of
resistance, macrolides are not recommended as monotherapy for a moderately ill
patient (SOR C). Ciprofloxacin, a first-generation quinolone, has no antimicrobial
activity against Streptococcus pneumoniae and is therefore not appropriate
treatment for community-acquired pneumonia (SOR C).
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 - ANSWERS-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 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).
A 42-year-old construction worker with a 3-day history of cough, fever, chills,
dyspnea, and right posterolateral chest pain with inspiration is brought to the
emergency department by his wife. He has been in good health until this illness,
and has never been hospitalized. He does not take any routine medications, does
not smoke, and drinks alcohol only occasionally.On examination he appears ill and
in mild respiratory distress. His temperature is 40.3°C (104.5°F), pulse rate 130
beats/min, respiratory rate 32/min, blood pressure 136/70 mm Hg, and oxygen
saturation 88% on room air. He has diminished breath sounds in the right
posterolateral chest. His Pneumonia Severity Index is 97. Based on the severity of
his illness you recommend hospital admission.Antibiotic choices recommended
, for empiric treatment in this patient include which of the following? (Mark all that
are true.)
Ceftriaxone (Rocephin) plus azithromyci - ANSWERS-A, B, E
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) - ANSWERS-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).
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
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