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ABFM HOSPITAL MEDICINE questions and answers rated A+2025/2026
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ABFM HOSPITAL MEDICINE questions and answers rated A+2025/2026
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ABFM HOSPITAL MEDICINEA 42-yr-antique construction worker with a three-day records of cough, fever, chills, dyspnea,
and proper posterolateral chest pain with inspiration is introduced to the emergency branch
by means of his wife. He has been in proper health until this infection, and has in no way
been hospitalized. He does not take any habitual medicinal drugs, does no longer smoke,
and beverages alcohol best occasionally.On examination he seems ill and in moderate
respiration misery. His temperature is forty.Three°C (104.5°F), pulse charge one hundred
thirty beats/min, respiratory price 32/min, blood stress 136/70 mm Hg, and oxygen saturation
88% on room air. He has dwindled breath sounds within the proper posterolateral chest. His
Pneumonia Severity Index is 97. Based at the severity of his infection you advise health
facility admission.Antibiotic choices advocated for empiric treatment on this patient include
which of the following? (Mark all which might be proper.)
Ceftriaxone (Rocephin) plus azithromycin - ANSA, B, E
Relative threat stratification ought to be completed for sufferers with network-received
pneumonia, the usage of a clinical prediction device together with the Pneumonia Severity
Index (PSI) or the CURB-sixty five (SOR A). These equipment can be used together with the
judgment of the medical doctor to determine whether or not or now not a affected person can
be dealt with as an outpatient or must be admitted to the sanatorium. This patient is fairly
sick and, based totally on his presentation, has a PSI rating of 97 (primarily based on his
age, respiratory rate, temperature, and pulse oximetry). This rating suggests that he must to
begin with be treated within the hospital.A macrolide plus a β-lactam is usually
recommended for mixture remedy in patients hospitalized with network-acquired pneumonia
who're at low threat (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) may be used as monotherapy (SOR A). Because
of concerns approximately increasing stages of resistance, macrolides aren't advocated as
monotherapy for a moderately ill patient (SOR C). Ciprofloxacin, a first-era quinolone, has no
antimicrobial hobby against Streptococcus pneumoniae and is therefore not appropriate
remedy for community-obtained pneumonia (SOR C).
A 32-yr-vintage nonpregnant lady with a records of poorly controlled kind 2 diabetes mellitus
is admitted to the health center for abdominal wall cellulitis. On sanatorium day 2 she
develops slight shortness of breath. Her physical exam is normal, except for a respiratory
price of 22/min and belly wall erythema, warm temperature, and tenderness. Laboratory
findings are normal excluding a fasting blood glucose stage of 268 mg/dL and mild
leukocytosis. Her D-dimer stage is 250 ng/mL.True statements regarding the use of the
D-dimer assay for diagnosing pulmonary embolism in this case include which of the
following? (Mark all which might be authentic.)
It has accurate sensitivity
It has properly specificity
It has an amazing superb predictive value
It has a very good negative predictive fee - ANSA, D
, D-dimer is a degradation made from go-related fibrin. The PIOPED II investigators
recommend stratification of all sufferers with suspected pulmonary embolism according to an
goal scientific possibility assessment. D-dimer need to be measured with the aid of a
quantitative rapid enzyme-connected immunosorbent assay (ELISA), and the aggregate of a
bad D-dimer with a low or mild medical opportunity can competently exclude pulmonary
embolism in many patients. The sensitivity of the D-dimer assay is 90%-95% for pulmonary
embolus, however D-dimer levels are ordinary in only forty%-sixty eight% of patients without
pulmonary embolus (SOR A). A D-dimer value >500 ng/mL is taken into consideration to be
atypical. Values ≤500 ng/mL have a high poor predictive cost for pulmonary embolism in
patients with a low to moderate pretest possibility (SOR A).
A fifty eight-year-old male with kind 2 diabetes mellitus undergoes non-obligatory knee
surgical operation. After the surgery he's restarted on all of his traditional medicinal drugs
with intensive glucose monitoring. On his first postoperative day he's determined to be
burdened and torpid with a blood glucose degree of 32 mg/dL.When used by myself, which
of the subsequent diabetes medications can purpose this trouble? (Mark all which are
genuine.)
Nateglinide (Starlix)
Glipizide (Glucotrol)
Insulin glargine (Lantus)
Metformin (Glucophage)
Pioglitazone (Actos) - ANSA, B, C
Some diabetes medications can cause 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 regarded aspect
impact (SOR B). Metformin and pioglitazone each assist control diabetes through sensitizing
the body to the effects of insulin. These medicinal drugs aren't an immediate cause of
hypoglycemia when given at regular dosages in maximum conditions (SOR B).
An eighty two-yr-vintage lady is hospitalized with acute pancreatitis and intestinal ileus, and
you decide that she will be able to require overall parenteral vitamins through a significant
venous catheter. Which of the subsequent will lower the probability of catheter-related
headaches on this patient? (Mark all which are actual.)
Placement of the catheter inside the femoral vein
Ultrasound-guided placement of the catheter into the inner jugular vein
Routinely converting the catheter over a twine every 3-5 days
Routinely moving the catheter to a different insertion web page every 3-5 days
Using chlorhexidine gluconate-impregnated sponges within the catheter dressings - ANSB,
E
Studies display that ultrasound-guided placement of the catheter into the inner jugular vein is
associated with a higher achievement charge and a decrease hardship rate all through
insertion, even among physicians particularly experienced in the procedure (SOR A).
Placement of the catheter inside the femoral vein is related to a better fee of post-insertion
headaches (SOR A). Routinely changing the catheter over a cord each 3-5 days has been
shown to increase the fee of catheter-related infections (SOR A). Evidence has shown no
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