Internal Medicine ABIM Board Exam Style Question

e’s a practice question directly from Knowmedge’s Internal Medicine Board (ABIM) Exam QVault.

In which of the following scenarios is it appropriate to allow outpatient treatment of community-acquired pneumonia (CAP)?

A. 67-year-old male with CAP, blood pressure of 120/85mmHg, and confusion

B. 68-year old male with CAP, blood pressure of 130/80mmHg, and respiratory rate of 18/min

C. 69-year old female with CAP, blood pressure of 125/82mmHg, and creatinine of 2.1mg/dL (Baseline is 0.8mg/dL)

D. 58-year old female with CAP, blood pressure of 100/50mmHg, and confusion

E. 32-year-old female with CAP, blood pressure of 90/50mmHg, altered mental status, and respiratory rate 34/min

Explanation

After diagnosing a patient with community-acquired pneumonia, we must determine whether the patient needs to be hospitalized or not. In order to facilitate this decision, the CURB-65 guidelines can be used. CURB stands for:

● C – Confusion (altered mental status) 
● U – Uremia
● R – Respiratory rate greater than 30/minute 
● B – Blood pressure that is low (Systolic <90mmHg or Diastolic <60mmHg) 
● 65 – Age 65 years or greater

Each category is assigned 1 point

● 0-1 points total means the patient can be treated as an outpatient 
● 2 points total requirements treatment in the medical ward 
● 3 or more points requires ICU admission

Let’s go over the answer choices:

● Choice A (67-year-old male with CAP, blood pressure of 120/85mmHg, and confusion) has 2 points (age greater than 65 and confusion) and should require admission to the medical ward.

● Choice B (68-year-old male with CAP, blood pressure of 130/80mmHg, and respiratory rate of 18/min) will be the scenario that will require outpatient therapy. This patient only has one point (age greater than 65) so he can be treated for CAP as an outpatient.

● Choice C (69-year old female with CAP, blood pressure of 125/82mmHg, and creatinine of 2.1mg/dL) has 2 points (age greater than 65 and compromised renal function) which means admission to medical ward is most appropriate. 

● Choice D (58-year old female with CAP, blood pressure of 100/50mmHg and some confusion) has 2 points (low blood pressure and confusion). Even though this patient has 2 points, this patient may require ICU admission because the patient may be septic. For such scenarios, the CURB score simply serves a guideline but the clinical picture plays a bigger role in deciding where the patient will receive the most appropriate care. 

● Choice E (32-year-old female with CAP, blood pressure of 90/50mmHg, altered mental status, and respiratory rate 34/min) has 3 points (altered mental status, respiratory rate greater than 30/min and low blood pressure) that will require the patient to go to the ICU.

You can see all the previous ABIM Exam Review Questions of the Week at the Knowmedge Blog. You can also find additional topics and questions directly from the Knowmedge Internal Medicine ABIM Board Exam Review Questions QVault.