American Board of Internal Medicine (ABIM) Certification Practice Exam

Patients with hemodynamic instability are considered for hospitalization in which condition?

1. Chronic cystitis

2. Acute pyelonephritis

3. Urinary retention

4. Prostatitis

The correct answer is: Acute pyelonephritis

Hemodynamic instability refers to a state in which a patient's blood pressure or circulation is compromised, leading to inadequate blood flow to the organs. This can manifest as shock, severe sepsis, or significant changes in vital signs. In the context of urinary tract infections, particularly acute pyelonephritis, it is critical to recognize when hospitalization is necessary. Acute pyelonephritis is a serious kidney infection that can lead to significant systemic complications, including sepsis. Patients presenting with acute pyelonephritis may have fever, flank pain, nausea, vomiting, and a high white blood cell count, and they may develop hemodynamic instability due to sepsis. In such cases, intravenous antibiotics, fluid resuscitation, and close monitoring are essential, which can only be effectively managed in a hospital setting. Other conditions listed may not ordinarily lead to hemodynamic instability: - Chronic cystitis is generally less severe and managed on an outpatient basis. - Urinary retention can be uncomfortable but typically does not result in hemodynamic instability unless there are significant complications like kidney damage or bladder rupture, which are rare. - Prostatitis can cause significant discomfort and may lead to some systemic symptoms, but it does not usually cause hemodynamic