10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The CPA-HM exam has 120 questions and runs 2 hours.
These 10 free CPA-HM questions are organized by exam domain, so you can see how each part of the Certificate of Added Qualifications in Hospital Medicine blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Cardiovascular 17% of exam
Question 1
During treatment of pneumonia, a 74-year-old man has high-sensitivity troponin I concentrations of 42, 186, and 91 ng/L over eight hours; the assay's male 99th-percentile upper reference limit is 34 ng/L. He reports no ischemic symptoms. Serial ECGs show no ischemic changes, and echocardiography shows no new regional wall-motion abnormality. His chronic kidney disease is unchanged from baseline. What do these findings establish?
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Correct answer: A - Acute myocardial injury without sufficient evidence to diagnose infarction
Question 2
"My heart function is normal now. Can I stop these medicines?" A 56-year-old man with nonischemic dilated cardiomyopathy asks this during discharge counseling. His ejection fraction has risen from 26% to 55% over 18 months on sacubitril/valsartan, carvedilol, spironolactone, and dapagliflozin. He is asymptomatic and euvolemic, with blood pressure 118/72 mmHg, potassium 4.3 mmol/L, stable renal function, and no medication adverse effects. Which recommendation is justified?
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Correct answer: A - Continue the disease-modifying regimen to reduce the risk of heart-failure relapse
Domain 2: Pulmonology 13% of exam
Question 3
After initial bronchodilators and systemic corticosteroids for a COPD exacerbation, a 70-year-old man remains tachypneic at 30/min. On controlled oxygen, saturation is 90%; arterial pH is 7.28, PaCO₂ 68 mmHg, and bicarbonate 31 mmol/L. He is alert, cooperative, clearing his secretions, and hemodynamically stable. How should respiratory support be changed?
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Correct answer: D - Begin bilevel noninvasive ventilation with close reassessment
Question 4
Despite appropriate antibiotics for bacterial pneumonia, a patient remains febrile with right-sided pleuritic pain. Ultrasound shows a moderate pleural effusion with a safe drainage window. Diagnostic aspiration yields nonpurulent fluid with pH 7.12 and glucose 34 mg/dL; the pH sample was collected without local-anesthetic contamination and analyzed promptly. Gram stain is negative and culture is pending. What should the pleural fluid findings prompt?
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Correct answer: B - Arrange image-guided chest tube drainage while continuing antibiotics
Domain 3: Gastroenterology 9% of exam
Question 5
A patient with decompensated cirrhosis and known esophageal varices presents with hematemesis. Following initial resuscitation, blood pressure is 112/68 mmHg and hemoglobin is 8.2 g/dL. An octreotide infusion is started and urgent endoscopy is arranged. He is afebrile, and examination reveals no infectious focus. Which additional medication is indicated at this stage?
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Correct answer: C - Ceftriaxone to provide short-course antibiotic prophylaxis
Domain 4: Endocrinology 6% of exam
Question 6
A 58-year-old woman taking empagliflozin for type 2 diabetes is admitted after two days of vomiting and poor intake. Glucose is 186 mg/dL, beta-hydroxybutyrate 5.8 mmol/L, venous pH 7.22, bicarbonate 12 mmol/L, and potassium 3.1 mmol/L. Empagliflozin is withheld, isotonic crystalloid is running, and urine output is adequate. Which treatment sequence is appropriate?
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Correct answer: B - Replace potassium before starting the insulin infusion
Domain 5: Nephrology/Genitourinary 9% of exam
Question 7
An inpatient with profuse diarrhea becomes drowsy after receiving intravenous opioid analgesia. Arterial blood gas results are pH 7.10, bicarbonate 12 mmol/L, and PaCO₂ 40 mmHg. Applying Winter's formula to the metabolic acidosis, which expected PaCO₂ range and interpretation of the measured value are correct?
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Correct answer: B - 24-28 mmHg; metabolic acidosis with additional respiratory acidosis
Domain 6: Hematology/Oncology 8% of exam
Question 8
A platelet decline prompts evaluation for heparin-induced thrombocytopenia in an immobilized medical inpatient receiving prophylactic unfractionated heparin. Review of the complete platelet trend, exposure history, examination, and alternative causes yields a 4Ts score of 2. Platelets are 126,000/µL; there is no bleeding or suspected thrombosis, and pharmacologic venous thromboembolism prophylaxis remains indicated. Which plan fits this assessment?
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Correct answer: A - Continue heparin prophylaxis without ordering HIT testing
Domain 8: Psychiatry 5% of exam
Question 9
Twelve hours after admission for an uncomplicated fracture, a man who drinks heavily each day develops marked tremor, diaphoresis, anxiety, and a pulse of 118/min. His ethanol concentration has fallen from 260 to 74 mg/dL. He is afebrile and oriented, with normal glucose and oxygen saturation. He previously had a seizure during alcohol cessation. Which medication best addresses both his symptoms and risk of recurrent seizures?
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Correct answer: D - Lorazepam, titrated to withdrawal symptoms under monitoring
Domain 9: Infectious Diseases 12% of exam
Question 10
An 83-year-old woman with mild dementia develops fluctuating inattention during hospitalization for a vertebral compression fracture. A urine specimen obtained during the evaluation shows pyuria and more than 100,000 CFU/mL of Escherichia coli. She has no dysuria, urgency, suprapubic pain, or flank tenderness. Temperature is 36.8°C, blood pressure 132/74 mmHg, and leukocyte count 7,900/µL. She has no urinary catheter, and no urologic procedure is planned. How should the positive culture affect care?
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Correct answer: C - Withhold antibiotics and evaluate other causes of delirium