ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies 2

Question 1

A patient presents with oliguria, BUN 80, creatinine 6.2 (baseline 1.0), and no urine output for 12 hours. Bladder scan shows 600 mL. What is the next step?

Accepted Answer

Foley catheter placement

Answer

Start hemodialysis

Answer

IV furosemide

Answer

Nephrology consult first

Question 2

A patient with diabetes presents with nausea, vomiting, blood glucose 520 mg/dL, pH 7.20, bicarbonate 10, and ketones positive. What is the most critical initial intervention?

Accepted Answer

IV fluid resuscitation with normal saline

Answer

Insulin infusion immediately

Answer

Sodium bicarbonate infusion

Answer

Dextrose 50% IV

Question 3

A patient on ACE inhibitor presents with serum potassium of 6.8 mEq/L and peaked T-waves on ECG. What is the FIRST treatment to administer?

Accepted Answer

Calcium gluconate IV

Answer

Sodium bicarbonate IV

Answer

Insulin plus dextrose

Answer

Kayexalate

Question 4

A patient presents with confusion, serum sodium of 118 mEq/L, and euvolemia. What is the safest correction rate for chronic hyponatremia?

Accepted Answer

No more than 8–10 mEq/L in 24 hours

Answer

Correct as fast as possible

Answer

Correct to 130 within 4 hours

Answer

Give 3% saline at rapid rate

Question 5

A patient with a history of kidney stones presents with colicky flank pain radiating to the groin, hematuria, and nausea. CT shows a 7 mm ureteral stone. What is the appropriate management?

Accepted Answer

Pain control, hydration, alpha-blocker, and urology follow-up

Answer

Immediate urologic intervention

Answer

Extracorporeal shock wave lithotripsy in ED

Answer

Foley catheter and observation

Question 6

A patient presents with altered mental status, tachycardia, fever, and a thyroid-stimulating hormone near zero with T4 markedly elevated. What is the diagnosis?

Accepted Answer

Thyroid storm

Answer

Myxedema coma

Answer

Sick euthyroid syndrome

Answer

Subacute thyroiditis