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

Post-renal AKI from bladder outlet obstruction requires immediate Foley catheterization to relieve the obstruction.

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

IV fluid resuscitation is the most critical first step in DKA to restore intravascular volume before initiating insulin therapy.

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

Calcium gluconate is the first-line treatment in hyperkalemia with ECG changes because it stabilizes the cardiac membrane immediately.

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

Overcorrecting chronic hyponatremia faster than 8–10 mEq/L per 24 hours risks osmotic demyelination syndrome (central pontine myelinolysis).

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

Stones 5–10 mm have a moderate chance of spontaneous passage; alpha-blockers (e.g., tamsulosin) plus analgesia and urology follow-up is appropriate.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies 2