ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies 3

Question 1

A patient presents with a serum glucose of 40 mg/dL and confusion. The patient is unable to swallow safely. What is the correct treatment?

Accepted Answer

Dextrose 50% (D50) IV push

Answer

Orange juice PO

Answer

Subcutaneous insulin

Answer

IM glucagon only if no IV access

Question 2

A patient taking metformin presents with lactic acidosis, pH 7.05, lactate 12, and acute renal failure. What is the most effective treatment?

Accepted Answer

Hemodialysis

Answer

Sodium bicarbonate infusion

Answer

Activated charcoal

Answer

IV saline and observation

Question 3

A patient with end-stage renal disease on dialysis presents with shortness of breath, JVD, crackles, and BP 200/110. What is the most appropriate ED treatment?

Accepted Answer

Nitroglycerin and emergent dialysis

Answer

Furosemide 40 mg IV

Answer

Beta-blockers only

Answer

Morphine and observation

Question 4

A patient presents with severe epigastric pain, fever, and jaundice. RUQ ultrasound shows CBD dilation and stones. What is the diagnosis?

Accepted Answer

Ascending cholangitis (Charcot's triad)

Answer

Cholecystitis

Answer

Biliary colic only

Answer

Hepatitis

Question 5

A patient with known Addison's disease presents with hypotension, weakness, and hyponatremia with hyperkalemia. What is the immediate treatment?

Accepted Answer

IV hydrocortisone and normal saline

Answer

Fludrocortisone alone

Answer

Oral prednisone

Answer

Vasopressors first

Question 6

A patient presents with calcium of 14.2 mg/dL, confusion, polyuria, and constipation. What is the first-line treatment for hypercalcemic crisis?

Accepted Answer

IV normal saline hydration

Answer

Bisphosphonates IV immediately

Answer

Furosemide as first step

Answer

Calcitonin before fluids