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

IV D50 is the fastest and most reliable treatment for symptomatic hypoglycemia when the patient cannot safely swallow.

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

Hemodialysis is the definitive treatment for severe metformin-associated lactic acidosis as it removes metformin and corrects acidosis.

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

ESRD patients are anuric and unresponsive to diuretics; nitroglycerin for afterload reduction and emergent dialysis is definitive treatment for flash pulmonary edema.

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

Charcot's triad (fever, jaundice, RUQ pain) represents ascending cholangitis — a surgical emergency requiring antibiotics and biliary decompression.

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

Adrenal crisis requires immediate IV hydrocortisone (stress-dose) and aggressive IV normal saline to restore volume and cortisol deficiency.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies 3