ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies 1 — Questions and Answers
Question 1: A patient presents with sudden severe 'tearing' back pain, pulsatile abdominal mass, and hypotension. What is the immediate priority?
- CT angiography to confirm
- Emergent vascular surgery consultation and operative repair (Correct answer)
- IV fluids to normalize BP
- Aortic ultrasound only
Correct answer: Emergent vascular surgery consultation and operative repair
A ruptured AAA with hemodynamic instability requires immediate operative intervention; delaying for imaging is associated with mortality.
Question 2: A patient with known cirrhosis presents with confusion and asterixis. Ammonia level is elevated. What is the first-line treatment for hepatic encephalopathy?
- Protein restriction only
- Lactulose and rifaximin (Correct answer)
- IV neomycin
- Hemodialysis
Correct answer: Lactulose and rifaximin
Lactulose reduces ammonia absorption from the gut, and rifaximin reduces ammonia-producing gut bacteria; both are first-line for hepatic encephalopathy.
Question 3: A patient presents with midepigastric pain radiating to the back, nausea, and elevated lipase 3× the upper limit of normal. What is the cornerstone of initial management?
- Immediate ERCP
- IV fluid resuscitation and NPO (Correct answer)
- Urgent cholecystectomy
- Nasogastric tube decompression
Correct answer: IV fluid resuscitation and NPO
Aggressive IV fluid resuscitation and bowel rest are the mainstays of initial acute pancreatitis management.
Question 4: A patient with ulcerative colitis presents with >10 bloody stools per day, fever, tachycardia, and Hgb of 8. What is the first management step in the ED?
- Oral mesalamine
- IV corticosteroids and GI consultation (Correct answer)
- Colonoscopy immediately
- Oral prednisone and discharge
Correct answer: IV corticosteroids and GI consultation
Severe ulcerative colitis requires hospitalization, IV corticosteroids, and urgent GI consultation to prevent toxic megacolon.
Question 5: A patient with history of alcohol use presents with hematemesis. EGD shows actively bleeding esophageal varices. Which medication should be administered immediately?
- PPI infusion only
- Octreotide IV infusion (Correct answer)
- IV vasopressin alone
- Beta-blockers
Correct answer: Octreotide IV infusion
Octreotide reduces portal hypertension by inhibiting vasodilatory peptides, and is given as a continuous infusion in acute variceal bleeding.
Question 6: A patient presents with right lower quadrant pain, fever, and elevated WBC. CT confirms acute appendicitis without perforation. What is the standard management?
- Antibiotics alone and discharge
- Appendectomy with IV antibiotics (Correct answer)
- Observation only
- Colonoscopy to confirm
Correct answer: Appendectomy with IV antibiotics
Acute uncomplicated appendicitis is treated with surgical appendectomy; IV antibiotics are given perioperatively.
ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies 1
A patient presents with sudden severe 'tearing' back pain, pulsatile abdominal mass, and hypotension.
What is the immediate priority?