ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies

Question 1

A patient presents with sudden severe 'tearing' back pain, pulsatile abdominal mass, and hypotension. What is the immediate priority?

Accepted Answer

Emergent vascular surgery consultation and operative repair

Answer

CT angiography to confirm

Answer

IV fluids to normalize BP

Answer

Aortic ultrasound only

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?

Accepted Answer

Lactulose and rifaximin

Answer

Protein restriction only

Answer

IV neomycin

Answer

Hemodialysis

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?

Accepted Answer

IV fluid resuscitation and NPO

Answer

Immediate ERCP

Answer

Urgent cholecystectomy

Answer

Nasogastric tube decompression

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?

Accepted Answer

IV corticosteroids and GI consultation

Answer

Oral mesalamine

Answer

Colonoscopy immediately

Answer

Oral prednisone and discharge

Question 5

A patient with history of alcohol use presents with hematemesis. EGD shows actively bleeding esophageal varices. Which medication should be administered immediately?

Accepted Answer

Octreotide IV infusion

Answer

PPI infusion only

Answer

IV vasopressin alone

Answer

Beta-blockers

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?

Accepted Answer

Appendectomy with IV antibiotics

Answer

Antibiotics alone and discharge

Answer

Observation only

Answer

Colonoscopy to confirm