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

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?

Accepted Answer

Lactulose and rifaximin

Answer

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?

Accepted Answer

IV fluid resuscitation and NPO

Answer

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?

Accepted Answer

IV corticosteroids and GI consultation

Answer

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?

Accepted Answer

Octreotide IV infusion

Answer

Octreotide reduces portal hypertension by inhibiting vasodilatory peptides, and is given as a continuous infusion in acute variceal bleeding.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM ABEM Gastrointestinal, Renal & Metabolic Emergencies