Hepatic Failure/GI/Endocrine Emergencies

A 46-year-old man presents with alcohol-induced

severe acute pancreatitis (AP). Pertinent medical

history includes alcoholic cirrhosis and several admis-

sions for aspiration pneumonia secondary to hepatic

encephalopathy. He is given intravenous fluids for ini-

tial volume resuscitation with lactated Ringer solution.

Which action would be best for the patient’s nutrition?

the pancreas until AP is resolved.

route.

route.

A 37-year-old woman presents after a Roux-en-Y

gastric bypass for morbid obesity. Her postoperative

course was complicated by the formation of an entero-

cutaneous fistula, fevers, and leukocytosis. She was

initiated on broad-spectrum antibiotics, and a wound

vacuum-assisted closure was placed on her fistula site

to help with drainage and healing. Her fistula output

was 570 mL/day yesterday, and today, it was 250 mL/

day. Which statement is most accurate regarding her

fistula output between the two recordings?

both days.

that has converted to a low output.

that has converted to a moderate output.

both days.

A 68-year-old man presents for a large bowel resec-

tion. Given the high incidence of postoperative ileus

(POI) with this procedure, he is initiated on alvimo-

pan before surgery. To reduce the cardiovascular risk

associated with alvimopan, the U.S. Food and Drug

Administration (FDA) placed a restriction on alvi-

mopan use that has been implemented through the

EASE (ENTEREG Access Support & Education)

program. Which best represents that restriction?

monitoring on initiation to monitor for cor-

rected QT (QTc) prolongation.

15 doses.

myocardial infarction.

A 40-year-old woman presents for elective abdomi-

nal surgery to remove a malignancy from her liver.

Given the extensiveness of the surgery, the expected

use of volatile anesthetics, and the use of periop-

erative opioids, a multimodal plan is developed to

avoid postoperative nausea and vomiting (PONV).

Which best describes the timing of prophylactic

administration with respect to surgery?

the end of surgery.

inducing anesthesia.

40–125 mg) given at the end of surgery.

at the end of surgery.

A 69-year-old woman presents to the surgical inten-

sive care unit (ICU) at your institution with upper

gastrointestinal bleeding (UGIB) caused by a gas-

tric ulcer. She has lost a significant amount of blood

because of the bleed and currently requires blood

transfusions. As part of her diagnostic workup to

determine the etiology of her ulcer, she tests posi-

tive for a Helicobacter pylori infection. Which best

reflects an inappropriate treatment option for her?

hour for 72 hours.

antibiotic combination for 14 days.

greater than 7 g/dL.

Which set of laboratory abnormalities best reflects

those that patients in thyroid storm typically present

with?

triiodothyronine (T3), and thyroxine (T4)

concentrations.