1. 10 mL of 10% magnesium sulfate intravenously

2. Oral vitamin D

3. 100 μg oral Synthroid

4. oral calcium gluconate

5. Continuous infusion of calcium gluconate

23. A 65-year-old man has an enterocutaneous fistula originating in the jejunum secondary to

inflammatory bowel disease. Which of the following would be the most appropriate fluid for replacement

of his enteric losses?

1. D5W

2. 3% normal saline

3. Ringer lactate solution

4. 0.9% sodium chloride

5. 6% sodium bicarbonate solution

24. A 45-year-old woman undergoes an uneventful laparoscopic cholecystectomy for which she

Receives 1 dose of cephalosporin. One week later, she returns to the emergency room with fever, nausea, and copious diarrhea and is suspected of having pseudomembranous colitis. She is afebrile and has no

peritoneal signs on abdominal examination. She has a mild leukocytosis with a left shift. Which of the

following is the appropriate initial management strategy?

1. Administration of an antidiarrheal agent

2. Exploratory laparotomy with left hemi-colectomy and colostomy

3. Exploratory laparotomy with subtotal abdominal colectomy and ileostomy

4. Administration of intravenous vancomycin

5. Administration of oral metronidazole

25. A 42-year-old man sustains a gunshot wound to the abdomen and is in shock. Multiple units

of packed red blood cells are transfused in an effort to resuscitate him. He complains of numbness around

his mouth and displays carpopedal spasm. An electrocardiogram demonstrates a prolonged QT interval.

Which of the following is the most appropriate treatment?

1. Intravenous bicarbonate

2. Intravenous potassium

3. Intravenous calcium

4. Intravenous digoxin

5. Intravenous parathyroid hormone

1. A 36-year-old man who was hit by a car presents to the ER with hypotension. On examination,

he has tenderness and bruising over his left lateral chest below the nipple. An ultrasound examination is

performed and reveals free fluid in the abdomen. What is the most likely organ to have been injured in

this patient?

1. Liver

2. Kidney

3. Spleen

4. Intestine

5. Pancreas

27. A 25-year-old woman arrives in the ER following an automobile accident. She is acutely

dyspneic with a respiratory rate of 60 breaths per minute. Breath sounds are markedly diminished on the

right side. Which of the following is the best first step in the management of this patient?

1. Take a chest x-ray.

2. Draw arterial blood for blood-gas determination.

3. Decompress the right pleural space.

4. Perform pericardiocentesis.

5. Administer intravenous fluids

28. A 27-year-old man presents to the ER after a high-speed motor vehicle collision with chest pain

and marked respiratory distress. On physical examination, he is hypotensive with distended neck veins

and absence of breath sounds in the left chest. Which of the following is the proper initial treatment?