Frailty assessment US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Frailty assessment. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Frailty assessment US Medical PG Question 1: A 56-year-old previously healthy woman with no other past medical history is post-operative day one from an open reduction and internal fixation of a fractured right radius and ulna after a motor vehicle accident. What is one of the primary ways of preventing postoperative pneumonia in this patient?
- A. Shallow breathing exercises
- B. Incentive spirometry (Correct Answer)
- C. Outpatient oral antibiotics
- D. Hyperbaric oxygenation
- E. In-hospital intravenous antibiotics
Frailty assessment Explanation: ***Incentive spirometry***
- **Incentive spirometry** is a cornerstone of postoperative care, actively encouraging patients to take slow, deep breaths. This expands the lungs and prevents the collapse of alveoli, reducing the risk of **atelectasis** and subsequent **pneumonia**.
- Its effectiveness lies in promoting lung aeration and clearing secretions, which are crucial after anesthesia and surgery, especially in patients with reduced mobility or pain.
*Shallow breathing exercises*
- **Shallow breathing** is insufficient for adequate lung expansion and can actually contribute to **atelectasis** and the pooling of secretions in the lungs.
- Effective pulmonary hygiene requires **deep breaths** to maximize alveolar recruitment and prevent respiratory complications.
*Outpatient oral antibiotics*
- **Prophylactic antibiotics** are typically given around the time of surgery to prevent surgical site infections, not primarily to prevent postoperative pneumonia in an outpatient setting.
- Administering antibiotics without a diagnosed infection can lead to **antibiotic resistance** and is not a standard practice for preventing pneumonia unless a specific risk factor or existing infection is identified.
*Hyperbaric oxygenation*
- **Hyperbaric oxygenation** involves breathing 100% oxygen in a pressurized chamber and is used for conditions like **decompression sickness**, non-healing wounds, or severe infections.
- It is not a standard or primary method for preventing postoperative pneumonia, as its mechanism of action is unrelated to common pulmonary hygiene techniques.
*In-hospital intravenous antibiotics*
- While antibiotics can treat pneumonia, their routine, **prophylactic use** intravenously in-hospital solely for preventing postoperative pneumonia is generally unwarranted and can contribute to **antibiotic resistance**.
- Antibiotics are indicated if there is evidence of an active infection, but the primary prevention of pneumonia focuses on mechanical lung expansion and airway clearance.
Frailty assessment US Medical PG Question 2: A 21-year-old male presents to the emergency department after losing his footing and falling 20 feet off a construction scaffold. He hit his left side on a railing on the way down before landing on his left arm. He denies loss of consciousness during the event or feelings of lightheadedness. He has no significant past medical or surgical history and does not take any regular medications. Evaluation in the trauma bay revealed mild lacerations to the upper and lower extremities, pain to palpation in the distal left forearm, and bruising to the upper left quadrant of the abdomen as well as the lower left thorax. Free fluid was found in the abdomen by ultrasound, fluids were started, and he was rushed to the operating room for an exploratory laparotomy. A heavily lacerated spleen was discovered and removed. No other sources of bleeding were found. Further workup determined he suffered a non-displaced left distal radius fracture and non-displaced 9th and 10th rib fractures. Which of the following should be administered to this patient?
- A. Total parenteral nutrition (TPN)
- B. Prophylactic ceftriaxone
- C. Pneumococcal vaccine (Correct Answer)
- D. Nothing by mouth (NPO)
- E. Open reduction internal fixation
Frailty assessment Explanation: ***Pneumococcal vaccine***
- The patient underwent a **splenectomy**, which renders him **immunocompromised** and highly susceptible to infections by **encapsulated bacteria**, particularly *Streptococcus pneumoniae*, *Haemophilus influenzae*, and *Neisseria meningitidis*.
- **Prompt vaccination** against pneumococcus (as well as Hib and meningococcus) is the **most critical intervention** post-splenectomy to prevent life-threatening **overwhelming post-splenectomy infection (OPSI)**.
- Vaccination should ideally be given **at least 14 days before splenectomy** when possible, but in emergency splenectomy cases like this, should be administered **before discharge** or as soon as the patient is stable.
*Total parenteral nutrition (TPN)*
- There is no indication in the clinical scenario to suggest this patient has **malabsorption, intestinal failure**, or is unable to tolerate **enteral feedings**.
- **Enteral nutrition** is generally preferred over TPN due to its fewer complications and role in maintaining gut integrity, assuming the gut is functional.
- This patient had a splenectomy without bowel injury and should be able to resume oral intake once stable post-operatively.
*Prophylactic ceftriaxone*
- While **prophylactic antibiotics** (typically **penicillin V or amoxicillin**) are actually recommended post-splenectomy for at least 2 years (and sometimes lifelong), **vaccination is the most important and primary intervention** that must be addressed first.
- Daily prophylactic antibiotics are part of post-splenectomy care, but **vaccination provides more comprehensive and durable protection** against encapsulated organisms.
- In the context of this question asking what "should be administered," vaccination takes priority as the most critical immediate intervention.
*Nothing by mouth (NPO)*
- While initial NPO status is common immediately after surgery, there is no information to suggest a prolonged need for NPO status.
- The patient had an **exploratory laparotomy** and **splenectomy**, but no other injuries were found (specifically no bowel injury) that would contraindicate eventual transition to oral intake.
*Open reduction internal fixation*
- The patient sustained a **non-displaced left distal radius fracture** and **non-displaced 9th and 10th rib fractures**.
- **Non-displaced fractures** are typically managed conservatively with immobilization (e.g., casting for the radius fracture), and surgery like ORIF is not indicated for such injuries.
- Rib fractures are generally managed with pain control and pulmonary hygiene rather than surgical fixation.
Frailty assessment US Medical PG Question 3: A 66-year-old man is brought into the emergency department by his daughter for a change in behavior. Yesterday the patient seemed more confused than usual and was asking the same questions repetitively. His symptoms have not improved over the past 24 hours, thus the decision to bring him in today. Last year, the patient was almost completely independent but he then suffered a "series of falls," after which his ability to care for himself declined. After this episode he was no longer able to cook for himself or pay his bills but otherwise had been fine up until this episode. The patient has a past medical history of myocardial infarction, hypertension, depression, diabetes mellitus type II, constipation, diverticulitis, and peripheral neuropathy. His current medications include metformin, insulin, lisinopril, hydrochlorothiazide, sodium docusate, atorvastatin, metoprolol, fluoxetine, and gabapentin. On exam you note a confused man who is poorly kept. He has bruises over his legs and his gait seems unstable. He is alert to person and place, and answers some questions inappropriately. The patient's pulse is 90/minute and his blood pressure is 170/100 mmHg. Which of the following is the most likely diagnosis?
- A. Normal aging
- B. Lewy body dementia
- C. Vascular dementia (Correct Answer)
- D. Pseudodementia (depression-related cognitive impairment)
- E. Alzheimer's dementia
Frailty assessment Explanation: ***Vascular dementia***
- This diagnosis is strongly supported by the patient's **stepwise decline** in cognitive function following a "series of falls" (likely small strokes or transient ischemic attacks) and his extensive history of **vascular risk factors** including hypertension, diabetes, and previous myocardial infarction.
- The acute worsening of confusion over 24 hours, coupled with pre-existing impaired executive function (inability to cook or pay bills), is characteristic of **vascular dementia's fluctuating course** and presentation often linked to new cerebrovascular events.
*Incorrect: Normal aging*
- **Normal aging** involves a very gradual and mild decline in cognitive functions, primarily affecting processing speed and memory recall, without significant impairment in daily activities.
- This patient's rapid, stepwise decline and inability to perform instrumental activities of daily living (IADLs) such as cooking and managing finances go beyond what is considered normal cognitive changes with aging.
*Incorrect: Lewy body dementia*
- **Lewy body dementia** is characterized by prominent **fluctuations in attention and alertness**, recurrent visual hallucinations, and spontaneous parkinsonism, none of which are explicitly mentioned as primary features in this patient's presentation.
- While fluctuations in confusion are present, the history of a clear stepwise decline post-falls and significant vascular risk factors points away from Lewy body dementia as the most likely primary cause.
*Incorrect: Pseudodementia (depression-related cognitive impairment)*
- **Pseudodementia** refers to cognitive impairment that occurs in the context of **major depression**, where patients may exhibit poor concentration, memory difficulties, and psychomotor slowing that mimics dementia.
- While this patient is on fluoxetine for depression, the **stepwise decline** after clear vascular events (falls), multiple vascular risk factors, and impaired executive function point to a true neurodegenerative process rather than depression-induced cognitive changes, which typically improve with treatment of the underlying mood disorder.
*Incorrect: Alzheimer's dementia*
- **Alzheimer's dementia** typically presents with a **gradual and progressive decline** in memory, particularly episodic memory, followed by other cognitive domains over several years.
- The patient's history of a clear **stepwise decline** in function after acute events (falls) and the strong presence of **vascular risk factors** make vascular dementia a more fitting diagnosis than Alzheimer's, which is not typically associated with such a sudden, step-like progression.
Frailty assessment US Medical PG Question 4: A 25-year-old man comes to the physician for severe back pain. He describes the pain as shooting and stabbing. On a 10-point scale, he rates the pain as a 9 to 10. The pain started after he lifted a heavy box at work; he works at a supermarket and recently switched from being a cashier to a storekeeper. The patient appears to be in severe distress. Vital signs are within normal limits. On physical examination, the spine is nontender without paravertebral muscle spasms. Range of motion is normal. A straight-leg raise test is negative. After the physical examination has been completed, the patient asks for a letter to his employer attesting to his inability to work as a storekeeper. Which of the following is the most appropriate response?
- A. “Yes. Since work may worsen your condition, I would prefer that you stay home a few days. I will write a letter to your employer to explain the situation.”
- B. You say you are in severe pain. However, the physical examination findings do not suggest a physical problem that can be addressed with medications or surgery. I'd like to meet on a regular basis to see how you're doing.
- C. I understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes at your job. (Correct Answer)
- D. The physical exam findings do not match your symptoms, which suggests a psychological problem. I would be happy to refer you to a mental health professional.
- E. The physical exam findings suggest a psychological rather than a physical problem. But there is a good chance that we can address it with cognitive-behavioral therapy.
Frailty assessment Explanation: ***"I understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes at your job."***
- This response acknowledges the patient's reported discomfort while gently highlighting the **discrepancy between symptoms and objective findings**, which is crucial in cases of suspected **somatoform or functional pain**.
- It also opens communication about potential **psychosocial stressors** related to his job change, which could be contributing to his symptoms, without dismissing his pain or making a premature diagnosis.
*"You say you are in severe pain. However, the physical examination findings do not suggest a physical problem that can be addressed with medications or surgery. I'd like to meet on a regular basis to see how you're doing."*
- While this option correctly identifies the lack of physical findings, it can be perceived as dismissive of the patient's pain, potentially damaging the **physician-patient relationship**.
- Suggesting regular meetings without a clear plan for addressing his immediate concerns or exploring underlying issues might not be the most effective initial approach.
*“Yes. Since work may worsen your condition, I would prefer that you stay home a few days. I will write a letter to your employer to explain the situation.”*
- This response would **validate the patient's claim of severe pain** without objective evidence, potentially reinforcing illness behavior and avoiding addressing the underlying issue.
- Providing a doctor's note for inability to work without a clear diagnostic basis or understanding of the pain's origin is **medically inappropriate** and could set a precedent for future such requests.
*"The physical exam findings do not match your symptoms, which suggests a psychological problem. I would be happy to refer you to a mental health professional."*
- Directly labeling the problem as "psychological" can be **stigmatizing and alienating** to the patient, leading to distrust and resistance to care.
- While a psychological component might be present, immediately referring to mental health without further exploration of the patient's situation or current stressors is premature and lacks empathy.
*"The physical exam findings suggest a psychological rather than a physical problem. But there is a good chance that we can address it with cognitive-behavioral therapy."*
- Similar to the previous option, explicitly stating a "psychological problem" can be **stigmatizing**.
- Jumping directly to recommending **cognitive-behavioral therapy (CBT)** without a comprehensive discussion and patient buy-in is premature and may lead to non-compliance.
Frailty assessment US Medical PG Question 5: A 57-year-old man presents to the clinic for a chronic cough over the past 4 months. The patient reports a productive yellow/green cough that is worse at night. He denies any significant precipitating event prior to his symptoms. He denies fever, chest pain, palpitations, weight changes, or abdominal pain, but endorses some difficulty breathing that waxes and wanes. He denies alcohol usage but endorses a 35 pack-year smoking history. A physical examination demonstrates mild wheezes, bibasilar crackles, and mild clubbing of his fingertips. A pulmonary function test is subsequently ordered, and partial results are shown below:
Tidal volume: 500 mL
Residual volume: 1700 mL
Expiratory reserve volume: 1500 mL
Inspiratory reserve volume: 3000 mL
What is the functional residual capacity of this patient?
- A. 4500 mL
- B. 2000 mL
- C. 2200 mL
- D. 3200 mL (Correct Answer)
- E. 3500 mL
Frailty assessment Explanation: ***3200 mL***
- The **functional residual capacity (FRC)** is the volume of air remaining in the lungs after a normal expiration.
- It is calculated as the sum of the **expiratory reserve volume (ERV)** and the **residual volume (RV)**. In this case, 1500 mL (ERV) + 1700 mL (RV) = 3200 mL.
*4500 mL*
- This value represents the sum of the **inspiratory reserve volume (3000 mL)** and the **residual volume (1700 mL)**, which does not correspond to a standard lung volume or capacity.
- It does not logically relate to the definition of functional residual capacity.
*2000 mL*
- This value represents the sum of the **tidal volume (500 mL)** and the **expiratory reserve volume (1500 mL)**, which is incorrect for FRC.
- This would represent the inspiratory capacity minus the inspiratory reserve volume, which is not a standard measurement used in pulmonary function testing.
*2200 mL*
- This value could be obtained by incorrectly adding the **tidal volume (500 mL)** and the **residual volume (1700 mL)**, which is not the correct formula for FRC.
- This calculation represents a miscombination of lung volumes that does not correspond to any standard pulmonary capacity measurement.
*3500 mL*
- This value is the sum of the **tidal volume (500 mL)**, the **expiratory reserve volume (1500 mL)**, and the **residual volume (1700 mL)**.
- This would represent the FRC plus the tidal volume, which is not a standard measurement and does not represent the functional residual capacity.
Frailty assessment US Medical PG Question 6: A 57-year-old woman presents to her primary care physician for weakness. The patient states that she barely feels able to lift a bag of groceries from her car into her house anymore. The patient has a past medical history of a suicide attempt, constipation, anxiety, asthma, and atopic dermatitis. Her current medications include fluoxetine, lisinopril, albuterol, diphenhydramine, sodium docusate, and a multivitamin. She was recently started on atorvastatin for dyslipidemia. Her temperature is 97°F (36.1°C), blood pressure is 90/65 mmHg, pulse is 70/min, respirations are 11/min, and oxygen saturation is 98% on room air. On physical exam, you note a fatigued appearing woman with thinning hair. Cardiopulmonary exam is within normal limits. She demonstrates 3/5 strength in her upper and lower extremities with 1+ sluggish reflexes. Sensation is symmetrical and present in the upper and lower extremities. Pain/tenderness upon palpation of the patient's extremities is noted. Laboratory values are ordered as seen below:
Hemoglobin: 12 g/dL
Hematocrit: 36%
Leukocyte count: 5,500/mm^3 with normal differential
Platelet count: 190,000/mm^3
Serum:
Na+: 139 mEq/L
Cl-: 101 mEq/L
K+: 4.4 mEq/L
HCO3-: 24 mEq/L
BUN: 20 mg/dL
Glucose: 90 mg/dL
Creatinine: 1.1 mg/dL
Ca2+: 10.1 mg/dL
AST: 12 U/L
ALT: 10 U/L
Which of the following is the best next step in management?
- A. Discontinue atorvastatin
- B. TSH level (Correct Answer)
- C. Coenzyme Q10
- D. Muscle biopsy
- E. Aldolase level
Frailty assessment Explanation: ***TSH level***
- The patient's symptoms of **generalized weakness**, **constipation**, **fatigue**, **thinning hair**, and **sluggish reflexes** are highly suggestive of **hypothyroidism**.
- A TSH level is the most appropriate initial screening test for evaluating thyroid function.
*Discontinue atorvastatin*
- While **statins can cause myopathy**, leading to muscle weakness and pain, the patient's presentation with **thinning hair** and **sluggish reflexes** points more strongly towards hypothyroidism.
- Labs would likely show elevated **creatine kinase** in statin-induced myopathy, which is not provided as elevated here.
*Coenzyme Q10*
- **Coenzyme Q10** supplementation is sometimes suggested for statin-induced myopathy, but there is limited evidence for its efficacy, and it would not address the broader constellation of symptoms seen here.
- This is an intervention, not a diagnostic step, and the underlying cause of weakness needs to be identified first.
*Muscle biopsy*
- A **muscle biopsy** is an invasive procedure and is typically reserved for cases where less invasive tests have failed to provide a diagnosis, especially in suspected **inflammatory myopathies** or **muscular dystrophies**.
- It is not the initial diagnostic step for generalized weakness, particularly with symptoms suggestive of an endocrine disorder.
*Aldolase level*
- **Aldolase** is an enzyme found in muscle tissue and can be elevated in conditions causing **muscle breakdown**, similar to creatine kinase.
- While it may be elevated in myopathies, the clinical picture with **thinning hair** and **sluggish reflexes** makes hypothyroidism a more likely initial diagnosis to investigate.
Frailty assessment US Medical PG Question 7: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?
- A. "Does the diarrhea typically precede the constipation, or vice-versa?"
- B. "Is the diarrhea foul-smelling?"
- C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
- D. "Are the symptoms worse in the morning or at night?"
- E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)
Frailty assessment Explanation: ***Can you tell me more about the symptoms you have been experiencing?***
- This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis.
- In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions.
*Does the diarrhea typically precede the constipation, or vice-versa?*
- While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience.
- It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture.
*Is the diarrhea foul-smelling?*
- Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions.
- However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed.
*Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life*
- Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time.
- However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially.
*Are the symptoms worse in the morning or at night?*
- Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related.
- This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.
Frailty assessment US Medical PG Question 8: You are interested in studying the etiology of heart failure reduced ejection fraction (HFrEF) and attempt to construct an appropriate design study. Specifically, you wish to look for potential causality between dietary glucose consumption and HFrEF. Which of the following study designs would allow you to assess for and determine this causality?
- A. Cross-sectional study
- B. Case series
- C. Cohort study (Correct Answer)
- D. Case-control study
- E. Randomized controlled trial
Frailty assessment Explanation: ***Cohort study***
- A **cohort study** observes a group of individuals over time to identify risk factors and outcomes, allowing for the assessment of **temporal relationships** between exposure (dietary glucose) and outcome (HFrEF).
- This design is suitable for establishing a potential **causal link** as it tracks participants from exposure to outcome, enabling the calculation of incidence rates and relative risks.
*Cross-sectional study*
- A **cross-sectional study** measures exposure and outcome simultaneously at a single point in time, making it impossible to determine the **temporal sequence** of events.
- This design can only identify **associations** or correlations, not causation, as it cannot establish whether high glucose consumption preceded HFrEF.
*Case series*
- A **case series** describes characteristics of a group of patients with a particular disease or exposure, often to highlight unusual clinical features, but it lacks a **comparison group**.
- It cannot assess causality because it does not provide information on the frequency of exposure in healthy individuals or the incidence of the disease in unexposed individuals.
*Case-control study*
- A **case-control study** compares individuals with the outcome (cases) to those without the outcome (controls) to determine past exposures, which makes it prone to **recall bias**.
- While it can suggest associations, it cannot definitively establish a temporal relationship or causation as the outcome is already known when exposure is assessed.
*Randomized controlled trial*
- A **randomized controlled trial (RCT)** is the gold standard for establishing causation by randomly assigning participants to an intervention or control group, but it may not be ethical or feasible for studying long-term dietary exposures and chronic diseases like HFrEF due to the long follow-up period and complexity of diet.
- While ideal for causality, directly controlling and randomizing dietary glucose intake over decades to observe HFrEF development might be practically challenging or unethical.
Frailty assessment US Medical PG Question 9: A 66-year-old man weighing 50 kg (110 lb) is admitted to the hospital because of sepsis complicated by acute respiratory distress syndrome. The physician decides to initiate total parenteral nutrition and prescribes short-term hypocaloric intake of 20 kcal/kg/day with 20% of the total energy requirement provided by proteins and 30% provided by fats. The physician calculates that a total volume of 1100 mL/day should be infused during the parenteral nutrition therapy to maintain fluid balance. A colloid containing 10 g/dL of albumin and an emulsion with a fat concentration of 33 g/dL are used to prepare parenteral nutrition modules. Which of the following is the most appropriate module to meet the carbohydrate requirement in this patient over the next 24 hours?
- A. 500 mL of 25% dextrose solution (Correct Answer)
- B. 750 mL of 25% dextrose solution
- C. 750 mL of 10% dextrose solution
- D. 500 mL of 10% dextrose solution
- E. 250 mL of 50% dextrose solution
Frailty assessment Explanation: ***500 mL of 25% dextrose solution***
- The patient requires 1000 kcal/day total (50 kg * 20 kcal/kg/day). With 20% from protein (200 kcal) and 30% from fat (300 kcal), 500 kcal must come from carbohydrates. Given that **1 g of dextrose provides 3.4 kcal**, 500 kcal requires approximately 147 g of dextrose (500 kcal / 3.4 kcal/g). A **25% dextrose solution contains 250 g of dextrose per liter**, so 500 mL would provide 125 g of dextrose (0.5 L * 250 g/L), which translates to 425 kcal (125 g * 3.4 kcal/g). This is the closest and most appropriate option.
- While not exactly 500 kcal, this option delivers the closest amount of carbohydrate calories while fitting within fluid restrictions and is a common concentration used in TPN.
*750 mL of 25% dextrose solution*
- This option would provide approximately 187.5 g of dextrose (0.75 L * 250 g/L), resulting in 637.5 kcal. This is **too high a carbohydrate load** for the patient's calculated needs (500 kcal from carbs) and would exceed the desired energy distribution.
- Additionally, this volume might lead to **fluid overload** given the 1100 mL/day total fluid restriction.
*750 mL of 10% dextrose solution*
- This option provides approximately 75 g of dextrose (0.75 L * 100 g/L), resulting in 255 kcal. This is **insufficient to meet the required 500 kcal** from carbohydrates.
- While the volume is high, the caloric content from carbohydrate is low.
*500 mL of 10% dextrose solution*
- This option provides approximately 50 g of dextrose (0.5 L * 100 g/L), resulting in 170 kcal. This is **significantly below the target of 500 kcal** from carbohydrates and would lead to underfeeding.
- It would also leave a substantial amount of the 1100mL fluid volume unaccounted for if this were the only carbohydrate source.
*250 mL of 50% dextrose solution*
- This option provides approximately 125 g of dextrose (0.25 L * 500 g/L), resulting in 425 kcal. While the caloric content is similar to the correct answer, using **50% dextrose in a standard TPN formulation can be challenging** due to its high osmolality, and typically requires central line administration, which might not be practical for a "module" if other components dilute it.
- A 25% solution is generally preferred for its better compatibility within TPN admixtures and safer peripheral administration if necessary.
Frailty assessment US Medical PG Question 10: A 30-year-old male gang member is brought to the emergency room with a gunshot wound to the abdomen. The patient was intubated and taken for an exploratory laparotomy, which found peritoneal hemorrhage and injury to the small bowel. He required 5 units of blood during this procedure. Following the operation, the patient was sedated and remained on a ventilator in the surgical intensive care unit (SICU). The next day, a central line is placed and the patient is started on total parenteral nutrition. Which of the following complications is most likely in this patient?
- A. Mesenteric ischemia
- B. Hypocalcemia
- C. Refeeding syndrome
- D. Sepsis (Correct Answer)
- E. Cholelithiasis
Frailty assessment Explanation: ***Sepsis***
- This patient has undergone **major abdominal surgery** after a **gunshot wound**, which carries a high risk of **peritoneal contamination** and subsequent infection.
- He also has several risk factors for sepsis, including **intubation**, central line placement, and possibly prolonged ventilation, all of which increase the risk of nosocomial infections and subsequent sepsis.
*Mesenteric ischemia*
- While possible in critically ill patients, there is no direct evidence such as advanced age, atherosclerosis, or specific signs of **bowel ischemia** (e.g., severe abdominal pain disproportionate to exam, bloody diarrhea) presenting in this case.
- The initial injury was to the small bowel, but the current context points more to systemic complications rather than a focal vascular event.
*Hypocalcemia*
- Hypocalcemia can occur in critically ill patients due to various reasons, but it is not the *most likely* complication given the patient's presentation primarily focused on surgical trauma and subsequent interventions.
- Dilutional effects from massive transfusions or **citrate toxicity** could contribute to temporary hypocalcemia, but sepsis poses a more immediate and widespread threat.
*Refeeding syndrome*
- Refeeding syndrome occurs when severely malnourished patients are rapidly refed, leading to shifts in **electrolytes** (especially **phosphate**, potassium, magnesium).
- Although the patient is starting **total parenteral nutrition (TPN)**, there's no indication of prior severe malnutrition, making sepsis a more prominent immediate concern due to the gunshot wound and surgery.
*Cholelithiasis*
- **Cholelithiasis** (gallstones) can be a long-term complication of total parenteral nutrition (TPN) due to gallbladder stasis.
- However, it is unlikely to develop so acutely within a day of starting TPN and is thus not the most immediate or likely complication for this patient's acute critical state.
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