American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the initial management for patients with gastroparesis?

1. Prompt identification and treatment of dehydration, electrolyte disturbances, and micronutrient deficiencies

2. Immediate surgical intervention

3. Administration of high-calorie intravenous fluids

4. Use of experimental medications

The correct answer is: Prompt identification and treatment of dehydration, electrolyte disturbances, and micronutrient deficiencies

The initial management for patients with gastroparesis primarily involves prompt identification and treatment of dehydration, electrolyte disturbances, and micronutrient deficiencies due to the condition’s impact on gastric emptying. Gastroparesis can lead to poor oral intake, nausea, and vomiting, which may result in dehydration and imbalances in electrolytes, as well as deficiencies in essential vitamins and minerals. Addressing these issues is critical to stabilizing the patient and preventing complications that may arise from malnutrition or dehydration. It sets a foundation for further management of gastroparesis, which may include dietary modifications, prokinetic agents, or symptomatic treatment depending on the underlying cause and severity of the symptoms. Other options such as surgical intervention, administration of high-calorie intravenous fluids, or experimental medications do not represent initial management steps. Surgical interventions may be considered in select cases if conservative measures fail, while intravenous fluids and experimental treatments would typically come after ensuring the patient is stable and free from the complications of nutritional deficiencies. Thus, focusing on hydration and electrolyte balance is the most appropriate first step in managing a patient with gastroparesis.