1. A 45-year-old woman with a history of type 1 diabetes for 20 years presents with persistent nausea, vomiting, and early satiety for the past 3 months. She has lost 10 kgs in the last 2 months. Physical examination reveals a distended abdomen with hypoactive bowel sounds. Laboratory tests show normal electrolytes and blood sugar control. Abdominal X-ray shows a gastric bezoar. Which of the following is the most appropriate initial management strategy for this patient?

• Oral Metoclopramide for nausea and vomiting
• Intravenous fluids and nutritional support
• Surgical removal of the gastric bezoar
• Empirical antibiotics for suspected bowel obstruction

2. A 62-year-old man with poorly controlled type 2 diabetes presents with worsening abdominal bloating, constipation, and a feeling of fullness after small meals. A gastric emptying study confirms a diagnosis of gastroparesis. He has tried dietary modifications and prokinetic medications with limited improvement. Considering his medication history and refractory symptoms, what is the next best step in the management of this patient?

• Increase the dose of his current prokinetic medication
• Refer for gastric electrical stimulation therapy
• Initiate a trial of tricyclic antidepressants
• Consider endoscopic pyloric dilation

3. A 32-year-old woman with a history of idiopathic gastroparesis presents to the emergency department with severe nausea, vomiting, and abdominal pain. She reports being unable to tolerate any oral intake for the past two days. Her blood pressure is low, and electrolytes show mild hypokalemia. Which of the following is the most appropriate immediate management for this patient?

• Nasogastric tube placement and prokinetic medication
• Oral rehydration therapy with electrolyte solutions
• Intravenous fluids, electrolyte replacement, and bowel rest
• Urgent surgical consultation for potential obstruction

4. A 55-year-old woman with a long-standing history of gastroparesis has managed her symptoms relatively well with dietary changes, medications, and occasional gastric venting via a gastrostomy tube. However, she recently developed a persistent low-grade fever and left upper quadrant abdominal pain. In addition to a thorough physical exam, what is the most appropriate initial diagnostic investigation for this patient?

• Gastric emptying study
• Upper endoscopy (EGD)
• Abdominal ultrasound with focus on the gallbladder
• Computed tomography (CT) scan of the abdomen

5. A 70-year-old man with chronic gastroparesis finds it increasingly difficult to maintain adequate nutrition with dietary modifications alone. He is hesitant about invasive procedures. His primary care physician discusses medication options to improve his nutritional status. Which of the following medications is FDA-approved specifically for the treatment of gastroparesis in adults who are unable to tolerate oral nutrition?

• Domperidone
• Metoclopramide
• Erythromycin
• Prucalopride