A 16-year-old woman with no significant medical history presents with quickly progressing encephalopathy and jaundice. A friend feels she may have taken a bottle of acetaminophen tablets one day prior to admission. Her bilirubin is 2.4 mg/dL, alkaline phosphatase 240 U/L, AST 2400 U/L, ALT 3200 U/L, creatinine 2.7, arterial pH 7.2, INR 6.6, and acetaminophen level 60. Which of the following is false?

Correct Answer: C

Rationale: This young woman has a poor prognosis for recovery using the King's College criteria, and will likely need a liver transplant. She should be intubated immediately for airway protection, given N-acetylcysteine, and transferred to a transplant center. Lactulose has no efficacy in acute liver failure.

Correct Answer: A

Rationale: Spicy foods can irritate the gastric mucosa and exacerbate PUD symptoms, making avoidance the most appropriate advice.

Correct Answer: B

Rationale: Managing and preventing shock is critical in a bleeding ulcer due to the risk of hypovolemia from significant blood loss.

Correct Answer: B

Rationale: Caffeinated beverages stimulate acid production, worsening PUD symptoms, and should be avoided.

Correct Answer: B

Rationale: Bismuth subsalicylate coats the ulcer, forming a protective barrier against acid and pepsin.