MedMigrant

Question 32 · LEK · Upper gastrointestinal bleeding

A 54-year-old woman came to the ER because of bloody stool. On physical examination: good verbal communication, apathy, tachycardia 120/min, blood pressure 90/60 mmHg, pale skin, abdominal walls at the level of costal margins, the abdomen soft on palpation with no peritoneal signs, hyperactive bowel sounds, fresh blood visible on per rectum examination. On lab tests: WBC 17 000/mm³, RBC 2.9x10⁶/mm³, HGB 8.7 g/dL, PLT 60x10³/mm³, APTT 40 s, INR 1.9. Additionally there is hepatitis B infection several years earlier in the medical history. Indicate the true statements:

1) the first step should be fluids infusion and blood transfusion in order to manage hypovolemic shock;
2) colonoscopy should be performed because the most probable place of the bleeding 11 z 117 29.06.2026, 14:15 Centrum Egzaminów Medycznych https://test.cem.edu.pl/pytcem/wyswietl_baza_pdf.php is located in the lower gastrointestinal tract;
3) blood tests should be repeated in short time to confirm active bleeding;
4) urgent gastroscopy is indicated;
5) gastric tube should be placed in the stomach to evaluate its contents which would allow formulation of the correct diagnosis and proper treatment.
The correct answer is:
  1. A. 1,2,3.
  2. B. 2,3,5.
  3. C. 1,4.
  4. D. all the above.
  5. E. only 4.
Hint

Shock with fresh rectal blood and signs of liver disease suggests a brisk bleed from higher up; decide what comes first and what next.

The answer, the explanation and a note on every option are available once you log in. The account is free: topic tests, a mock exam, mistake review and statistics.

Create a free account Log in

More questions on Surgery