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Self-Assessment Questions

Gastroenterology

Gastrointestinal Hemorrhage: Review Questions

Douglas G. Adler, MD, and Todd H. Baron, MD, FACP

Dr. Adler is a Gastroenterology Fellow and Dr. Baron is an Associate Professor of Medicine, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.


Choose the single best answer for each question.

1. A 60-year-old man comes to the emergency department vomiting bright red blood. Severe retching preceded the bleeding. Esophagogastroduodenoscopy (EGD) is performed, revealing a clean-based but clearly visible laceration of the mucosa at the gastroesophageal junction (Mallory-Weiss tear). No active bleeding is present at the time of endoscopy. Which of the following is the most appropriate next step in this patient’s treatment?
  1. Observation
  2. Endoscopic heater probe therapy
  3. Blakemore tube (balloon tamponade)
  4. Surgical oversewing of the tear
  5. Transjugular intrahepatic portosystemic shunt (TIPS) placement
Click here to compare your answer.


2. A 45-year-old man has iron deficiency anemia and guaiac-positive stools. He takes prednisone, acetaminophen, and ibuprofen to treat his rheumatoid arthritis, smokes 2 packs of cigarettes daily, and drinks several cups of coffee each morning. EGD and colonoscopy are unremarkable. Small bowel enteroscopy reveals multiple shallow ulcers and several areas of stricturing with inflammation in the jejunum. Use of which of the following substances is the most likely cause of the findings in this patient?

  1. Acetaminophen
  2. Cigarettes
  3. Coffee
  4. Ibuprofen
  5. Prednisone
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3. A 50-year-old woman with cirrhosis is admitted to the intensive care unit because of gross hematemesis. EGD reveals multiple esophageal varices and portal hypertensive gastropathy. One of the esophageal varices that is acutely bleeding is successfully treated with endoscopic band ligation. Which of the following is the best treatment plan for this patient upon discharge from the hospital?

  1. Administration of propranolol only
  2. Administration of propranolol and endoscopic band ligation of the remaining varices
  3. Administration of propranolol and endoscopic sclerotherapy of the remaining varices
  4. Endoscopic band ligation of the remaining varices only
  5. Endoscopic sclerotherapy of the remaining varices only
Click here to compare your answer.


  4. A 70-year-old man with severe atherosclerosis who takes 1 baby aspirin (81 mg) daily undergoes cardiac catheterization because of chest pain. Later in the day, he develops severe abdominal pain and passes a large amount of bloody diarrhea. Physical examination reveals no peritoneal signs. Which of the following is the most likely cause of the patient’s bleeding?
  1. Colon cancer
  2. Diverticulitis
  3. Hemorrhoids
  4. Mesenteric ischemia
  5. Nonsteroidal anti-inflammatory drug enteropathy
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5. A 50-year-old man with cirrhosis comes to the hospital with massive upper gastrointestinal bleeding. EGD reveals actively bleeding gastric varices, but the gastroenterologist is unable to stop the bleeding. Despite vigorous blood and fluid replacement, the patient remains profoundly hypotensive. Which of the following is the most appropriate next step in this patient’s treatment?

  1. Emergent TIPS placement
  2. Insertion of a Blakemore tube
  3. Octreotide administration
  4. Propranolol administration
  5. Surgery
Click here to compare your answer.
 

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