GI Bleeding Flashcards
A 34-year old woman comes to the clinic with fresh bleeding per rectum. What’s the most common cause of her lower GI bleeding?
A. Anal fissures.
B. IBD.
C. Hemorrhoids.
D. Angiodysplasia.
C
A 55 year old woman presents with intermittent bright red PR bleeding. On examination she is stable, and PR shows small external hemorrhoids. What is the appropriate treatment for this lady?
A. Reassure, prescribe treatment for hemorrhoids.
B. Refer to surgery for elective hemorrhoidectomy.
C. Prescribe the treatment for hemorrhoids, and arrange outpatient colonoscopy with surgical follow-up.
D. No further treatment necessary.
E. Admit to hospital for colonoscopy or double contrast barium enema.
C
woman with came in with frequent diarrhea that was experienced even during sleep, significant weight loss over 5 months and night sweats. Her mom has history of frequent diarrhea. What is the best next step?
A. Colonoscopy with endoscopy.
B. Endoscopy with laparotomy.
C. MRI of abdomen.
A
Patient with history of repaired tetralogy of fallot surgery in the past is now scheduled for colonoscopy due to lower GI bleeding. He is allergic to penicillin. The gastroenterologist asks you regarding this patient’s prophylaxis before starting the colonoscopy.
A. Oral amoxicillin.
B. Oral clindamycin.
C. Ciprofloxacin and metronidazole.
D. No prophylaxis required.
D
What is the most common cause of lower GI bleeding under 50 years of age?
A. Anal fissure.
B. Benign polyps.
C. Hemorrhoids.
D. IBD.
E. Diverticulosis.
C
All of the following are correct regarding upper GI bleeding except?
A. Use of NSAIDs double the risk of an upper GI bleed.
B. Urea will increase relative to creatinine in acute bleed.
C. Presence of fresh blood on aspiration of NG tube increases mortality as opposed to a clear aspirate.
D. Active bleeding seen at endoscopy has a 5% risk of rebleeding after treatment.
E. Most deaths occur from decompensation of other organ systems rather than exsanguination.
D
62 year old male with chronic history of progressive shortness of breath, fatigue and occasional lightheadedness. Initial investigations revealed the presence severe iron deficiency anemia. Which one of the following is least indicated in this clinical context?
A. Stool for occult blood.
B. Questions about melena, hematemesis or hematochezia.
C. Questions relevant to GI cancers, especially gastric, colon cancers.
D. Upper and/or lower GI endoscopy.
E. Vitamin B12 level.
E
Patient complaining of coffee ground vomiting, what is the most likely cause?
A. GI bleed.
B. GERD.
A
A 49 year old man known to have type 2 DM on metformin. He presented to the ER with history of bloody diarrhea for one week. It is associated with lower abdominal pain and fever. No history of nausea, vomiting or hematemesis. Patient is tolerating oral intake very well. No family member is having a similar presentation. On physical examination: BP 121/67, HR 105, temp 38.9, RR 18 and O2 sat 97%. His abdomen is diffusely tender with no rigidity or rebound tenderness. Initial work up showed leukocytosis with neutrophil predominance, normal hemoglobin level and normal metabolic panel.
What is the best next step?
A. Reassurance with no further testing.
B. Referral to gastroenterology for colonoscopy.
C. Request stool sample for culture/ova and parasite.
D. Request urgent CT abdomen/pelvic with contrast.
C
