Single choice questions on acute upper GI bleeding for
training 6
th
year students
To answer these questions, refer to seminar on acute upper GI
bleeding, please
Q1: A 30-year-old female presented with history of a single episode of vomiting a coffee
ground like material. She also claimed a tarry coloured stool for preceding 3 days. No
history of drug ingestion or liver disease. The most likely cause for his current illness is:
a) Acute erosive gastritis
b) Peptic ulcer disease
c) Esophageal variceal bleeding
d) Acute duodenitis
e) Mallory - Weiss syndrome
Q2: A 50-year-old male patient admitted to emergency department with diagnosis of
acute upper GI bleeding. All of the following are true regarding initial assessment and risk
stratification, except:
a) Hemodynamic status should be assessed immediately upon presentation and
resuscitative measures begun as needed.
b) Blood transfusions should target hemoglobin >= 9 g/dl, even in patients without
clinical evidence of intravascular volume depletion or comorbidities.
c) Risk assessment should be performed to stratify patients into higher and lower risk
categories.
d) Nasogastric tube is not necessary in majority of cases.
e) The patient's prothrombin time (PT), and international normalized ratio (INR) should
be checked immediately.
Q3: A 40-year-old patient presented with several bouts of blood containing vomitus.
Which one of the following points in history of the patient is least likely to indicate a
variceal source for bleeding?
a) History of pancreatitis.
b) History of excessive alcohol intake.
c) History of chronic hepatitis B.
d) History of portal vein thrombosis.
e) History of significant weight loss and fatigue.
Q4: In a patient with presumed non-variceal bleeding without co-morbid illnesses, BP
stabled at 110/65, PR 80/m and his upper endoscopy demonstrated a clear base, non-
bleeding duodenal ulcer. According to calculated Rockall scores, which of the following
actions is necessary at this step:
a) This patient can be discharged safely on the same day.
b) The patient needs admission to hospital for at least 3 days before discharging.
c) IV rather than oral PPI is very necessary at this step.
d) H. pylori eradication is not necessary in most of such cases.
e) Tarlipressin 4 mg IV is indicated if the patient re-bleeds.
Q5: A 50-year-old male patient with history of 30 -35 units of alcohol drinking per week for
years, presented with vomiting of about 2 cupful bright red vomiting in past 3 hours. On
examination the patient looks confused and agitated, with flapping tremor and numerous
spider angiomata over his upper torso. Abdominal examination revealed a distended
abdomen with positive shifting dullness. The most likely cause for his bleeding is:
a) Thrombocytopenia due to hypersplenism.
b) Acute erosive gastritis due to excessive alcohol ingestion.
c) Acute variceal bleeding.
d) Peptic ulcer disease.
e) Coagulopathy due to damaged hepatic cells.
Q6: An upper endoscopy was arranged for 65 year-old- male patient because of twice
vomiting of coffee ground like material. Endoscopic finding revealed the presence of non-
bleeding pulsatile vessel at a base of an ulcer at first part of duodenum. According to
Forrest classification this lesion considers:
a) Forrest I a
b) Forrest I b
c) Forrest II a
d) Forrest II b
e) Forrest II c
Q7: A 45 -year-old patient with previous history of esophageal varices, presented with
severe acute, upper GI bleeding. Initial resuscitation was done for him in emergency
department. Further management of this patient includes all the following, except:
a) Urgent endoscopy and band ligation.
b) Non-selective Beta blocker on discharge.
c) Management in intensive care unit.
d) IV tarlipressin.
e) IV proton pumps inhibitor (PPI).
Q8: A patient presented with severe upper GI bleeding with history of dyspepsia for 4
months. On examination there were no stigmata of chronic liver disease. A mild
tenderness was present at epigastric region. The endoscopist suggests an IV erythromycin
prior to endoscopy. The main role of giving erythromycin IV before endoscopy in severe
non-variceal bleeding is:
a) Creating a clear field endoscopy because erythromycin enhances gastric emptying.
b) To protect against bacterial infection.
c) It may decrease mortality.
d) It helps early discharge from hospital.
e) It is found that erythromycin helps to stop bleeding in some patients.
Q9: The actual role of octreotide in management of a 35-year-old patient presented with
upper GI bleeding due to variceal bleeding:
a) It decreases both portal and portal-systemic collateral blood flow.
b) It has no direct vasoconstrictive action on mesenteric arteries.
c) It corrects coagulopathy due to liver disease.
d) It is also recommended for routine use in patients with acute nonvariceal upper GI
bleeding.
e) It clears the endoscopic field, so eases the variceal ligation.
Q10: A 65-yeasr-old man presented with history of passing a tarry color, shiny and sticky
stool during last week. Also she claimed a dizzy feeling on standing. On examination she
looks pale with BP 107/65. What is the least likely cause for her current condition?
a) Peptic ulcer disease.
b) A bleeding lesion in small intestine.
c) Caecal carcinoma.
d) Bleeding piles (hemorrhoids).
e) Carcinoma of ascending colon.