Welcome to your 1. 🩸 Dysphagia, Upper GI Bleeding & Vomiting with Upper GI Bleeding Clinical Long Case Arena — 40 MCQs
1.
A 3-day-old neonate develops repeated bilious vomiting and abdominal distension. The infant becomes increasingly lethargic, with delayed capillary refill and reduced peripheral perfusion. An abdominal radiograph shows dilated intestinal loops, and intestinal malrotation with volvulus is suspected. Which management decision is most appropriate?
2.
A 49-year-old woman presents with intermittent dysphagia that has gradually worsened over two years. She reports nocturnal regurgitation, occasional coughing during sleep, and difficulty maintaining her weight. Upper GI endoscopy excludes an obstructing lesion. A barium swallow demonstrates a dilated esophagus with smooth tapering at the gastroesophageal junction. Which investigation would most appropriately confirm the underlying functional abnormality?
3.
A 56-year-old man taking ibuprofen for knee pain develops hematemesis and melena. He reports burning epigastric discomfort for three weeks. Examination reveals tachycardia and hypotension without evidence of chronic liver disease. Which is the most likely underlying cause of his bleeding?
4.
A 64-year-old man undergoes successful endoscopic treatment of a bleeding duodenal ulcer with a visible vessel. He is now hemodynamically stable. Which additional treatment is most appropriate to reduce the risk of early rebleeding?
5.
A 60-year-old patient with upper gastrointestinal bleeding is pale and tachycardic. His abdomen is soft, with mild epigastric tenderness but no guarding or rigidity. Which conclusion is most appropriate?
6.
A 56-year-old man presents with hematemesis and melena. Examination reveals pallor, a pulse of 118/min, blood pressure of 88/56 mmHg, cool extremities and delayed capillary refill. Which is the most appropriate interpretation of these findings?
7.
A 43-year-old woman presents with gradually increasing difficulty swallowing solid food. She has longstanding gastroesophageal reflux symptoms. Upper GI endoscopy identifies a short, smooth narrowing in the distal esophagus, and biopsy excludes malignancy. Which management strategy most directly addresses both the narrowing and its underlying cause?
8.
A 6-week-old infant presents with persistent nonbilious vomiting and poor weight gain. Ultrasonography confirms hypertrophic pyloric stenosis. After intravenous fluid replacement, the infant's serum potassium remains low and bicarbonate remains elevated. The surgical team postpones pyloromyotomy. Which explanation best justifies this decision?
9.
A 61-year-old man is admitted after several episodes of hematemesis. Following intravenous fluid resuscitation, his blood pressure improves to 112/70 mmHg. His hemoglobin is 8.8 g/dL, platelet count is normal, and coagulation tests are within reference ranges. He has no known liver disease. Which therapeutic approach is most appropriate while arranging early endoscopy?
10.
A 72-year-old man presents with progressive dysphagia and a recent episode of food impaction. Endoscopy identifies a tight, irregular narrowing in the middle third of the esophagus. Multiple biopsies are obtained, and the patient is unable to maintain adequate oral nutrition. Which approach is most appropriate?
11.
A 32-year-old woman at 10 weeks of gestation has persistent vomiting despite initial dietary measures and oral antiemetics. She remains unable to tolerate fluids, has reduced urine output, and demonstrates significant electrolyte disturbance. What is the most appropriate management decision?
12.
A 62-year-old patient undergoes successful endoscopic treatment for a bleeding duodenal ulcer. Several hours later, he develops fresh hematemesis, tachycardia, hypotension and a further fall in hemoglobin. Which is the most appropriate next step?
13.
A 62-year-old man presents with hematemesis. He reports several episodes of forceful vomiting before noticing blood in his vomitus. He has no preceding epigastric pain, known liver disease or recent NSAID use. Which bleeding source is most strongly suggested by this history?
14.
A 54-year-old man presents with hematemesis. Examination reveals jaundice, ascites, splenomegaly and spider angiomas. Which interpretation best explains the significance of this combination of findings?
15.
A 28-year-old woman recovering from hyperemesis gravidarum reports anxiety about persistent nausea and possible effects on her pregnancy. Her oral intake is improving, and investigations show correction of previous electrolyte abnormalities. Which approach best addresses her ongoing care?
16.
A 29-year-old primigravida at 12 weeks of gestation presents with severe vomiting and poor oral intake. She reports palpitations, tremor, and heat intolerance. Examination reveals mild tachycardia, and thyroid function tests show suppressed TSH with mildly elevated free thyroxine. There is no goiter or ophthalmopathy. Which interpretation is most appropriate?
17.
A 67-year-old man presents with intermittent hematemesis and progressive fatigue. He has experienced loss of appetite, unintentional weight loss and early satiety over three months. He denies recent NSAID use or preceding retching. Which diagnosis requires particular consideration?
18.
An 8-month-old infant presents with recurrent vomiting, reduced feeding, and poor weight gain. The child has persistent regurgitation and episodes of coughing during feeds. Examination shows mild nutritional compromise without acute dehydration. Which feature most strongly indicates that the vomiting requires investigation rather than reassurance alone?
19.
A 46-year-old man presents with hematemesis after several episodes of forceful retching associated with acute alcohol intake. He has no history of liver disease or previous peptic ulcer symptoms. Endoscopy reveals a longitudinal mucosal tear at the gastroesophageal junction without active bleeding. Which mechanism best explains the lesion?
20.
A 56-year-old man with hematemesis and melena undergoes upper gastrointestinal endoscopy after initial stabilization. A duodenal ulcer with a non-bleeding visible vessel is identified. Which is the most appropriate interpretation of this endoscopic finding?
21.
A 70-year-old man with upper gastrointestinal bleeding initially responds to resuscitation. Over the next few hours, his urine output falls, his pulse increases and his blood pressure decreases despite treatment. Which complication should be suspected?
22.
A 67-year-old woman taking aspirin for coronary artery disease presents with coffee-ground vomiting and melena. After initial stabilization, her hemoglobin falls from 10.1 to 8.3 g/dL, and she develops postural hypotension. Upper GI endoscopy reveals a gastric ulcer with a visible nonbleeding vessel. Which interpretation is most appropriate?
23.
A 56-year-old man arrives with ongoing hematemesis, a pulse of 122/min and blood pressure of 82/48 mmHg. He is pale, anxious and has cold extremities. Which immediate management approach is most appropriate?
24.
A 59-year-old man is admitted with significant hematemesis and melena. His hemoglobin is 8.2 g/dL, urea is 15 mmol/L and creatinine is 1.1 mg/dL. Which is the most appropriate interpretation of the elevated urea level in this clinical context?
25.
A 58-year-old man with hematemesis and melena reports progressive abdominal distension over several months. He has previously been diagnosed with liver cirrhosis and has undergone therapeutic paracentesis. Which potential bleeding source should receive particular consideration?
26.
A 56-year-old man presents with two episodes of hematemesis and one episode of melena over six hours. He reports dizziness on standing and intermittent epigastric discomfort. Which additional history would be most useful in identifying a likely underlying cause of his bleeding?
27.
A 61-year-old patient with suspected upper gastrointestinal bleeding undergoes nasogastric aspiration for a separate clinical indication. The aspirate is clear, but the patient has a history of hematemesis and ongoing melena. Which conclusion is most appropriate?
28.
A 63-year-old man presents shortly after a large episode of hematemesis. His pulse is 124/min, blood pressure is 85/50 mmHg and his initial hemoglobin is 12.1 g/dL. Which interpretation should guide the treating team?
29.
A 54-year-old man with decompensated cirrhosis presents with hematemesis. Following initial stabilization, intravenous vasoactive treatment is started and urgent endoscopy is arranged. The endoscopist identifies actively bleeding esophageal varices. Which intervention is most appropriate for definitive endoscopic control?
30.
A 24-year-old pregnant woman with severe hyperemesis has been unable to maintain adequate food intake for two weeks. During admission, she develops difficulty walking, confusion, and abnormal eye movements. She received carbohydrate-containing intravenous fluids without prior vitamin supplementation. Which complication is most strongly suggested?
31.
A 63-year-old patient undergoes endoscopic treatment for a bleeding peptic ulcer. Despite successful hemostasis, the medical team continues monitoring blood pressure, pulse, urine output, serial hemoglobin, and stool characteristics. What is the principal reason for this approach?
32.
A 26-year-old woman at 11 weeks of pregnancy is admitted with severe persistent vomiting. She is dehydrated and unable to tolerate oral fluids. Laboratory investigations reveal hyponatremia, hypokalemia, and elevated urea. Her blood pressure is 94/60 mmHg. Which initial treatment strategy is most appropriate?
33.
A 10-week-old infant has frequent vomiting, reduced feeding, and insufficient weight gain. The infant is clinically stable, and investigations exclude mechanical obstruction. Assessment suggests clinically significant gastroesophageal reflux. Which is the most appropriate initial therapeutic approach?
34.
A 56-year-old man presents with hematemesis, melena, tachycardia and hypotension. He has been taking ibuprofen and has recurrent epigastric discomfort. Which statement best summarizes the clinical problem before definitive investigations?
35.
A 59-year-old man is hospitalized with severe upper gastrointestinal bleeding. After initial resuscitation, endoscopic treatment successfully controls a bleeding duodenal ulcer. Six hours later, his pulse increases from 86 to 118/min, blood pressure decreases, and he passes another large black stool. Which is the most appropriate next clinical action?
36.
A 56-year-old man is preparing for discharge after treatment of an NSAID-associated bleeding duodenal ulcer. He is stable and asks what precautions he should take. Which counselling advice is most appropriate?
37.
A 30-year-old woman at 13 weeks of pregnancy presents with persistent vomiting despite appropriate initial antiemetic treatment. She now has marked abdominal pain, fever, and localized abdominal tenderness. The clinical team considers whether all symptoms can be attributed to hyperemesis gravidarum. Which interpretation is most appropriate?
38.
A 59-year-old man has a bleeding duodenal ulcer treated successfully by endoscopy. He reports regular ibuprofen use and subsequent testing confirms Helicobacter pylori infection. Which long-term management approach best reduces his risk of recurrent ulcer bleeding?
39.
A 58-year-old man is admitted with hematemesis and melena. Following initial fluid resuscitation, his blood pressure improves and he remains conscious without further large-volume hematemesis. A non-variceal upper gastrointestinal source is suspected. Which investigation plan is most appropriate?
40.
A 4-week-old infant is evaluated for persistent vomiting. The parents report increasing abdominal distension and episodes of green vomitus. Examination reveals reduced bowel sounds and clinical dehydration. Which investigation is most appropriate as an initial imaging assessment while urgent surgical evaluation is arranged?
