Upper Gastrointestinal Haemorrhage

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Question 1 of 10

1. Question
A 70-year-old man presents to the emergency department after three large episodes of haematemesis and melaena over the preceding four hours. He has a history of chronic kidney disease.

Which of the following is true?
- Peptic ulcer disease is the most likely cause
- Bleeds from a peptic ulcer are the result of a raised portal pressure
- Mortality from upper GI bleeding has fallen significantly with advances in endoscopy.
- Overall mortality from an upper GI bleed is 1%
- Variceal bleeding is the most likely cause
Question 2 of 10

2. Question
The patient looks clammy and is cool peripherally. Pulse is 130 beats per minute and blood pressure 80/40mmHg

Which of the following is the most appropriate initial management option?
- Endoscopy
- Omeprazole 40mg IV
- Oxygen via non-breather mask
- Terlipressin 2mg IV
- Tranexamic acid 1g
Question 3 of 10

3. Question
With regards to risk assessment in this patient, which of the following is true?
- Rockall scores are good at predicting re-bleeding but not mortality
- The patient’s risk of death is less than ten percent
- The patient’s modified Rockall score is two
- The Glasgow-Blatchford score relies on endoscopic findings
- The pre-endoscopy Rockall score can be calculated with the information available
Question 4 of 10

4. Question
A 70-year-old man presents to the emergency department after three large episodes of haematemesis and melaena over the preceding four hours. He has a history of chronic kidney disease.

Pick the most appropriate initial medical therapy for this patient.
- Octreotide infusion
- Omeprazole 40mg IV
- Terlipressin 2mg IV
- Vitamin K 10mg IV
- None of the above
Question 5 of 10

5. Question
A decision is made to endoscope the patient. Which of the following options is true?
- Banding of a bleeding vessel in the base of a peptic ulcer is commonly performed
- Endoscopy controls bleeding in 20% of bleeding peptic ulcers
- High dose intravenous PPIs reduce re-bleeding rate but have no overall effect on mortality
- Transfusion of red cells pre-endoscopy has been shown to worsen outcomes
- With appropriate medical therapy, endoscopy can always be safely delayed to the next day
Question 6 of 10

6. Question
A 24-year-old female presents with a single episode of haematemesis and mild epigastric pain. She has been taking aspirin for the last five days following an ankle sprain. She is haemodynamically stable and routine blood tests are normal.

Which of the following is true?
- Digital rectal examination for signs of melaena should be done
- Omeprazole 40mg IV should be administered
- Rockall score of one means endoscopy is not indicated
- She can be discharged from the ED with an oral PPI
- Tranexamic acid 1g IV should be given
Question 7 of 10

7. Question
A 51-year-old female presents with severe acute haematemesis. Which of the following does not suggest a variceal bleed?
- Jaundice
- Chronic alcohol use
- Previous variceal bleed
- Encephalopathy
- Ascites
Question 8 of 10

8. Question
She is noted to be jaundiced with gross ascites. As well as arranging for urgent blood products to be administered, which of the following should also form part of the initial management?
- Omeprazole 40mg IV
- Ceftriaxone 1g IV
- Sengstaken-Blakemore Tube insertion
- Vitamin K 10mg IV
- Sodium Chloride 0.9% 500ml
Question 9 of 10

9. Question
Which of the following would be among the first line agents to be administered for this patient?
- GTN infusion
- Metoprolol 5mg IV
- Octreotide infusion
- Terlipressin 1g IV
- Tranexamic acid 1g IV
Question 10 of 10

10. Question
The patient continues to bleed despite optimal medical management, endoscopy is delayed and you decide to insert a Sengstaken-Blakemore tube.

Which of the following is true?
- Both gastric and oesophageal balloons should be inflated initially
- Complications are uncommon
- Re-bleeding after insertion occurs in <5% of patients
- The tube can be left in-situ for up to 72 hours
- The airway should be secured with an endotracheal tube prior to insertion

Upper Gastrointestinal Haemorrhage – Post Test

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