GI Bleeding: ABFM practice questions

6 board-style questions on gi bleeding in the PulseMD family medicine question bank — physician-reviewed, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 72-year-old man on warfarin for atrial fibrillation presents to the emergency department with large-volume maroon-colored stools for the past 12 hours. His blood pressure is 92/58 mmHg, heart rate is 118 bpm, and hemoglobin is 7.2 g/dL. He appears pale, diaphoretic, and confused. INR returns at 4.2. After establishing two large-bore IV lines, which of the following is the most appropriate immediate management?

  1. Perform emergency colonoscopy immediately without correcting coagulopathy or hemodynamic instability
  2. Administer fresh frozen plasma alone and schedule colonoscopy within 72 hours
  3. Start IV pantoprazole drip and observe without transfusion since hemoglobin is above 7 g/dL
  4. Transfuse PRBCs to hemoglobin above 7 g/dL and reverse with IV vitamin K and 4-factor PCC

Sample question 2

A 73-year-old man with knee osteoarthritis reports inadequate pain relief with acetaminophen 1000 mg three times daily. His medical history includes hypertension, stage 3b chronic kidney disease with a GFR of 38 mL/min, and a hospitalization for upper gastrointestinal bleeding 2 years ago. He asks about trying a stronger pain medication for his knees. Which of the following is the most appropriate recommendation?

  1. Start naproxen 500 mg twice daily with a proton pump inhibitor
  2. Recommend topical diclofenac gel applied to the affected knees
  3. Start ibuprofen 400 mg three times daily with omeprazole
  4. Start celecoxib 200 mg daily as it has lower GI risk

Create a free PulseMD account to answer these, see the explanations, and practice five minutes a day.

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