GI Bleeding: ABFM practice questions

6 board-style questions on gi bleeding in the PulseMD family medicine question bank, 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 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

Sample question 2

A 65-year-old man on warfarin for atrial fibrillation presents with 2 episodes of large-volume maroon-colored stools over the past 6 hours. He denies abdominal pain, vomiting, or melena. Vital signs show heart rate 112 bpm, blood pressure 95/60 mmHg, and he appears pale. Labs show hemoglobin 8.1 g/dL (baseline 13.5 g/dL), BUN 22 mg/dL, creatinine 1.0 mg/dL, and INR 4.2. What is the most appropriate initial management?

1. IV fluid resuscitation, blood transfusion, reversal of anticoagulation, and urgent colonoscopy after adequate resuscitation
2. CT angiography of the abdomen and immediate surgical consultation
3. Oral PPI twice daily and outpatient upper endoscopy within 1 week
4. Emergent colonoscopy within 1 hour

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

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