MCCQE Study Set| 100 questions| With
Complete Solutions
What conditions should be considered in an adult presenting
with an upper GI bleed? correct answer: 1. Peptic ulcer disease:
Duodenal ulcers or Gastric ulcers
2. Varices
3. Mallory-weiss tears
4. Gastritis/esophagitis
5. Aortoenteric fistula
6. Malignancy
7. Angiodysplasia
What factors should be considered in the triage of upper GI
bleeding? correct answer: 1. Hemodynamic stability: pulse,
SBP
2. Hemoglobin level
3. BUN:Creatinine ratio
4. Symptoms: melena, syncope
5. Comorbidities: hepatic disease, cardiac failure
*Glasgow Blatchford score
*AIMS65: albumin, INR, AMS, SBP, age
What classes of medical therapy have a role in the treatment of
upper GI bleeds? correct answer: 1. PPIs (e.g., omeprazole,
pantoprazole): prevent rebleeds
2. Prokinetics (e.g., erythromycin): improve visualization
3. Stomatostatin analogs (e.g., octreotide): variceal bleeds
4. Antibiotics : patients with cirrhosis
,What benign causes of dark stool should be ruled-out before
considering a GI bleed? correct answer: 1. Iron supplementation
2. Recent Pepto-bismol use
What laboratory investigations should be ordered for a patient
with a suspected GI bleed? correct answer: 1. CBC
2. Coagulation: PTT/INR
3. Blood transfusion: group + screen (cross & type)
4. BUN/Cr (ration >10:1 suggests UGIB)
5. LFTs
*repeat labs in 4-6 hours to follow clinical course
Upper GI bleed + Epigastric or right upper quadrant pain
is suggestive of ________________________ correct answer:
Peptic ulcer disease
Upper GI bleed + Odynophagia, gastroesophageal reflux,
dysphagia
is suggestive of ________________________ correct answer:
Esophageal ulcer
Upper GI bleed + Emesis, retching, or coughing prior to
hematemesis
is suggestive of ________________________ correct answer:
Mallory-Weiss tear
(partial thickness tear)
Upper GI bleed + Jaundice, weakness, fatigue, anorexia,
abdominal distention
, is suggestive of ________________________ correct answer:
Variceal hemorrhage or portal hypertensive gastropathy
Upper GI bleed + Dysphagia, early satiety, involuntary weight
loss, cachexia
is suggestive of ________________________ correct answer:
Malignancy
What are signs of hemodynamic instability on physical exam?
correct answer: 1. Orthostatic hypotension (progressing to
supine)
2. Resting tachycardia
For most patients, at what hemoglobin level should transfusion
be initiated? correct answer: Hb 70 g/L
Why should transfusing patients with suspected variceal
bleeding to a hemoglobin >10 g/dL (100 g/L) be avoided?
correct answer: Overtransfusion in patients with suspected
variceal bleeding may precipitate worsening of the bleeding
What score is used to predict prognosis in chronic liver disease
and cirrhosis? correct answer: The Child-Pugh score:
1. Bilirubin (total)
2. Albumin
3. PTT
4. Ascites
5. Hepatic encephalopathy
*MELD score is used in End-stage liver disease
Complete Solutions
What conditions should be considered in an adult presenting
with an upper GI bleed? correct answer: 1. Peptic ulcer disease:
Duodenal ulcers or Gastric ulcers
2. Varices
3. Mallory-weiss tears
4. Gastritis/esophagitis
5. Aortoenteric fistula
6. Malignancy
7. Angiodysplasia
What factors should be considered in the triage of upper GI
bleeding? correct answer: 1. Hemodynamic stability: pulse,
SBP
2. Hemoglobin level
3. BUN:Creatinine ratio
4. Symptoms: melena, syncope
5. Comorbidities: hepatic disease, cardiac failure
*Glasgow Blatchford score
*AIMS65: albumin, INR, AMS, SBP, age
What classes of medical therapy have a role in the treatment of
upper GI bleeds? correct answer: 1. PPIs (e.g., omeprazole,
pantoprazole): prevent rebleeds
2. Prokinetics (e.g., erythromycin): improve visualization
3. Stomatostatin analogs (e.g., octreotide): variceal bleeds
4. Antibiotics : patients with cirrhosis
,What benign causes of dark stool should be ruled-out before
considering a GI bleed? correct answer: 1. Iron supplementation
2. Recent Pepto-bismol use
What laboratory investigations should be ordered for a patient
with a suspected GI bleed? correct answer: 1. CBC
2. Coagulation: PTT/INR
3. Blood transfusion: group + screen (cross & type)
4. BUN/Cr (ration >10:1 suggests UGIB)
5. LFTs
*repeat labs in 4-6 hours to follow clinical course
Upper GI bleed + Epigastric or right upper quadrant pain
is suggestive of ________________________ correct answer:
Peptic ulcer disease
Upper GI bleed + Odynophagia, gastroesophageal reflux,
dysphagia
is suggestive of ________________________ correct answer:
Esophageal ulcer
Upper GI bleed + Emesis, retching, or coughing prior to
hematemesis
is suggestive of ________________________ correct answer:
Mallory-Weiss tear
(partial thickness tear)
Upper GI bleed + Jaundice, weakness, fatigue, anorexia,
abdominal distention
, is suggestive of ________________________ correct answer:
Variceal hemorrhage or portal hypertensive gastropathy
Upper GI bleed + Dysphagia, early satiety, involuntary weight
loss, cachexia
is suggestive of ________________________ correct answer:
Malignancy
What are signs of hemodynamic instability on physical exam?
correct answer: 1. Orthostatic hypotension (progressing to
supine)
2. Resting tachycardia
For most patients, at what hemoglobin level should transfusion
be initiated? correct answer: Hb 70 g/L
Why should transfusing patients with suspected variceal
bleeding to a hemoglobin >10 g/dL (100 g/L) be avoided?
correct answer: Overtransfusion in patients with suspected
variceal bleeding may precipitate worsening of the bleeding
What score is used to predict prognosis in chronic liver disease
and cirrhosis? correct answer: The Child-Pugh score:
1. Bilirubin (total)
2. Albumin
3. PTT
4. Ascites
5. Hepatic encephalopathy
*MELD score is used in End-stage liver disease
