HY GASTROINTESTINAL EMERGENCY
MEDICINE. EXAM QUESTIONS AND
ANSWERS 100% PASS
What is GIB? - ANS Gastrointestinal Bleeding (GIB) is a life-threatening emergency with
potentially catastrophic outcomes.
What should be prioritized in GIB cases? - ANS Hemodynamic stability should always be
prioritized before determining the etiology.
What distinguishes upper GIB from lower GIB? - ANS Upper GIB is bleeding proximal to the
ligament of Treitz, while lower GIB is distal to it.
What does hematemesis indicate? - ANS Hematemesis indicates vomiting blood, with bright
red suggesting a brisk, recent bleed and coffee-ground indicating partially digested blood.
What is melena? - ANS Melena is black, tarry, foul-smelling stool, indicating blood has been
present in the GI tract for a prolonged time.
What does hematochezia refer to? - ANS Hematochezia refers to bright red blood per
rectum, which can be caused by massive upper GIB or slow lower GIB.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Name a common cause of upper GIB. - ANS Esophageal varices, Mallory-Weiss tear, peptic
ulcer disease, or Dieulafoy lesion.
What are common causes of lower GIB? - ANS Diverticulosis, arteriovenous malformations,
colon cancer, and hemorrhoids.
What are classic risk factors for GIB? - ANS NSAID use, anticoagulation, steroids, and alcohol
abuse.
What are signs of hypovolemic shock in GIB patients? - ANS Tachycardia, hypotension,
altered mental status (AMS), and orthostatic vitals.
What initial setup is required in the ED for GIB? - ANS Two large-bore IVs, cardiac monitor,
supplemental oxygen, and baseline labs including CBC and CMP.
What does a bright red aspirate from an NG tube indicate? - ANS It indicates an upper GIB.
What is the role of endoscopy in upper GIB? - ANS Endoscopy is both diagnostic and
therapeutic, identifying the cause in approximately 95% of upper GIB cases.
What is the 3:1 rule in GIB management? - ANS For every 1 mL of blood lost, administer 3 mL
of crystalloid fluid.
What is the goal urine output (UOP) in GIB management? - ANS The goal UOP is ≥30 mL/hr.
What treatment is indicated for peptic ulcer disease? - ANS Proton pump inhibitors (PPIs) and
treatment for H. pylori.
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, What is a key one-liner to remember about hematochezia? - ANS Hematochezia can still be
an upper bleed.
What is the significance of elevated BUN in GIB? - ANS Elevated BUN supports the diagnosis
of upper GIB.
What should be done before localizing the source of GIB? - ANS Resuscitation should be
performed before localizing the source.
What does the rectal exam reveal in GIB patients? - ANS The rectal exam is mandatory and
can provide important diagnostic information.
What is the treatment for variceal bleeding? - ANS Octreotide or vasopressin, endoscopic
banding/sclerotherapy, and Sengstaken-Blakemore tube.
What is Acute Mesenteric Ischemia (AMI)? - ANS A catastrophic abdominal emergency that
can lead to bowel infarction, perforation, sepsis, and death.
What is the mortality rate associated with AMI? - ANS Approximately 70%.
What is crucial for survival in cases of AMI? - ANS Early recognition and rapid surgical
intervention.
Which artery supplies the majority of the small bowel? - ANS Superior Mesenteric Artery
(SMA).
What is the most common mechanism of ischemia in AMI? - ANS Arterial embolism,
particularly from an SMA embolus due to atrial fibrillation.
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
MEDICINE. EXAM QUESTIONS AND
ANSWERS 100% PASS
What is GIB? - ANS Gastrointestinal Bleeding (GIB) is a life-threatening emergency with
potentially catastrophic outcomes.
What should be prioritized in GIB cases? - ANS Hemodynamic stability should always be
prioritized before determining the etiology.
What distinguishes upper GIB from lower GIB? - ANS Upper GIB is bleeding proximal to the
ligament of Treitz, while lower GIB is distal to it.
What does hematemesis indicate? - ANS Hematemesis indicates vomiting blood, with bright
red suggesting a brisk, recent bleed and coffee-ground indicating partially digested blood.
What is melena? - ANS Melena is black, tarry, foul-smelling stool, indicating blood has been
present in the GI tract for a prolonged time.
What does hematochezia refer to? - ANS Hematochezia refers to bright red blood per
rectum, which can be caused by massive upper GIB or slow lower GIB.
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Name a common cause of upper GIB. - ANS Esophageal varices, Mallory-Weiss tear, peptic
ulcer disease, or Dieulafoy lesion.
What are common causes of lower GIB? - ANS Diverticulosis, arteriovenous malformations,
colon cancer, and hemorrhoids.
What are classic risk factors for GIB? - ANS NSAID use, anticoagulation, steroids, and alcohol
abuse.
What are signs of hypovolemic shock in GIB patients? - ANS Tachycardia, hypotension,
altered mental status (AMS), and orthostatic vitals.
What initial setup is required in the ED for GIB? - ANS Two large-bore IVs, cardiac monitor,
supplemental oxygen, and baseline labs including CBC and CMP.
What does a bright red aspirate from an NG tube indicate? - ANS It indicates an upper GIB.
What is the role of endoscopy in upper GIB? - ANS Endoscopy is both diagnostic and
therapeutic, identifying the cause in approximately 95% of upper GIB cases.
What is the 3:1 rule in GIB management? - ANS For every 1 mL of blood lost, administer 3 mL
of crystalloid fluid.
What is the goal urine output (UOP) in GIB management? - ANS The goal UOP is ≥30 mL/hr.
What treatment is indicated for peptic ulcer disease? - ANS Proton pump inhibitors (PPIs) and
treatment for H. pylori.
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, What is a key one-liner to remember about hematochezia? - ANS Hematochezia can still be
an upper bleed.
What is the significance of elevated BUN in GIB? - ANS Elevated BUN supports the diagnosis
of upper GIB.
What should be done before localizing the source of GIB? - ANS Resuscitation should be
performed before localizing the source.
What does the rectal exam reveal in GIB patients? - ANS The rectal exam is mandatory and
can provide important diagnostic information.
What is the treatment for variceal bleeding? - ANS Octreotide or vasopressin, endoscopic
banding/sclerotherapy, and Sengstaken-Blakemore tube.
What is Acute Mesenteric Ischemia (AMI)? - ANS A catastrophic abdominal emergency that
can lead to bowel infarction, perforation, sepsis, and death.
What is the mortality rate associated with AMI? - ANS Approximately 70%.
What is crucial for survival in cases of AMI? - ANS Early recognition and rapid surgical
intervention.
Which artery supplies the majority of the small bowel? - ANS Superior Mesenteric Artery
(SMA).
What is the most common mechanism of ischemia in AMI? - ANS Arterial embolism,
particularly from an SMA embolus due to atrial fibrillation.
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
