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Acute upper gastrointestinal bleeding — SCE Acute Medicine MCQ

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EasyAcute Gastrointestinal PresentationsAcute upper gastrointestinal bleedingSCE Acute Medicine

A 71-year-old woman presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show haematemesis, melaena, hypotension and Hb 76 g/L. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Resuscitate with blood products and arrange urgent endoscopy once stabilised

The key discriminator is that haematemesis, melaena, hypotension and Hb 76 g/L, which makes Resuscitate with blood products and arrange urgent endoscopy once stabilised the single best answer. Arrange urgent specialist referral is less appropriate because it does not address the dominant acute risk in the vignette; Arrange routine outpatient follow-up would fit a different presentation or later stage of care. Give controlled oxygen and senior review and Give intravenous fluids with reassessment are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE CG141