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Severe lower gastrointestinal bleeding — SCE Acute Medicine MCQ

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HardAcute Gastrointestinal PresentationsSevere lower gastrointestinal bleedingSCE Acute Medicine

A 51-year-old man 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 ongoing haematochezia with hypotension and Hb 72 g/L. What is the most appropriate investigation?

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Correct answer: D — CT angiography

The key discriminator is that ongoing haematochezia with hypotension and Hb 72 g/L, which makes CT angiography the single best answer. Urgent CT angiography is less appropriate because it does not address the dominant acute risk in the vignette; Blood cultures before antibiotics would fit a different presentation or later stage of care. Non-contrast CT head and Serial high-sensitivity troponin 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: BSG lower GI bleeding guideline