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Upper gastrointestinal bleeding — USMLE Step 2 CK MCQ

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HardInternal MedicineUpper gastrointestinal bleedingUSMLE Step 2 CK

A 49-year-old Hispanic woman comes to the emergency department because of abdominal pain or gastrointestinal symptoms. History and focused examination are notable for hematemesis, melena, orthostasis, and elevated blood urea nitrogen. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Laboratory studies show hemoglobin 8.4 g/dL, platelets 230,000/mm3, and creatinine 0.9 mg/dL unless otherwise specified. Which of the following is the most appropriate initial diagnostic study?

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Correct answer: C — Upper endoscopy after hemodynamic stabilization

The vignette describes Upper gastrointestinal bleeding, supported by hematemesis, melena, orthostasis, and elevated blood urea nitrogen. Upper endoscopy after hemodynamic stabilization is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: American College of Gastroenterology 2021 Upper GI Bleeding Guideline