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gastrointestinal bleeding

Practice targeted AMC-style multiple-choice questions on gastrointestinal bleeding.

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gastroenterologyabdominal paincomputed tomography (CT)middle-aged manmelenaemergency managementabdominal imaginganemiaemergency medicinenausea
Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 45-year-old male presents with intermittent abdominal pain and melena. The provided image was obtained. What is the most likely underlying cause?

A. Henoch-Schönlein purpura
B. Cystic fibrosis
C. Meckel's diverticulum
D. Peutz-Jeghers syndrome
E. Blue rubber bleb nevus syndrome
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 38-year-old male presents to the emergency department with a 2-day history of intermittent abdominal pain, nausea, and vomiting. He reports passing dark, tarry stools. He has a known history of multiple cutaneous hemangiomas since childhood. On examination, his abdomen is distended and tender to palpation, particularly in the periumbilical region. Bowel sounds are hyperactive. Vitals are: HR 110 bpm, BP 100/60 mmHg, RR 20 breaths/min, SpO2 97% on room air, Temp 37.2°C. A CT scan of the abdomen and pelvis is performed, and a representative image is shown. Given the clinical presentation and imaging findings, what is the MOST appropriate initial management strategy?

A. Endoscopic evaluation with possible cauterization
B. Initiation of high-dose corticosteroids
C. Administration of intravenous antibiotics
D. Surgical exploration
E. Observation with serial abdominal examinations
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A 62-year-old man presents with a 4-month history of increasing fatigue, unintentional weight loss of 7 kg, and intermittent upper abdominal discomfort. He reports no change in bowel habits, dysphagia, or vomiting. His past medical history includes hypertension and osteoarthritis. He is a non-smoker and drinks alcohol occasionally. On examination, he is pale. His vital signs are stable. Abdominal examination reveals mild epigastric tenderness but no masses or organomegaly. There is no peripheral lymphadenopathy. Initial blood tests show haemoglobin 92 g/L (reference range 130-170), MCV 74 fL (80-95), ferritin 12 mcg/L (30-300), and CRP 18 mg/L (<5). Liver function tests and renal function tests are within normal limits. Which of the following is the most appropriate initial investigation?

A. Abdominal and pelvic CT scan
B. Faecal occult blood testing
C. Gastroscopy and colonoscopy
D. Upper gastrointestinal barium study
E. Bone marrow biopsy
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Giant hiatal hernia, CT image. 63 year old man.
Image by Jmarchn — CC BY 4.0 · Source

A 63-year-old man presents with iron deficiency anemia. The provided CT was performed. What is the MOST likely cause of his anemia?

A. Cameron lesions
B. Vitamin B12 deficiency
C. Gastric malignancy
D. Hookworm infestation
E. Pernicious anemia
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 45-year-old male with a known history of Blue Rubber Bleb Naevus Syndrome, characterised by recurrent gastrointestinal bleeding and multiple cutaneous vascular lesions, presents to the emergency department with acute onset severe, colicky abdominal pain, nausea, and vomiting. On examination, his abdomen is distended and diffusely tender with reduced bowel sounds. Vital signs are within normal limits. An urgent abdominal CT scan is performed. Considering the patient's history, acute presentation, and the findings on the abdominal CT scan, what is the most appropriate immediate management strategy?

A. Urgent surgical consultation for operative management
B. Attempt non-operative reduction via hydrostatic or pneumatic enema
C. Perform urgent upper and lower endoscopy to identify bleeding lesions
D. Initiate conservative management with intravenous fluids and nasogastric tube insertion
E. Administer broad-spectrum antibiotics and observe closely
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 35-year-old male with a history of multiple cutaneous vascular lesions presents with recurrent episodes of crampy abdominal pain and melena over the past month. His vital signs are stable. An abdominal CT scan is performed. Considering the clinical presentation and the findings demonstrated in the provided image, what is the most appropriate next step in the management of this patient?

A. Obtain an urgent abdominal MRI for better soft tissue detail
B. Surgical consultation for potential exploration
C. Conservative management with IV fluids and observation
D. Urgent colonoscopy to assess the bowel lumen
E. Attempt hydrostatic reduction with barium enema
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown — CC BY-SA 3.0 · Source

A 58-year-old male presents with iron deficiency anemia and a change in bowel habits. A colonoscopy was performed, and the image is shown. Biopsies were taken. Assuming the biopsies confirm malignancy, what is the next step?

A. Repeat colonoscopy in 6 months
B. Referral to a gastroenterologist for endoscopic mucosal resection
C. Fecal immunochemical test (FIT)
D. Initiate chemotherapy
E. CT scan of the abdomen and pelvis
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 45-year-old male presents with intermittent abdominal pain, bloating, and melena. He has a history of multiple cutaneous hemangiomas. A CT scan of the abdomen is performed, as shown. What is the MOST likely underlying cause of the patient's presentation?

A. Peutz-Jeghers syndrome
B. Blue rubber bleb nevus syndrome
C. Gardner syndrome
D. Cronkhite-Canada syndrome
E. Henoch-Schönlein purpura
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 45-year-old male presents with intermittent abdominal pain and melena. The provided image was obtained. What is the most appropriate next step in management?

A. Surgical resection of affected bowel segments
B. Perform colonoscopy to rule out other causes of bleeding
C. Initiate a trial of high-dose corticosteroids
D. Prescribe iron supplementation and monitor hemoglobin levels
E. Start empiric antibiotic therapy for suspected bacterial overgrowth
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 45-year-old male presents with intermittent abdominal pain and melena. He has multiple cutaneous hemangiomas. The provided image was obtained. What is the MOST likely underlying cause of the patient's presentation?

A. Peutz-Jeghers syndrome
B. Blue rubber bleb nevus syndrome
C. Gardner syndrome
D. Henoch-Schönlein purpura
E. Osler-Weber-Rendu syndrome
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 32-year-old male presents to the emergency department complaining of intermittent abdominal pain, nausea, and vomiting for the past 24 hours. He reports passing a small amount of blood in his stool this morning. He denies any fever or chills. His past medical history is significant for multiple cutaneous hemangiomas, which he has had since childhood. On physical examination, his abdomen is mildly distended and tender to palpation in the periumbilical region. Bowel sounds are hyperactive. The patient is hemodynamically stable. A CT scan of the abdomen is performed, the results of which are shown. Given the clinical presentation and imaging findings, what is the MOST appropriate next step in the management of this patient?

A. Initiation of high-dose corticosteroids
B. Surgical exploration
C. Colonoscopy with biopsy
D. Barium enema
E. Observation with serial abdominal examinations
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A patient with severe lower GI bleeding refractory to colonoscopy requires further management. Which intervention is most appropriate if the bleeding source is suspected in the small bowel or inaccessible colon?

A. Repeat colonoscopy
B. Increased dose of proton pump inhibitor
C. Angiography with potential embolization
D. Capsule endoscopy
E. Surgical resection
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown — CC BY-SA 3.0 · Source

A 65-year-old male presents with fatigue and occult blood in stool. Colonoscopy reveals the lesion shown. Biopsy confirms adenocarcinoma. What is the MOST appropriate next investigation to determine disease stage?

A. MRI of abdomen
B. CEA level
C. PET scan
D. CT scan of abdomen and pelvis
E. Endoscopic ultrasound
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An ultrasound showing target sign which is a characteristic finding for intussusception on ultrasound, this ultrasound is for a 3 year old boy with intestinal intussusception.
Image by Frank Gaillard — CC BY-SA 3.0 · Source

A 3-year-old boy presents with intermittent abdominal pain and bloody stools. An ultrasound is performed. What is the MOST appropriate next step in management?

A. IV antibiotics
B. Appendectomy
C. Air enema
D. Stool culture
E. Observation
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 45-year-old patient with a known history of multiple cutaneous vascular lesions presents to the emergency department with a 2-day history of intermittent, colicky abdominal pain and nausea. They report chronic fatigue and have a history of iron deficiency anaemia requiring occasional transfusions. On physical examination, vital signs are stable (BP 120/80, HR 75, RR 16, Temp 36.8°C). There is mild diffuse abdominal tenderness without guarding or rebound. Cutaneous examination reveals multiple blue-purple papules and nodules scattered over the trunk and limbs. An abdominal CT scan is performed. Considering the patient's clinical presentation, known history, and the findings demonstrated in the provided image, what is the most appropriate initial management strategy?

A. Discharge home with oral analgesia and urgent outpatient gastroenterology follow-up.
B. Inpatient medical management with pain control, intravenous fluids, and close observation for signs of obstruction or bleeding.
C. Immediate referral for small bowel capsule endoscopy to identify bleeding sources.
D. Initiate empirical treatment with intravenous antibiotics for suspected enteritis.
E. Urgent surgical exploration for reduction of the identified findings.
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A 25-year-old woman presents to the clinic with a 2-week history of abdominal pain and diarrhea. She reports that the pain is crampy and occurs mostly in the lower abdomen. She has also noticed some blood in her stool. She has no significant past medical history and is not on any medications. On examination, she has mild tenderness in the lower abdomen but no rebound tenderness or guarding. What is the most likely diagnosis?

A. Diverticulitis
B. Ulcerative colitis
C. Irritable bowel syndrome
D. Celiac disease
E. Gastroenteritis
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 48-year-old man with multiple cutaneous hemangiomas presents with crampy abdominal pain and guaiac-positive stools. The provided image was obtained. What is the MOST appropriate initial diagnostic test to identify the source of bleeding?

A. Tagged red blood cell scan
B. Upper endoscopy
C. Barium swallow
D. Colonoscopy
E. Capsule endoscopy
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Endoscopy image of colon adenocarcinoma in sigmoid colon.
Image by Unknown — CC BY-SA 3.0 · Source

A 65-year-old male presents with fatigue and occult blood in stool. Colonoscopy findings are shown. What is the MOST appropriate next step in management?

A. Start empiric antibiotics
B. Administer corticosteroids
C. Initiate iron supplementation
D. Repeat colonoscopy in 1 year
E. Surgical resection
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A 28-year-old male with Crohn's disease presents with increased abdominal pain, fever, and bloody stools. He is on azathioprine. What is the most appropriate next step?

A. Prescribe a high-fibre diet.
B. Start a course of oral metronidazole.
C. Increase the dose of azathioprine.
D. Order a CT scan of the abdomen and pelvis.
E. Reassure the patient and schedule a follow-up appointment.
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 35-year-old male presents to the ED with intermittent abdominal pain, nausea, and melena. He has multiple cutaneous hemangiomas. A CT scan is performed, as shown. What is the MOST appropriate next step in management?

A. Initiation of high-dose corticosteroids
B. Surgical resection
C. Observation with serial abdominal exams
D. Empiric antibiotic therapy
E. Colonoscopy with polypectomy
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An 98-year-old lady with cognitive impairment has had 2 episodes of acute delirium, is pacing, and is vomiting blood. What is the immediate management?

A. Give oral antiemetics and observe.
B. Start IV fluids and wait for review by GP.
C. Call 000 and transfer to the regional hospital.
D. SC line and administer haloperidol, morphine, and midazolam.
E. Arrange an urgent gastroscopy for tomorrow.
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 45-year-old patient with a long history of recurrent gastrointestinal bleeding and multiple cutaneous vascular lesions presents with acute onset severe abdominal pain, nausea, and distension. Physical examination reveals a distended, mildly tender abdomen. Bowel sounds are reduced. Vital signs are stable. Imaging is performed. Considering the patient's presentation and the findings demonstrated in the image, which of the following represents the most appropriate initial management approach?

A. Urgent upper and lower endoscopy to identify bleeding source.
B. Initiation of systemic medical therapy targeting vascular malformations.
C. Further imaging with mesenteric angiography.
D. Laparotomy for reduction or resection of affected bowel segments.
E. Non-operative management with nasogastric tube decompression and intravenous fluids.
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Synchronous multiple small bowel intussusceptions in an adult with blue rubber bleb naevus syndrome. CT scan of abdomen showing i) multiple intussusceptions demonstrating doughnut signs (white arrows), intussusceptiens [A], intussusceptum [B], distended loop of small bowel [C] and ii) haemangioma of right quadratus lumborum muscle (dark arrow).
Image by Lee C, Debnath D, Whitburn T, Farrugia M, Gonzalez F — CC BY 2.0 · Source

A 50-year-old man with multiple cutaneous lesions presents with recurrent episodes of abdominal pain and iron deficiency anemia. The provided image was obtained. What is the MOST appropriate next step in management?

A. Colonoscopy with polypectomy
B. Initiation of high-dose corticosteroids
C. Surgical resection of the affected bowel segment
D. Observation with serial abdominal exams
E. Empiric treatment for Helicobacter pylori
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