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melena

Practice targeted AMC-style multiple-choice questions on melena.

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abdominal paingastroenterologygastrointestinal bleedingabdominal imagingcomputed tomography (CT)middle-aged mannauseayoung adultdifferential diagnosisemergency medicine
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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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 likely underlying pathology responsible for the patient's symptoms and the observed bowel findings?

A. Mesenteric adenitis triggering intussusception
B. Inflammatory strictures leading to obstruction
C. Lymphoid hyperplasia causing transient intussusception
D. Malignant polyps causing intussusception
E. Intestinal haemangiomas acting as lead points
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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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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 45-year-old male presents with intermittent abdominal pain and melena. The provided image was obtained. What associated cutaneous finding is most likely?

A. Blue rubber bleb naevi
B. Pustular lesions
C. Erythema nodosum
D. Café-au-lait spots
E. Spider angiomas
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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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