06 S P M P On Acute Gastrointestinal Bleeding


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06 S P M P On Acute Gastrointestinal Bleeding

  1. 1. SPMP on Acute Gastrointestinal Bleeding<br />Dr. S. Aswini Kumar. MD<br />A 45 year-old man is admitted with sudden onset of vomiting of blood in large quantities: <br />VI. 01. The diagnosis or upper gastrointestinal bleeding can be suspected in presence of the following EXCEPT:<br />Blood vomited is red in color<br />Coffee ground vomitus<br />Presence of accompanying food particles<br />History of cough with expectoration<br />Presence of black tarry stools<br />VI. 02. Hemoptysis is more likely possibility in presence of all of the following symptoms EXCEPT: <br />Coughing which precedes <br />Sputum accompanying the spitting of blood<br />Previous history of lung disease<br />CXR demonstrating pulmonary lesion<br />All of the above<br />VI. 03. Common cause for upper gastrointestinal bleeding in the adult is: <br />Peptic ulcer disease<br />Esophageal varices<br />Acute erosive gastritis<br />Mallory Weiss tears<br />All of the above<br />VI. 04. Uncommon causes of UGI bleeding in an adult are the following EXCEPT: <br />Esophagitis<br />Stress ulcer<br />Esophageal or gastric neoplasm<br />Appendicitis<br />Vascular Ectasia<br />VI. 05. Amount of blood lost from the stomach can be inferred from:<br />Quantity of blood lost as narrated by patient<br />Amount of blood drained by Ryle’s tube<br />Blood pressure fall in sequential recordings<br />The progressive increase in pallor<br />All of the above<br />VI. 06. The following statements about nasogastric aspiration are TRUE, EXCEPT: <br />A NGT should be inserted in all patients<br />The NGT should be manually aspirated<br />Continuous suction is contraindicated<br />Presence of blood or coffee ground s is diagnostic<br />A heme occult test should be performed on it<br />VI. 07. Investigations to be done as an emergency are the following EXCEPT:<br />Estimation of Hb and CBC<br />PT APTT and platelet count<br />Blood grouping and cross matching<br />Liver function tests in all patients<br />X-Ray films of chest and abdomen<br />VI. 08. Following treatment should be instituted immediately EXCEPT:<br />Insertion of large bore IV fluid access.<br />Administer large volumes of normal saline <br />Naso-gastric lavage with ice cold normal saline.<br />Emergency transfusion of fresh whole blood, <br />Inj. Heparin 5000units S/C 8hrly<br />VI. 09. All of the following are indications for urgent Blood Transfusion EXCEPT: <br />Naso-gastric aspiration showing active bleeding<br />Patient is in shock or BP is below 90mmHg<br />Hemoglobin is less than 5 gm%<br />Total amount of blood lost is less than 200ml<br />Black tarry stools are present <br />VI. 10. All the following statements regarding Octreotide are TRUE EXCEPT:<br /><ul><li>It should be given to all patients with GI Bleed
  2. 2. Initial dose of 50 micro gram /hour IV is given
  3. 3. Maintenance dose is 25ug/hour as IV infusion.
  4. 4. No major contra indications except hypersensitivity.
  5. 5. Octreotide 50ug is injected intra-variceally.</li></ul>VI. 11. All the following statements regarding Vasopressin are TRUE EXCEPT:<br /><ul><li>Only beneficial for bleeding esophageal varices
  6. 6. Initiated as a stop gap measure until endoscopy
  7. 7. Dose of 100 units in 250ml of 5% dextrose IV.
  8. 8. Can cause coronary, mesenteric or cerebral ischemia
  9. 9. Selective arterial infusion is preferred route of admn</li></ul>VI. 10. Following additional treatment can be given in UGI bleeding EXCEPT:<br /><ul><li>Ranitidine 50mg IV q 6 hourly</li></ul>Pantoprazole 40mg IV bid.<br />Vitamin K 10mg IM OD X 3 consecutive days<br />Correction of coagulopathy with FFP and PRP<br />All of the above<br />VI. 11. Supportive therapy will include the following EXCEPT<br /><ul><li>Sedation with Promethazine 25-50mg IM
  10. 10. Nil orally till bleeding stops
  11. 11. Liquid diet with milk or kanji water, thereafter
  12. 12. Prohibition of tea, coffee, alcohol and smoking
  13. 13. Non steroidal anti inflammatory drugs </li></ul>VI. 14. If bleeding continues in spite of above measures the following treatment modalities may be instituted EXCEPT:<br />Introduction of a Senstaken Blackmore tube <br />Minnesota modification of the tube if available<br />Emergency endoscopy and sclero-therapy <br />Banding of the esophageal varices<br />Surgical resection of duodenum <br />VI. 15. Emergency gastro-duodenal endoscopy is indicated in the following situation: <br />Bleeding due to esophageal varices<br />Actively continuing UGI bleeding <br />Massive upper GI bleeding<br />Hemodynamically unstable patient<br />All of the above<br />VI. 16. In patients with CLD & variceal bleeding treatment to prevent Hepatic encephalopathy should be given EXCEPT:<br /><ul><li>Lactulose 30ml three times daily
  14. 14. Inj. Ampicillin 1gm IV q6hrly
  15. 15. Bowel wash BID
  16. 16. High protein low carbohydrate diet by mouth
  17. 17. Propranolol 20-40 mg thrice daily </li></ul>VI. 17. Indications for emergency surgical consultation are the following EXCEPT: <br />Associated perforation, obstruction or malignancy <br />Bleeding after recent GI surgery<br />Good response to endoscopic therapy<br />Endoscopic stigmata of high risk of re-bleeding<br />Suspected aorto=enteric fistula or vasculopathy<br />