8/6 CorePendium Board Review

A 65-year-old man presents with hematemesis and hypotension. He is pale and diaphoretic. What is the most appropriate initial step in management?

• Start proton pump inhibitor

• Perform nasogastric lavage

• Insert a large-bore nasogastric tube

• Initiate two large-bore IVs and begin resuscitation

Which of the following features most strongly suggests an upper GI source of bleeding?

• Bright red blood per rectum

• Hematochezia with normal BUN

• Melena with elevated BUN:Cr ratio

• Abdominal cramping and tenesmus

A 58-year-old male with cirrhosis presents with hematemesis and altered mental status. BP is 80/60 mmHg. What is the next best treatment step?

• Immediate endoscopy

• Initiate antibiotics, octreotide, and fluid resuscitation

• Place a Sengstaken-Blakemore tube

• Administer NSAIDs for portal hypertension

A 72-year-old woman with known diverticulosis presents with painless bright red blood per rectum. Her vitals are normal. What is the most appropriate next step?

• Emergent colonoscopy

• CT angiography

• Rectal exam and supportive care with observation

• Surgical consultation for urgent colectomy

Which of the following interventions is indicated prior to endoscopy in an unstable patient with upper GI bleeding?

• Broad-spectrum antibiotics only

• Anticoagulation reversal if applicable

• Nasogastric lavage to clear the stomach

• Platelet transfusion regardless of count

A 45-year-old man presents with rectal pain and a tender perianal mass. On exam, he has a thrombosed external hemorrhoid. What is the most appropriate initial management?

• Emergent surgical referral

• Rubber band ligation in the ED

• Warm sitz baths and topical analgesia

• Excision with elliptical incision if within 72 hours of onset

Which of the following is most characteristic of internal hemorrhoids?

• Sharp pain with defecation

• Visible perianal mass

• Painless rectal bleeding during bowel movements

• Foul-smelling discharge from the rectum

A 37-year-old postpartum woman presents with anal swelling and intense pain. Examination confirms a thrombosed external hemorrhoid. Which of the following is a contraindication to excision?

• A) Presentation within 24 hours of symptom onset

• B) Pregnancy status

• C) Immunocompetent status

• D) Delayed presentation beyond 72 hours

Which of the following is true regarding ED management of hemorrhoids?

• Narcotics are first-line pain relief

• Topical nitroglycerin is routinely used for bleeding hemorrhoids

• Stool softeners and fiber supplementation are key to prevention

• Antibiotics are routinely indicated in thrombosed hemorrhoids

A 29-year-old woman presents with sharp rectal pain and small amounts of bright red blood on toilet paper. She avoids defecation due to severe pain. Which finding on physical exam is most consistent with anal fissure?

• Painless protrusion of internal hemorrhoid

• Longitudinal tear at the posterior midline of the anal canal

• Firm external perianal mass

• Lateral ulcer with purulent drainage