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  #1  
Old 04-23-2011
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GIT Man with history of PUD

A 55-year-old man who has a history of peptic ulcer disease reports two episodes of haematemesis over 24 hours. He feels giddy in the standing position. The radial pulse is 120/min and the blood pressure in the supine position is 60/40 mm Hg. He is slightly disorientated to place.

Which one of the following is the most appropriate step in the management of this patient?
A. Nasogastric tube placement and gastric lavage
B. Rapid blood replacement
C. Intravenous infusion of H2 receptor antagonists
D. Urgent upper GI endoscopy
E. Emergency laparotomy
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  #2  
Old 04-23-2011
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This is a good question.
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Old 04-23-2011
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Quote:
Originally Posted by add1 View Post
The answer would be rapid blood replacement.
dont u think it should be rapid fluid replacement with emergency laparotomy due to perhaps an ulcer rupture? rapid blood replacement is not routinely done in emergency situations ryte?

sorry i dont have the answer to this question.
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Old 04-23-2011
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i think D ......
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  #5  
Old 04-23-2011
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ahmedadel can u please explain ur answer?
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Old 04-23-2011
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guys, it says most appropriate step in management, not next best step, so in any case, surgery is the only way to stop the bleeding permanently so answer is E.
If the question says next best step, it should be fluid replacement. I don't think blood transfusion is done in acute cases like this
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Old 04-23-2011
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guys are these NBME questions?
please don't post nbme questions!!! (I speak for everyone when I say this)
thanks!
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Old 04-23-2011
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it really doesn't feel like an NBME question! btw people IN CASE you are posting NBME questions please mark as NBME so that those who want to take the forms don't get unrealistic predictions!

PLEASE GUYS! It's for the benefit of everyone and then those who have taken that form can still answer!
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  #9  
Old 04-23-2011
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Ideally 2 large IV access with fluid resuscitation promptly, then urgent endoscopy!

I would go with D.
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  #10  
Old 04-23-2011
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i still think i agree with E being the answer.

relax guys. these are not NBME questions. its an entrance exam to do residency in the UAE. not tht im thinking of taking my residency there but after my residency in the states ill have to follow my hubby to the UAE. and these questions have no answers. so ones tht are hard for me i discuss here...
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Old 04-23-2011
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100% " Emergency laprotomy"....E
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Old 04-23-2011
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best ans is E.......this is a case of ulcer peforation which has to be treated by laparotomy ........actly such cases r treated as follows----

A---aspiration with ryles tube
B---bowel care (dont give purgatives) / Blood transfusion if needed
C---maintaining Charts like temp. pulse , BP , RR ie.vitals plus uriine output etc
D---drugs like antibiotics to prevent post-operative infection
E---Emergency laparotomy in which perforation is sutured
F---Fluid replacement ( both pre-and post-operative ) to prevent electrolyte imbalance
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  #13  
Old 04-23-2011
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well recently i did a qs in Uworld n exactly it was to resuscitate the pt n do laparatomy...but this resuscitation is always on operating table bcx if directly opt for laparatomy without resuscitation, pt will be expired n already with 90/60 bp.
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  #14  
Old 04-23-2011
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1st we need to resuscitate the patient to stabilize him, thn in nxt step we wll go for endoscopy..
as pulseof 120 and B.p of 60(sys) and giddiness indicate resuscitation necessory.
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  #15  
Old 04-23-2011
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Emergency management always begins with
A-airway
B- breathing
C - circulation
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