USMLE Forum Archives - USMLE Step 2 CK - MALENA
MALENA
bingousmle - 05-18-10 00:55
A 58-year-old man seeks attention in the emergency department for weakness and melena, which he has had for 3 days. He says he has not had significant abdominal pain and had no prior gastrointestinal bleeding. On examination he is disheveled and unshaven, appears older than his stated age, and has a 20 mmHg orthostatic drop in blood pressure. Findings include bilateral temporal wasting, anicteric and pale conjunctivae, spider angiomas on his upper torso, muscle wasting, hepatosplenomegaly, and hyperactive bowel sounds without abdominal tenderness to palpation. Stool is melenic. Nasogastric aspiration reveals "coffee-grounds" material, which quickly clears with lavage. Hematocrit is 30 percent, and mean corpuscular volume is 105 fL. Saline gastric lavage is initiated. The appropriate next step in the management of this man's illness would be to
A perform gastroscopy
B pass a Sengstaken-Blakemore tube and begin an intravenous infusion of vasopressin (Pitressin)
C order an upper gastrointestinal series
D order immediate visceral angiography
E insert a large-bore intravenous line and type and cross-match the man's blood
bingousmle - 05-18-10 00:55
A 58-year-old man seeks attention in the emergency department for weakness and melena, which he has had for 3 days. He says he has not had significant abdominal pain and had no prior gastrointestinal bleeding. On examination he is disheveled and unshaven, appears older than his stated age, and has a 20 mmHg orthostatic drop in blood pressure. Findings include bilateral temporal wasting, anicteric and pale conjunctivae, spider angiomas on his upper torso, muscle wasting, hepatosplenomegaly, and hyperactive bowel sounds without abdominal tenderness to palpation. Stool is melenic. Nasogastric aspiration reveals "coffee-grounds" material, which quickly clears with lavage. Hematocrit is 30 percent, and mean corpuscular volume is 105 fL. Saline gastric lavage is initiated. The appropriate next step in the management of this man's illness would be to
A perform gastroscopy
B pass a Sengstaken-Blakemore tube and begin an intravenous infusion of vasopressin (Pitressin)
C order an upper gastrointestinal series
D order immediate visceral angiography
E insert a large-bore intravenous line and type and cross-match the man's blood
The correct answer and explanation will be available after you answer.
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#2
Re: MALENA
bingousmle - 05-18-10 01:25 E insert a large-bore intravenous line and type and cross-match the man's blood
#7
Re: MALENA mtniharika - 05-18-10 15:08 My answer is: e.
E. insert a large-bore intravenous line and type and cross-match the man's blood because the man requires blood transfusion very sooner.....
#8
Re: MALENA babbu5508 - 05-19-10 14:12 My answer is: e.
E insert a large-bore intravenous line and type and cross-match the man's blood because with a hematocrit of 30% he requires an immediate transfusion
#9
Re: MALENA ammulufy - 05-19-10 19:51 My answer is: e.
I feel the patient is suffering from probably liver pathology which has led to portal hypertension leading to Upper GI bleeding.......he is also in the state of liver failure.....but the symptom which immediatey requires attention is the 20 mm Hg orthostatic drop in BP,probably due to third space accumulation of the blood.....hence he requires immediate blood transfusion....therefore I go wid E.
#12
Re: MALENA bingousmle - 05-20-10 04:37 @ammulufy" I feel the patient is suffering from probably liver pathology which has led to portal hypertension leading to Upper GI bleeding.......he is also in the state of liver failure.....but the symptom which immediatey requires attention is the 20 mm Hg orthostatic drop in BP,probably due to third space accumulation of the blood.....hence he requires immediate blood transfusion....therefore I go wid E.
PRECISELY..
#14
Re: MALENA mtniharika - 05-25-10 04:40 
posted by ammulufy on 05-19-10 19:51
[ANSWER e]
I feel the patient is suffering from probably liver pathology which has led to portal hypertension leading to Upper GI bleeding.......he is also in the state of liver failure.....but the symptom which immediatey requires attention is the 20 mm Hg orthostatic drop in BP,probably due to third space accumulation of the blood.....hence he requires immediate blood transfusion....therefore I go wid E.
[ANSWER e]
I feel the patient is suffering from probably liver pathology which has led to portal hypertension leading to Upper GI bleeding.......he is also in the state of liver failure.....but the symptom which immediatey requires attention is the 20 mm Hg orthostatic drop in BP,probably due to third space accumulation of the blood.....hence he requires immediate blood transfusion....therefore I go wid E.
good...
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