WBR0670
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| Author | [[PageAuthor::Twinkle Singh, M.B.B.S. [1]]] |
|---|---|
| Exam Type | USMLE Step 2 CK |
| Main Category | Internal medicine |
| Sub Category | Gastrointestinal, Gastrointestinal |
| Prompt | A 45 year old male comes to the emergency room with light headedness, abdominal pain and several episodes of vomiting which began after binge drinking of alcohol at a party. Vomiting was non bloody in the beginning but was associated with blood after few episodes. His vital signs include blood pressure 85/50, pulse 125/min, respiratory rate 19/min. What is the next step in management? |
| Answer A | Endoscopy and cauterization of bleeding vessels |
| Answer A Explanation | Endoscopy is the first investigation of choice in case of Mallory-Weiss syndrome, however in unstable patients fluid resuscitation is the first priority. |
| Answer B | IV fluid resuscitation |
| Answer B Explanation | Before endoscopy is done, IV fluids should be administered in any hemodynamic unstable patient. |
| Answer C | Omeprazole |
| Answer C Explanation | Proton pump inhibitors are indicated later in the course of treatment. |
| Answer D | Laboratory blood investigations |
| Answer D Explanation | Laboratory investigations are indicated, but not urgently. Attaining hemodynamic stability should be the priority in emergency room. |
| Answer E | No further management necessary |
| Answer E Explanation | Given patient is unstable therefore, requires fluid resuscitation and further investigations. |
| Right Answer | A |
| Explanation | It is a typical presentation of Mallory-Weiss syndrome which is characterized by blood in vomiting due to mucosal tears at junction of oesophagus and stomach. Most common precipitating factors are retching, forceful vomiting due to excessive alcohol use, alcohol binge, hiatal hernia and eating disorders. Endoscopy is the first investigation of choice and further management depends on endoscopic findings. However, before endoscopy is done, IV fluids should be administered in any hemodynamic unstable patient. Educational Objective: |
| Approved | No |
| Keyword | Mallory-Weiss syndrome, hemetemesis |
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