ROSH Gastrointestinal Practice Exam

What is the next best step in managing a 52-year-old man presenting with hematemesis and a normal blood count?

1. Admission to the intensive care unit for further observation

2. Insert a nasogastric tube to evacuate gastric contents

3. Order a type and screen and begin fluid resuscitation

4. Send the patient for endoscopy

The correct answer is: Send the patient for endoscopy

In a case involving a 52-year-old man who is experiencing hematemesis (vomiting blood) but has a normal blood count, the most appropriate next step in management is to send the patient for endoscopy. Hematemesis could indicate various conditions such as bleeding ulcers, esophageal varices, or malignancies, and an urgent endoscopy allows for direct visualization of the upper gastrointestinal tract. Additionally, it can facilitate both diagnosis and therapeutic interventions, such as cauterizing a bleeding vessel or banding varices. Considering the patient's stable condition with normal blood counts, immediate intensive care admission or intensive monitoring may not be necessary. The nasogastric tube option could help decompress the stomach and potentially identify the source of bleeding, but it does not provide the diagnostic certainty or treatment that endoscopy does. Ordering a type and screen and beginning fluid resuscitation are important steps in the management of any patient with gastrointestinal bleeding, but since this patient is stable, proceeding to endoscopy is prioritized for both diagnosis and treatment. Therefore, sending the patient for endoscopy is the most effective action at this stage.