A 40-Year-Old Man Comes to the Emergency Department After 2

question 177

Multiple Choice

A 40-year-old man comes to the emergency department after 2 episodes of coffee-ground vomiting.  He reports black, tarry stools for 1 day.  He has had no previous episodes and has no history of liver disease, jaundice, weight loss, ascites, edema, dysphagia, or illicit drug use.  He has been taking ibuprofen for lower back pain for the past 2 weeks.  He is otherwise in good general health and takes no prescription medications.
His supine blood pressure is 120/80 mm Hg and pulse is 84/min; after 1 minute of standing they are 118/76 mm Hg and 90/min.  There is no jaundice or scleral icterus.  Cardiopulmonary examination is normal.  There is mild epigastric tenderness on palpation.  There is no hepatomegaly or stigmata of chronic liver disease.  The remainder of the examination is within normal limits.
A nasogastric tube is inserted, with return of coffee ground material and some bright red blood with clots.
Laboratory results are as follows:

Urgent gastrointestinal endoscopy is scheduled.
Which of the following values for hemoglobin represents the optimal threshold for initiating blood transfusion in this patient?

• A)< 11 g/dL
• B)< 10 g/dL
• C)< 9 g/dL
• D)< 8 g/dL
• E)< 7 g/dL

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Definitions:

Learning Disorders

Neurodevelopmental disorders that affect the brain's ability to receive, process, analyze, or store information, making it difficult to learn in a typical manner.

Communication Disorders

Disorders characterized by persistent difficulties in the acquisition and use of language and other means of communicating.

Delirium

A sudden change in the brain that causes mental confusion and emotional disruption, often resulting from illness, medication, or surgery.

Dementia

A broad category of brain diseases that result in a long-term and often gradual decrease in the ability to think and remember, significantly affecting a person's daily functioning.