A 46-Year-Old Man Comes to the Emergency Department Due to Several

question 191

Multiple Choice

A 46-year-old man comes to the emergency department due to several episodes of vomiting.  The last episode of emesis contained blood.  Five hours ago, he had a fatty meal and several alcoholic drinks.  The patient's medical history is notable for alcohol use disorder.  He also has chronic dyspepsia, for which he was evaluated 3 days ago with upper gastrointestinal endoscopy and abdominal ultrasound.  The ultrasound revealed an enlarged, hyperechoic liver and gallstones in the gallbladder, and the endoscopy found mild esophagitis and gastritis.  His temperature is 36.6 C (97.9 F) , blood pressure is 120/70 mm Hg, pulse is 95/min, and respirations are 15/min.  The abdomen is soft and nontender.  The rectal examination shows no melena.  Laboratory results are as follows: Nasogastric suction returns normal stomach contents mixed with bright red blood.  Which of the following is the most likely explanation for this patient's bloody vomiting?

• A)Effort-related complete rupture of the esophagus
• B)Endoscopy-related esophageal perforation
• C)Hemobilia
• D)Mucosal tear at the gastroesophageal junction
• E)Rupture of esophageal varices
• F)Stress gastritis

---

Definitions:

Recommendation

A suggestion or proposal offered to solve a problem or improve a situation.

Appreciation

An expression of gratitude or recognition of the value or quality of something or someone.

Routine Requests

Standard inquiries or solicitations that follow established conventions and expect predictable responses.

Letters of Recommendation

Written endorsements by a third party, praising someone’s abilities, qualifications, or character, typically for employment or admission purposes.