GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 65-year-old man with a 10-pack-year smoking history and chronic NSAID use for osteoarthritis presents to the emergency department with a 6-hour history of epigastric pain followed by one episode of black tarry stools. He denies recent alcohol use or vomiting. Vital signs: BP 102/68 mmHg, HR 98 bpm, RR 16/min, temperature 37.2°C. Physical examination reveals epigastric tenderness without rebound or guarding. Laboratory studies show hemoglobin 9.2 g/dL (baseline 14 g/dL), INR 1.0, creatinine 0.9 mg/dL. Urgent upper endoscopy is performed and reveals a 1.5 cm clean-based ulcer in the gastric antrum with a visible nonbleeding vessel. H. pylori serology and stool antigen testing are both negative. Which of the following is the most appropriate next step in management?
Answer choices
- AInitiate high-dose intravenous proton pump inhibitor (80 mg bolus followed by continuous infusion) and discharge home with oral PPI
- BPerform endoscopic hemostasis using epinephrine injection followed by thermal coagulationCorrect answer
- CAdminister packed red blood cells to target hemoglobin >12 g/dL, then proceed to urgent CT angiography
- DPlace nasogastric tube for saline lavage and observe for 48 hours with serial hemoglobin measurements
- EProceed directly to interventional radiology for transcatheter arterial embolization
- FInitiate oral sucralfate and arrange outpatient follow-up endoscopy in 2 weeks
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