Rosh Emergency Medicine Practice Test

For a patient with peptic ulcer disease experiencing hematemesis and melena, what intervention is most likely to achieve acute hemostasis?

1. Colonoscopy

2. Endoscopy

3. Octreotide

4. Omeprazole

The correct answer is: Endoscopy

Endoscopy is the most effective intervention for achieving acute hemostasis in a patient with peptic ulcer disease experiencing hematemesis (vomiting blood) and melena (black, tarry stools). This procedure allows for direct visualization of the upper gastrointestinal tract, including the esophagus, stomach, and duodenum, where bleeding ulcers are commonly located. During endoscopy, therapeutic interventions can be performed that directly address the source of the bleeding. These procedures may include cauterization, clipping, or banding techniques that can effectively stop the hemorrhaging. The ability to visually identify and manage the bleeding lesion in real-time is crucial in stabilizing the patient and preventing further complications. In contrast, the other options would not be the primary interventions for acute hemostasis in this scenario. Colonoscopy focuses on the lower gastrointestinal tract, which is not the source of the hemorrhage in a case of peptic ulcer disease. Octreotide can be beneficial in controlling variceal bleeding or gastrointestinal hemorrhage by reducing portal pressure, but it does not directly control bleeding from peptic ulcers. Omeprazole, a proton pump inhibitor, helps reduce gastric acidity and promotes healing of the ulcers, but it does not stop active bleeding. Therefore, end