Upper GI Bleeding and Peptic Ulcer Disease Practice Questions

25 multiple-choice questions on Upper GI bleeding and peptic ulcer disease for paramedic and EMT students, from Chapter 21 (Abdominal and Gastrointestinal Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. The most common cause of upper GI bleeding is:

   1. A. Esophageal cancer
   2. B. Mallory-Weiss tear
   3. C. Diverticulosis
   4. D. Peptic ulcers
   Show answer

   Answer: D. Peptic ulcers

   Ulcers of the stomach and duodenum account for most upper GI bleeds. Diverticulosis is a lower GI source.

2. Hematemesis that looks like coffee grounds indicates:

   1. A. Blood partly digested by acid
   2. B. Brisk arterial bleeding
   3. C. Bleeding from the colon
   4. D. Swallowed blood from the nose only
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   Answer: A. Blood partly digested by acid

   Stomach acid turns blood dark brown and granular. Bright red hematemesis suggests faster, ongoing bleeding.

3. Melena generally means at least how much blood has entered the upper GI tract?

   1. A. About 5 to 10 mL
   2. B. At least 2 liters
   3. C. At least 1 full liter
   4. D. About 50 to 100 mL
   Show answer

   Answer: D. About 50 to 100 mL

   Black, tarry stool can result from as little as 50 to 100 mL of blood in the upper GI tract, so melena alone does not tell you how much was lost; vital signs and mental status do. A few milliliters will not turn stool black, and liters would cause shock.

4. A 55-year-old has vomited bright red blood twice and has a pulse of 118. This suggests:

   1. A. Slow bleeding that has stopped
   2. B. A lower GI source of bleeding
   3. C. Active, brisk upper GI bleed
   4. D. Bleeding from the gallbladder
   Show answer

   Answer: C. Active, brisk upper GI bleed

   Bright red hematemesis means blood has not sat in the stomach long. With tachycardia, the patient is losing significant volume and needs rapid transport.

5. Which medication history most increases the risk of a bleeding peptic ulcer?

   1. A. Daily acetaminophen for arthritis
   2. B. Daily ibuprofen and aspirin
   3. C. Daily multivitamin
   4. D. Daily antacid tablets
   Show answer

   Answer: B. Daily ibuprofen and aspirin

   NSAIDs and aspirin disrupt the stomach's mucosal barrier and impair platelets. Acetaminophen does not damage the stomach lining.

6. A patient who had a coronary stent placed 2 months ago, and takes aspirin and clopidogrel, has a GI bleed. You should not advise him to simply stop both drugs because:

   1. A. Stopping them early can clot the stent
   2. B. They do not affect bleeding at all
   3. C. Clopidogrel helps ulcers to heal
   4. D. Aspirin raises the blood pressure a lot
   Show answer

   Answer: A. Stopping them early can clot the stent

   Early interruption of dual antiplatelet therapy after a stent carries a high risk of stent thrombosis and MI, so the decision is made by the hospital team, balancing bleeding against clotting. Both drugs do increase bleeding, and neither heals ulcers.

7. Sudden severe epigastric pain that becomes diffuse, with a rigid abdomen, in a patient with ulcer history suggests:

   1. A. Healing ulcer
   2. B. Gastroesophageal reflux
   3. C. Simple gastritis
   4. D. Perforated ulcer
   Show answer

   Answer: D. Perforated ulcer

   Perforation spills acid and contents into the peritoneal cavity, causing chemical peritonitis with sudden pain and board-like rigidity.

8. Esophageal varices develop because of:

   1. A. Esophageal infection
   2. B. Portal hypertension
   3. C. Chronic vomiting
   4. D. Swallowed foreign bodies
   Show answer

   Answer: B. Portal hypertension

   Liver scarring raises portal pressure, forcing blood into thin-walled esophageal veins. These can rupture and bleed massively.

9. A patient with cirrhosis is vomiting large amounts of bright red blood. The greatest immediate threat is:

   1. A. Electrolyte imbalance
   2. B. Worsening jaundice
   3. C. Airway compromise and shock
   4. D. Worsening hepatic encephalopathy
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   Answer: C. Airway compromise and shock

   Variceal bleeding is often massive. Suction, positioning, and possibly an advanced airway come first, along with treatment for hemorrhagic shock.

10. A patient with known varices is vomiting blood. Telling the receiving hospital about the varices matters most because:

    1. A. They need specific drugs and endoscopy
    2. B. He can then go to any walk-in clinic
    3. C. Varices bleed less than ulcers do
    4. D. Varices usually stop bleeding on their own
    Show answer

    Answer: A. They need specific drugs and endoscopy

    Suspected variceal bleeding is treated with vasoactive drugs (such as octreotide), antibiotics, and urgent endoscopic banding, so early notice lets the hospital prepare. Variceal bleeds are often heavier and more deadly than ulcer bleeds and frequently recur.

11. A Mallory-Weiss tear is most often caused by:

    1. A. Swallowing caustic agents
    2. B. Long-term reflux
    3. C. Forceful vomiting
    4. D. Eating very hot food
    Show answer

    Answer: C. Forceful vomiting

    A longitudinal mucosal tear at the gastroesophageal junction follows forceful retching, commonly after alcohol use. Most stop bleeding on their own.

12. A 66-year-old with heart disease and an active upper GI bleed has chest pressure and new ST depression. The most likely cause is:

    1. A. A new ulcer in the esophagus
    2. B. Demand ischemia from blood loss
    3. C. Acid irritating the heart muscle
    4. D. Reflux of bile into the chest
    Show answer

    Answer: B. Demand ischemia from blood loss

    Anemia and hypotension reduce oxygen delivery to the heart, so patients with coronary disease can develop ischemic ECG changes during a GI bleed. Treat the bleeding and shock, and report the ECG findings.

13. A patient with a suspected upper GI bleed should go to a hospital with endoscopy when possible because endoscopy:

    1. A. Must be done before blood is transfused
    2. B. Replaces the need for IV fluids
    3. C. Measures the total volume of blood lost
    4. D. Finds and treats most bleeding sources
    Show answer

    Answer: D. Finds and treats most bleeding sources

    Upper endoscopy within 24 hours both identifies the cause and allows clipping, cautery, or banding of ulcers and varices. Transfusion does not wait for endoscopy, IV fluids are still needed, and endoscopy does not measure how much blood was lost.

14. An older patient with GI bleeding takes warfarin. This matters because:

    1. A. Warfarin causes black stools
    2. B. Warfarin raises heart rate
    3. C. Bleeding may be hard to stop
    4. D. Warfarin protects the stomach
    Show answer

    Answer: C. Bleeding may be hard to stop

    Anticoagulants worsen and prolong bleeding. Report them to the receiving facility, which may reverse them.

15. Iron supplements and bismuth can cause:

    1. A. Dark stools that mimic melena
    2. B. Bright red bleeding from the rectum
    3. C. Coffee-ground vomiting
    4. D. Pale, clay-colored stools
    Show answer

    Answer: A. Dark stools that mimic melena

    Both turn stool dark or black. True melena is tarry and foul-smelling; the history helps distinguish them.

16. Under current evidence, IV tranexamic acid for a patient with a major upper GI bleed:

    1. A. Halves the death rate if given early
    2. B. Has not been shown to lower deaths
    3. C. Should be given before any fluids
    4. D. Is required within 3 hours of onset
    Show answer

    Answer: B. Has not been shown to lower deaths

    The large HALT-IT trial found that TXA did not reduce deaths from GI bleeding and was linked to more venous clots and seizures, so it is not recommended. The 3-hour rule applies to trauma and postpartum hemorrhage, not GI bleeding.

17. Patients with cirrhosis and a GI bleed are given antibiotics in the hospital mainly because:

    1. A. The bleeding is caused by bacteria
    2. B. Antibiotics make blood clot faster
    3. C. Antibiotics lower the portal vein pressure
    4. D. Infection is common and raises mortality
    Show answer

    Answer: D. Infection is common and raises mortality

    Bacterial infections, such as spontaneous bacterial peritonitis, develop in many cirrhotic patients after a GI bleed, and short-course prophylactic antibiotics reduce infection, rebleeding, and death. Antibiotics do not directly clot blood or lower portal pressure.

18. Which group is at greatest risk of a silent, painless GI bleed?

    1. A. Adults on antacids
    2. B. Middle-aged adults on acetaminophen
    3. C. Older adults on NSAIDs
    4. D. Teens on oral contraceptives
    Show answer

    Answer: C. Older adults on NSAIDs

    Older adults often bleed from NSAID ulcers without pain and present with weakness, syncope, or dark stools. Acetaminophen, antacids, and oral contraceptives do not damage the stomach lining the way NSAIDs do.

19. A patient who vomited blood says she feels dizzy when she sits up. This most likely reflects:

    1. A. Inner ear disease
    2. B. Volume loss
    3. C. Low blood sugar
    4. D. Anxiety
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    Answer: B. Volume loss

    Orthostatic dizziness in a bleeding patient suggests significant volume loss even if supine vitals look acceptable.

20. Positioning for a conscious patient actively vomiting blood is best:

    1. A. Supine with legs raised
    2. B. Prone with face down
    3. C. Trendelenburg
    4. D. Upright or on the side
    Show answer

    Answer: D. Upright or on the side

    Allow the airway to drain. Upright or lateral positions reduce aspiration. If the patient is hypotensive, place in the recovery position.

21. Which complication of peptic ulcer disease causes vomiting of undigested food hours after meals?

    1. A. Gastric outlet obstruction
    2. B. Free perforation of the ulcer
    3. C. Esophageal variceal rupture
    4. D. Erosive gastritis
    Show answer

    Answer: A. Gastric outlet obstruction

    Scarring or swelling near the pylorus blocks emptying, so food stays in the stomach and comes back undigested.

22. Gastritis caused by heavy alcohol use usually causes bleeding that is:

    1. A. Massive and usually fatal within hours
    2. B. Bright red, brisk, and painless
    3. C. Small to moderate, often coffee ground
    4. D. Confined to the lower colon
    Show answer

    Answer: C. Small to moderate, often coffee ground

    Gastritis bleeding is usually slow and oozing. Massive bleeding in a heavy drinker should raise concern for varices or ulcer.

23. Which finding most suggests a patient's upper GI bleed has been going on for days?

    1. A. Bright red emesis and tachycardia
    2. B. Sudden fainting while vomiting blood
    3. C. Rapidly increasing abdominal girth
    4. D. Pallor, fatigue, exertional dyspnea
    Show answer

    Answer: D. Pallor, fatigue, exertional dyspnea

    Slow chronic bleeding causes anemia: pallor, fatigue, and shortness of breath with activity. Bright red emesis is acute bleeding.

24. Hematochezia with shock in a patient with known peptic ulcer suggests:

    1. A. Simple hemorrhoids
    2. B. Massive upper GI bleed
    3. C. Minor lower GI bleeding
    4. D. Normal stool coloring
    Show answer

    Answer: B. Massive upper GI bleed

    When upper GI bleeding is brisk, blood moves through quickly and appears red. With shock, think massive upper bleed.

25. Why may a patient with an upper GI bleed have a higher BUN on hospital testing?

    1. A. Digested blood raises urea
    2. B. The kidneys are bleeding
    3. C. The liver stops making urea
    4. D. Swallowed blood blocks urea excretion
    Show answer

    Answer: A. Digested blood raises urea

    Blood digested in the gut is absorbed as protein, which the liver converts to urea. It helps the hospital confirm an upper source. The liver keeps making urea (that is the source of the rise), blood in the gut does not stop the kidneys from excreting urea, and the kidneys are not the bleeding site.