Typical exam stem
A patient presents with haematemesis, melaena and postural dizziness. How would you assess and manage the patient?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What is the Glasgow-Blatchford score used for?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Resuscitation comes before definitive diagnosis
Begin with airway, breathing and circulation. Large-bore intravenous access, haemodynamic monitoring, blood sampling and appropriate blood product support take priority over a detailed endoscopic diagnosis in an unstable patient. Cross-match early when significant bleeding is suspected.
Risk stratification and cause
- Use the Glasgow-Blatchford score at initial assessment to support risk stratification.
- Consider peptic ulcer disease, portal hypertensive bleeding, erosive disease, malignancy and less common vascular causes.
- Ask about liver disease, alcohol use, NSAIDs, antiplatelets and anticoagulants.
- Look for chronic liver disease because suspected variceal bleeding requires additional early therapy.
Definitive pathway
Arrange endoscopy after initial resuscitation. Unstable severe bleeding requires urgent endoscopic assessment once the patient is sufficiently stabilised, while other patients generally undergo endoscopy within the recommended early window. Endoscopic therapy depends on the bleeding lesion.
When variceal bleeding is suspected, add vasoactive treatment and prophylactic antibiotics according to local protocol and arrange endoscopic variceal therapy. Recurrent or uncontrolled bleeding may require interventional radiology, TIPS or surgery depending on the source and available expertise.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.