Step II Step 2 Qbank Kaplan question

[Leopoldovich1]

Hello,
I was running thru questions on Kaplan Qbank, which I get thru my school, and happened upon this question I missed. Now the explanation makes sense in theory, but there is no where else I can find that states that the indicated correct answer choice is the best management in this case. Can anyone please help me explain this. Thanks

Sincerely,

Leopold Leopoldovich

 

[1badvette]

This what is mentioned in my OnlineMed notes ..

If the NG is negative do an EGD in almost all cases. The next step is to move to the colon. Here, the decision’s based on if there’s a lot of bleeding (Brisk Bleeding is >2cc/hr or 1Unit pRBC q4H), slow bleeding (<0.5cc/hr or 1Unit pRBC q1day), or no bleeding (none). The idea is since blood is moving downstream, attempting a colonoscopy with brisk bleeding will just visualize a river of blood coming at you (not very useful), while trying to find the source of a very slow bleed with an angiogram might not show anything. A tagged RBC study can find the source of the bleed - especially in locations where the colonoscopy can’t reach - but is unable to offer any intervention. A pill cam is the last resort for finding a bleed.

In general, testing goes like this:

1. 1) Brisk Bleed ->Angiogram = Possible intervention
   
   
2. 2) Slow Bleed->Tagged RBC = Localization only
   
   
3. 3) No Bleeding->Colonoscopy = Definitive diagnosis