Work up question....`Will follow up this question with another part later

[student-2]

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57 year old man walks into your ED and he tells you he had bright red blood in the toilet. What do you do?

A) Tell him to change underwear
B) Do upper GI series
C) Do lower GI series
D) Do upper and lower GI series
E) Do CT from pelvis to chin
F) Expectant management
G) Measure vitals and send blood work
H) Arrange an internal medicine consult

More to come as we work up this patient.........

[Anisha2939]

C.........??

[student-2]

C is not a bad answer but initially in any setting one should try to go from broad to narrow. We have a partial history we don't have info regarding a physical besides from the question stem that he "walked" into the ER and that he "tells"- this was to show you that he's currently stable which is one of the key things we would want to get from the physical exam. After getting subjective data we would want to move on to objective data ie= getting lab work/imaging/others....
Hence the answer here would most probably be get blood work G. Vitals was also thrown in there although usually you get them with the patient in the ED.
In the lab work we would look for Hct- to see if it's a chronic problem or new, Leukocytosis may help in a wide array of GI problems, PT/PTT can tell us if he has coag problem. LFTs' can hint for varices ETC....

[student-2]

Labs sent. Now what?
A) Tell him to change underwear
B) Do a bedside Esophagogastric endoscopic exam
C) Do a laryngoscopic exam
D) Place a naso gastric tube
E) Do CT from pelvis to chin
F) Expectant management
G) Re-take vitals and send blood work
H) Measure your own pulse
I) Order blood
J) Do option B and a DRE
K) Arrange an internal medicine consult