A 24 year old male complains of flu-like symptoms for 3 days. Within the last 30 minutes he has had violent episodes of dry-heaving and is now vomiting bright red blood. Vital signs are BP 70/40, P 130, R 32. Most likely cause?

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Multiple Choice

A 24 year old male complains of flu-like symptoms for 3 days. Within the last 30 minutes he has had violent episodes of dry-heaving and is now vomiting bright red blood. Vital signs are BP 70/40, P 130, R 32. Most likely cause?

The main idea is recognizing an upper GI bleed that follows forceful vomiting. When someone has severe retching or vomiting and then spits up bright red blood, a mucosal tear at the gastroesophageal junction often caused by the strain is likely. This Mallory-Weiss tear can produce brisk bleeding that leads to rapid deterioration in blood pressure, which matches this patient’s hypotension and tachycardia. Esophageal varices would point to portal hypertension, usually from liver disease, and they tend to bleed massively in patients with known cirrhosis or chronic liver issues—not typically after a single episode of retching in a young, otherwise healthy person. Peptic ulcers or gastritis can bleed too, but the clear trigger here is the violent vomiting, which makes Mallory-Weiss tear the best fit.

The main idea is recognizing an upper GI bleed that follows forceful vomiting. When someone has severe retching or vomiting and then spits up bright red blood, a mucosal tear at the gastroesophageal junction often caused by the strain is likely. This Mallory-Weiss tear can produce brisk bleeding that leads to rapid deterioration in blood pressure, which matches this patient’s hypotension and tachycardia.

Esophageal varices would point to portal hypertension, usually from liver disease, and they tend to bleed massively in patients with known cirrhosis or chronic liver issues—not typically after a single episode of retching in a young, otherwise healthy person. Peptic ulcers or gastritis can bleed too, but the clear trigger here is the violent vomiting, which makes Mallory-Weiss tear the best fit.

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