A 45-year-old man presents with hematemesis and melena. He has a history of alcohol abuse. On examination, he is hypotensive and tachycardic. Initial labs show hemoglobin of 7.2 g/dL. After initiating two large-bore IVs and fluid resuscitation, which of the following is the most appropriate next step in management?

The correct answer to the question "A 45-year-old man presents with hematemesis and melena. He has a history of alcohol abuse. On examination, he is hypotensive and tachycardic. Initial labs show hemoglobin of 7.2 g/dL. After initiating two large-bore IVs and fluid resuscitation, which of the following is the most appropriate next step in management?" is Option C: Octreotide infusion.

The other options — A) Endoscopic retrograde cholangiopancreatography (ERCP), B) Proton pump inhibitor (PPI) infusion, D) Urgent computed tomography angiography (CTA) — are incorrect for this USMLE Exam Prep question. As explained above: Given the history of alcohol abuse and signs of severe upper GI bleeding, variceal hemorrhage is suspected. Octreotide infusion helps reduce portal pressure and is a critical initial step alongside f…