A 58-year-old man with a history of NSAID use for chronic back pain presents to the emergency department with sudden onset hematemesis and melena. His blood pressure is 90/60 mmHg, heart rate 110 bpm, and he appears pale and diaphoretic. Initial labs show hemoglobin of 7.2 g/dL. After establishing two large-bore intravenous lines and initiating fluid resuscitation, what is the most appropriate next diagnostic and therapeutic step?

The correct answer to the question "A 58-year-old man with a history of NSAID use for chronic back pain presents to the emergency department with sudden onset hematemesis and melena. His blood pressure is 90/60 mmHg, heart rate 110 bpm, and he appears pale and diaphoretic. Initial labs show hemoglobin of 7.2 g/dL. After establishing two large-bore intravenous lines and initiating fluid resuscitation, what is the most appropriate next diagnostic and therapeutic step?" is Option C: Administer proton pump inhibitor (PPI) and arrange for urgent upper endoscopy.

The other options — A) Obtain an abdominal CT scan, B) Schedule a colonoscopy, D) Order a nuclear medicine tagged red blood cell scan — are incorrect for this USMLE Exam Prep question. As explained above: Hemodynamically unstable patients with suspected upper GI bleeding require urgent management. After fluid resuscitation, a proton pump inhibitor infusion should be started, and an urgent upper endosc…