Step 2 UWorld Self-Assessment (UWSA) 2 Practice Exam

When there is an acute upper GI bleed with hemodynamic instability, the priority is to restore perfusion and control ongoing blood loss while preparing for diagnostic and therapeutic intervention. Begin with rapid IV fluid resuscitation and administer blood products as needed to stabilize circulation and oxygen delivery. A high-dose IV proton pump inhibitor is given to elevate gastric pH and stabilize clots, reducing the risk of rebleeding. Once the patient is hemodynamically stable enough for endoscopic evaluation, perform urgent endoscopy within 24 hours to identify the source and provide definitive hemostasis if possible. Delaying intervention or relying on oral rehydration alone would leave the patient at persistent risk, and proceeding to surgery without resuscitation is unsafe. This sequence optimizes survival and shortens the time to source control.