General Medicine

20 learning units • 100 chapter sections • 200 explained questions. Assess the patient, choose investigations and build a monitored management plan across adult medical specialties.

Original RAHBAR study material for the Year 4 learning pathway. Clinical cases support supervised undergraduate learning. Treatment choices, doses and procedures must follow current local protocols and the responsible clinical team. References & further reading ↓

MODULE 09 / 20

Gastrointestinal Bleeding & Iron Deficiency

Stabilise bleeding, interpret haemoglobin cautiously and investigate the cause of iron deficiency rather than treating the number alone.

Choose an answer and check it immediately. Change your choice to try again. This is a self-study exercise; results are not saved.

Question 01. Why can haemoglobin initially be normal during major acute bleeding? A. Redistribution and dilution may not yet reflect the lossB. Significant blood loss never changes haemoglobinC. The result proves no bleeding occurredD. Red cells are immediately replaced

Question 02. What is the immediate priority in haematemesis with shock? A. Routine oral iron aloneB. Elective review after several weeksC. Waiting for a stool screening testD. Resuscitation and urgent specialist help

Question 03. Can brisk upper gastrointestinal bleeding cause fresh rectal blood? A. NeverB. Only after iron tabletsC. Only with haemorrhoidsD. Yes

Question 04. Which medicine can contribute to peptic-ulcer bleeding? A. A topical emollient aloneB. Saline nasal spray aloneC. An NSAIDD. A routine eye lubricant alone

Question 05. What is a limitation of ferritin? A. It never changes with inflammationB. It directly identifies a bleeding lesionC. It always excludes deficiency when within rangeD. Inflammation can raise it despite iron deficiency

Question 06. Which other condition can produce microcytosis? A. Isolated acute urticariaB. ThalassaemiaC. Uncomplicated tension headacheD. Simple myopia

Question 07. What should accompany iron replacement in unexplained deficiency? A. Permanent abandonment of follow-upB. Assuming diet is always responsibleC. Investigation of the causeD. Avoiding any bleeding history

Question 08. What changes the pathway when variceal bleeding is suspected? A. Automatic suitability for outpatient treatmentB. Need for specific urgent portal-hypertensive bleeding careC. No need for endoscopyD. Proof that anticoagulation is required

Question 09. Why individualise transfusion in an actively bleeding patient? A. One number captures every riskB. Transfusion is always unnecessaryC. Physiology and comorbidity matter alongside haemoglobinD. Every patient needs the same number of units

Question 10. An adult man has new unexplained iron-deficiency anaemia. What is important? A. Assume menstrual lossB. Treat indefinitely without cause assessmentC. Exclude malignancy because pain is absentD. Evaluate possible gastrointestinal blood loss

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References & Further Reading

Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.

NICE CG141 — Acute upper gastrointestinal bleeding

Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.