### Question 108
**Paraphrased Question:**
A 37-year-old male presented to the emergency room with a history of vomiting blood after repeated episodes of vomiting. His vitals are as follows: Blood pressure: 112/63 mmHg, Heart rate: 89/min, Respiratory rate: 21/min, Oxygen saturation: 96%. His hemoglobin is 135 g/L (normal: 130-170 g/L) and WBC is 7.8 x 10^9/L (normal: 4.5-10.5 x 10^9/L). What is the most appropriate next step in management?
**Options:**
A) Upper GI endoscopy
B) Conservative treatment
C) Exploratory laparotomy
D) Placement of Sengstaken-Blakemore tube
**Correct Answer:**
A) Upper GI endoscopy
**Explanation:**
The patient presents with symptoms suggestive of an upper gastrointestinal bleed, likely due to a source in the upper GI tract. The most appropriate next step in management is to perform an upper GI endoscopy to identify and possibly treat the source of bleeding. The patient’s vitals are stable, and his lab results do not show alarming changes, so conservative treatment or more invasive procedures like laparotomy or placement of a Sengstaken-Blakemore tube are not immediately warranted .