Gastroenterology: refractory variceal bleeding: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology: refractory variceal bleeding

Sample item

Variceal bleeding continues despite vasoactive therapy and two sessions of band ligation. What is the rescue treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Transjugular intrahepatic portosystemic shunt, with balloon tamponade as a bridge

Failure of medical and endoscopic therapy is treated with early TIPS or a covered stent, and Sengstaken-Blakemore or Linton balloon tamponade can be a temporary bridge. Shunt surgery is an alternative where TIPS is not available. Hepatic encephalopathy is a TIPS risk.

Option by option

  • A. Transjugular intrahepatic portosystemic shunt, with balloon tamponade as a bridge (correct)

    Correct. TIPS is the rescue procedure of choice.

  • B. Proton pump inhibitor infusion

    PPIs do not control portal hypertensive haemorrhage.

  • C. Increase oral propranolol

    Oral propranolol does not stop active bleeding.

  • D. Repeat colonoscopy

    Colonoscopy does not address variceal bleeding.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Transjugular intrahepatic portosystemic shunt, with balloon tamponade as a bridge. Failure of medical and endoscopic therapy is treated with early TIPS or a covered stent, and Sengstaken-Blakemore or Linton balloon tamponade can be a temporary bridge.

Why is "Proton pump inhibitor infusion" not the answer?

PPIs do not control portal hypertensive haemorrhage.

Why is "Increase oral propranolol" not the answer?

Oral propranolol does not stop active bleeding.

Why is "Repeat colonoscopy" not the answer?

Colonoscopy does not address variceal bleeding.

What concept does this question test?

It tests Gastroenterology: refractory variceal bleeding in General Medicine. Shunt surgery is an alternative where TIPS is not available. Hepatic encephalopathy is a TIPS risk.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology: refractory variceal bleeding?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.