Emergency medicine: variceal haemorrhage: 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 · Emergency medicine: variceal haemorrhage

Sample item

A 50-year-old man with alcohol-related cirrhosis vomits about 800 mL of blood. His blood pressure is 90/60 mmHg, heart rate 118 per minute and haemoglobin 8.4 g/dL. While awaiting endoscopy, which approach is most appropriate?

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

The answer and the reasoning

C. A vasoactive drug such as terlipressin, prophylactic intravenous ceftriaxone and a restrictive transfusion strategy

Suspected variceal bleeding needs a splanchnic vasoconstrictor (terlipressin or octreotide) to lower portal pressure, antibiotic prophylaxis that reduces infection and mortality, and cautious volume replacement, with endoscopic band ligation within 12 hours. A restrictive strategy transfuses only at haemoglobin below 7 g/dL, aiming for 7 to 8 g/dL, because over-transfusion raises portal pressure and rebleeding.

Option by option

  • A. A proton pump inhibitor infusion alone, with endoscopy after 72 hours

    Endoscopy delayed by 72 hours is far too late, and acid suppression does not stop variceal bleeding.

  • B. Oral propranolol and lactulose only

    Non-selective beta-blockers are for prevention and may worsen shock in active bleeding.

  • C. A vasoactive drug such as terlipressin, prophylactic intravenous ceftriaxone and a restrictive transfusion strategy (correct)

    Correct. This combination lowers portal pressure, prevents infection and avoids over-transfusion.

  • D. Transfusion to a haemoglobin above 10 g/dL

    Over-transfusion raises portal pressure and increases rebleeding and mortality.

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 C, A vasoactive drug such as terlipressin, prophylactic intravenous ceftriaxone and a restrictive transfusion strategy. Suspected variceal bleeding needs a splanchnic vasoconstrictor (terlipressin or octreotide) to lower portal pressure, antibiotic prophylaxis that reduces infection and mortality, and cautious volume replacement, with endoscopic band ligation within 12 hours.

Why is "A proton pump inhibitor infusion alone, with endoscopy after 72 hours" not the answer?

Endoscopy delayed by 72 hours is far too late, and acid suppression does not stop variceal bleeding.

Why is "Oral propranolol and lactulose only" not the answer?

Non-selective beta-blockers are for prevention and may worsen shock in active bleeding.

Why is "Transfusion to a haemoglobin above 10 g/dL" not the answer?

Over-transfusion raises portal pressure and increases rebleeding and mortality.

What concept does this question test?

It tests Emergency medicine: variceal haemorrhage in General Medicine. A restrictive strategy transfuses only at haemoglobin below 7 g/dL, aiming for 7 to 8 g/dL, because over-transfusion raises portal pressure and rebleeding.

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 Emergency medicine: variceal haemorrhage?

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.