Gastroenterology and hepatology: acute mesenteric ischaemia: 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.

Try it

General Medicine · Gastroenterology and hepatology: acute mesenteric ischaemia

Sample item

A 68-year-old man with atrial fibrillation, not on anticoagulants, develops sudden severe periumbilical pain with a soft, non-tender abdomen, vomiting and passage of blood. Lactate is raised. Which investigation is most appropriate now?

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

The answer and the reasoning

D. CT angiography of the mesenteric vessels

Severe pain out of proportion to the abdominal findings in a patient with atrial fibrillation suggests embolic occlusion of the superior mesenteric artery. CT angiography confirms the diagnosis quickly, and urgent revascularisation, heparin and resuscitation must follow before bowel necrosis.

Option by option

  • A. Barium follow-through

    Barium studies are slow and unsafe in an acute abdomen.

  • B. Upper gastrointestinal endoscopy

    Upper endoscopy does not assess the mesenteric vessels or small bowel supply.

  • C. Plain abdominal radiograph

    A plain film is usually normal early and cannot exclude ischaemia.

  • D. CT angiography of the mesenteric vessels (correct)

    Correct. CT angiography shows the vascular occlusion and bowel viability rapidly.

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, CT angiography of the mesenteric vessels. Severe pain out of proportion to the abdominal findings in a patient with atrial fibrillation suggests embolic occlusion of the superior mesenteric artery.

Why is "Barium follow-through" not the answer?

Barium studies are slow and unsafe in an acute abdomen.

Why is "Upper gastrointestinal endoscopy" not the answer?

Upper endoscopy does not assess the mesenteric vessels or small bowel supply.

Why is "Plain abdominal radiograph" not the answer?

A plain film is usually normal early and cannot exclude ischaemia.

What concept does this question test?

It tests Gastroenterology and hepatology: acute mesenteric ischaemia in General Medicine. CT angiography confirms the diagnosis quickly, and urgent revascularisation, heparin and resuscitation must follow before bowel necrosis.

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 and hepatology: acute mesenteric ischaemia?

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.