Diabetic Ketoacidosis — USMLE Step 2 CK MCQ

Correct answer: C — Intravenous octreotide and ceftriaxone with endoscopy within 12 hours

Suspected acute variceal hemorrhage requires coordinated therapy before definitive endoscopic hemostasis. Start a vasoactive agent such as intravenous octreotide as early as possible to reduce portal inflow, and give short-course antibiotic prophylaxis, commonly ceftriaxone 1 g daily for up to 7 days, because infection and rebleeding risks are high in cirrhosis. After stabilization, endoscopy should occur within 12 hours for diagnosis and treatment, usually band ligation for esophageal varices. Transfusion is generally restrictive, targeting hemoglobin around 7–9 g/dL unless the clinical context requires otherwise; overtransfusion can increase portal pressure. A proton-pump inhibitor may be given before the source is known but is not adequate variceal therapy. Nonselective beta blockers are used for prophylaxis after the acute episode, not as sole treatment during active bleeding. TIPS is reserved for selected high-risk patients early after endoscopic control or for bleeding that cannot be controlled; therapeutic heparin is inappropriate during active hemorrhage.

Reference: American Association for the Study of Liver Diseases. Standard Care for Acute Variceal Bleeding. https://www.aasld.org/liver-fellow-network/core-series/why-series/why-do-we-use-early-tips-management-variceal-bleeding