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Suspected variceal haemorrhage — SCE Acute Medicine MCQ

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ModerateAcute Gastrointestinal PresentationsSuspected variceal haemorrhageSCE Acute Medicine

A 55-year-old man presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show cirrhosis with large-volume haematemesis, ascites and coagulopathy. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Give terlipressin, antibiotics and arrange urgent endoscopy

The key discriminator is that cirrhosis with large-volume haematemesis, ascites and coagulopathy, which makes Give terlipressin, antibiotics and arrange urgent endoscopy the single best answer. Arrange routine outpatient follow-up is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent CT imaging would fit a different presentation or later stage of care. Provide supportive care and close monitoring and Optimise chronic medication and discharge are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE CG141; BSG variceal bleeding guideline