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Variceal bleed with encephalopathy — SCE Acute Medicine MCQ

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ModerateAcute Gastrointestinal PresentationsVariceal bleed with encephalopathySCE Acute Medicine

A 51-year-old woman 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, melaena, confusion, ascites and coagulopathy. What is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: B — Use restrictive transfusion, terlipressin, antibiotics, lactulose and urgent endoscopy

The key discriminator is that cirrhosis, melaena, confusion, ascites and coagulopathy, which makes Use restrictive transfusion, terlipressin, antibiotics, lactulose and urgent endoscopy the single best answer. Call critical care for escalation is less appropriate because it does not address the dominant acute risk in the vignette; Give targeted antidote or reversal therapy would fit a different presentation or later stage of care. Give intravenous fluids with reassessment and Provide supportive care and close monitoring 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/BASL cirrhosis care bundle