skip to main content

Cirrhosis variceal screening — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardGastroenterology/HepatologyCirrhosis variceal screeningABIM Board

A 56-year-old man has compensated alcohol-related cirrhosis without prior decompensation. Transient elastography is 14 kPa, platelet count is 182,000/µL and ultrasound shows no collaterals or splenomegaly. He is not taking a nonselective beta blocker. Which variceal-screening plan is reasonable?

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

Reveal the answer and explanation

Correct answer: D — Defer endoscopy and repeat noninvasive risk assessment periodically

The best answer is “Defer endoscopy and repeat noninvasive risk assessment periodically”. In compensated cirrhosis, favorable liver-stiffness and platelet criteria identify a low probability of varices needing treatment, allowing screening endoscopy to be deferred with periodic reassessment. This is not permanent exemption: worsening stiffness, falling platelets or decompensation changes the plan. Routine invasive pressure measurement or CT angiography is not required for screening.

Reference: AASLD Practice Guidance: Portal Hypertension and Varices in Cirrhosis: https://www.aasld.org/practice-guidelines/portal-hypertension-bleeding-cirrhosis