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Hepatorenal syndrome — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Hepatorenal syndromeUSMLE Step 3

A patient with cirrhosis presents with hematemesis and shock. After airway assessment and resuscitation, variceal bleeding is strongly suspected. Which bundle should begin before endoscopy?

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Correct answer: E — Start octreotide and ceftriaxone, then perform endoscopy within 12 hours

The best answer is “Start octreotide and ceftriaxone, then perform endoscopy within 12 hours”. Acute variceal hemorrhage requires vasoactive therapy at suspicion, antibiotic prophylaxis because infection and rebleeding risk are high, and timely endoscopic diagnosis and treatment after resuscitation. Beta blockade is not initiated during active shock.

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