Hepatobiliary Disease USMLE Step 1 Practice Question
A 62-year-old woman with hereditary hemochromatosis and biopsy-proven cirrhosis presents for screening upper endoscopy. She reports no prior variceal bleeding or hematemesis. Vital signs are normal. Physical examination reveals spider angiomas and splenomegaly. Endoscopy identifies small esophageal varices without red wale markings or active bleeding. Laboratory studies show: platelet count 98,000/μL, INR 1.3, albumin 3.2 g/dL, total bilirubin 1.8 mg/dL, and hemoglobin 11.2 g/dL. Abdominal ultrasound confirms cirrhosis with portal vein patency. Which of the following is the most appropriate next step in management?
Answer choices
- AEndoscopic variceal ligation
- BImmediate TIPS placement
- CTransjugular liver biopsy to assess iron overload
- DPropranolol to reduce portal venous pressureCorrect answer
- EObservation without pharmacologic prophylaxis
- FPlatelet transfusion followed by repeat endoscopy
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