mallory-weiss tear management

[DrMetal]

[usmle question ID 6036]
46-yo comes in with a mallory weiss secondary to boozing it up, you scope and band him. on day 2 of admission, he goes into withdrawal, has another episode of heavy hematemesis. What is your next step?

a) balloon tamp
b) IV octreotide + non selective beta blockers
c) Repeat scope
d) surgical shunt
e) TIPS


Correct answer is c) Repeat scope. I understand that this is the definitive answer, but the question was specifically asking for the "next step". If that's the question, shouldn't b) be the correct answer?

The patient should have been on octreotide after his first scope, to begin with, but the question stem makes no mention of it. So he definitely needs it before the second scope, right??? I agree that the non-selective BB is not that important right now. But undoubtedly, we would put him on octreotide first before calling GI to rescope, right?

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[Instatewaiter]

Octreotide and non-selective beta blockers are the treatment for esophageal varices.

 

[DrMetal]

Octreotide and non-selective beta blockers are the treatment for esophageal varices.

Yeah but you'd put him on octreotide first before scoping, no?

The answer explanation sais you would start oct if it wasnt already started. So, if the question stem makes no mention of it already being started, and if it appears as an answer choice in a "next step" type of question, why not select that as the answer choice?

 

[Instatewaiter]

Yeah but you'd put him on octreotide first before scoping, no?

The answer explanation sais you would start oct if it wasnt already started. So, if the question stem makes no mention of it already being started, and if it appears as an answer choice in a "next step" type of question, why not select that as the answer choice?

No, I wouldn't unless what they banded the first time were varices.