Complications of cirrhosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Complications of cirrhosis

Sample item

A patient with decompensated alcohol-related cirrhosis and ascites develops progressive oliguria and serum creatinine of 3.2 mg/dL. Urine sodium is under 10 mEq/L, urine sediment is bland and there is no proteinuria. There is no improvement after two days of diuretic withdrawal and albumin infusion. What is the most appropriate treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Terlipressin with albumin

This is hepatorenal syndrome type AKI, a functional renal failure from splanchnic vasodilatation and renal vasoconstriction. It is diagnosed after excluding shock, nephrotoxins, structural kidney disease and volume responsiveness. Terlipressin with albumin is the first-line treatment, and liver transplantation is definitive.

Option by option

  • A. Further large-volume intravenous normal saline

    Saline does not correct the vasodilatory state and worsens ascites.

  • B. Furosemide infusion to restore urine output

    Loop diuretics are stopped in this syndrome because they aggravate renal hypoperfusion.

  • C. Intravenous gentamicin

    Aminoglycosides are nephrotoxic and would worsen renal injury.

  • D. Terlipressin with albumin (correct)

    Correct. A splanchnic vasoconstrictor with albumin raises effective arterial volume and renal perfusion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Terlipressin with albumin. This is hepatorenal syndrome type AKI, a functional renal failure from splanchnic vasodilatation and renal vasoconstriction.

Why is "Further large-volume intravenous normal saline" not the answer?

Saline does not correct the vasodilatory state and worsens ascites.

Why is "Furosemide infusion to restore urine output" not the answer?

Loop diuretics are stopped in this syndrome because they aggravate renal hypoperfusion.

Why is "Intravenous gentamicin" not the answer?

Aminoglycosides are nephrotoxic and would worsen renal injury.

What concept does this question test?

It tests Complications of cirrhosis in General Medicine. It is diagnosed after excluding shock, nephrotoxins, structural kidney disease and volume responsiveness. Terlipressin with albumin is the first-line treatment, and liver transplantation is definitive.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Complications of cirrhosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.