Clinical biochemistry: ascitic fluid analysis: practice question

A Biochemistry 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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Biochemistry · Clinical biochemistry: ascitic fluid analysis

Sample item

A 48-year-old man has new ascites. Serum albumin is 3.0 g/dL and ascitic fluid albumin is 1.4 g/dL. What is the serum-ascites albumin gradient and what does it indicate?

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

The answer and the reasoning

D. 1.6 g/dL, indicating portal hypertension

SAAG equals serum albumin minus ascitic albumin: 3.0 - 1.4 = 1.6 g/dL. A gradient of 1.1 g/dL or more indicates portal hypertension, as in cirrhosis, cardiac ascites or Budd-Chiari syndrome. A gradient below 1.1 indicates a non-portal cause such as peritoneal tuberculosis, carcinomatosis or nephrotic syndrome.

Option by option

  • A. 4.4 g/dL, indicating portal hypertension

    Adding the two albumins gives 4.4, which is not how the gradient is calculated.

  • B. 0.9 g/dL, indicating cirrhosis

    A gradient of 0.9 g/dL is miscalculated, and a low gradient would not suggest cirrhosis.

  • C. 1.6 g/dL, indicating peritoneal tuberculosis

    Peritoneal tuberculosis gives a low gradient below 1.1.

  • D. 1.6 g/dL, indicating portal hypertension (correct)

    Correct. A gradient of 1.6 g/dL is at or above 1.1 and means portal hypertension.

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 Biochemistry question

What is the answer to this Biochemistry question?

The best answer is D, 1.6 g/dL, indicating portal hypertension. SAAG equals serum albumin minus ascitic albumin: 3.

Why is "4.4 g/dL, indicating portal hypertension" not the answer?

Adding the two albumins gives 4.4, which is not how the gradient is calculated.

Why is "0.9 g/dL, indicating cirrhosis" not the answer?

A gradient of 0.9 g/dL is miscalculated, and a low gradient would not suggest cirrhosis.

Why is "1.6 g/dL, indicating peritoneal tuberculosis" not the answer?

Peritoneal tuberculosis gives a low gradient below 1.1.

What concept does this question test?

It tests Clinical biochemistry: ascitic fluid analysis in Biochemistry. 0 - 1.4 = 1.6 g/dL. A gradient of 1.1 g/dL or more indicates portal hypertension, as in cirrhosis, cardiac ascites or Budd-Chiari syndrome. A gradient below 1.1 indicates a non-portal cause such as peritoneal tuberculosis, carcinomatosis or nephrotic syndrome.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Clinical biochemistry: ascitic fluid analysis?

Build one table of enzyme deficiency, disease, inheritance and key finding, then revise it by spaced recall. Then use the flashcards and the other Biochemistry 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.