Infectious diseases: amoebic liver abscess: 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 · Infectious diseases: amoebic liver abscess

Sample item

A 35-year-old man with alcohol use has fever and right upper quadrant pain. Ultrasound shows a single 6 cm abscess in the right lobe, and aspirated pus is chocolate-brown and odourless. He is started on metronidazole. Which additional drug is needed after the course of metronidazole?

AIvermectinBA luminal amoebicide such as paromomycin or diloxanide furoateCAlbendazoleDPraziquantel

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

The answer and the reasoning

B. A luminal amoebicide such as paromomycin or diloxanide furoate

Amoebic liver abscess is caused by Entamoeba histolytica, which reaches the liver through the portal vein from the colon. Metronidazole kills tissue trophozoites but is poorly active in the gut lumen, so a luminal agent (paromomycin or diloxanide furoate) is needed to eradicate colonic cysts and prevent relapse. Aspiration is considered for large or left-lobe abscesses or if there is no response.

Option by option

A. Ivermectin
Ivermectin treats strongyloides and scabies, not amoebiasis.
B. A luminal amoebicide such as paromomycin or diloxanide furoate (correct)
A luminal amoebicide clears intestinal cysts that metronidazole leaves behind.
C. Albendazole
Albendazole is an anthelmintic and has no activity against Entamoeba.
D. Praziquantel
Praziquantel treats schistosomiasis and tapeworm infections, not amoebiasis.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, A luminal amoebicide such as paromomycin or diloxanide furoate. Amoebic liver abscess is caused by Entamoeba histolytica, which reaches the liver through the portal vein from the colon.

Why is "Ivermectin" not the answer?

Ivermectin treats strongyloides and scabies, not amoebiasis.

Why is "Albendazole" not the answer?

Albendazole is an anthelmintic and has no activity against Entamoeba.

Why is "Praziquantel" not the answer?

Praziquantel treats schistosomiasis and tapeworm infections, not amoebiasis.

What concept does this question test?

It tests Infectious diseases: amoebic liver abscess in General Medicine. Metronidazole kills tissue trophozoites but is poorly active in the gut lumen, so a luminal agent (paromomycin or diloxanide furoate) is needed to eradicate colonic cysts and prevent relapse. Aspiration is considered for large or left-lobe abscesses or if there is no response.

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 Infectious diseases: amoebic liver abscess?

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.