Hepatology: hepatic encephalopathy prevention: 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 · Hepatology: hepatic encephalopathy prevention

Sample item

A 58-year-old man with alcohol-related cirrhosis has a second episode of overt hepatic encephalopathy within three months while taking lactulose regularly. Precipitants have been excluded. Which is the best addition to prevent further episodes?

ALong-term oral neomycinBStrict dietary protein restrictionCA benzodiazepine antagonist infusionDRifaximin

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

The answer and the reasoning

D. Rifaximin

Lactulose is first-line for secondary prophylaxis of hepatic encephalopathy. Rifaximin, a non-absorbed antibiotic that reduces gut ammonia-producing bacteria, is added after a second episode and lowers recurrence and hospital admission. Protein restriction is not recommended because it worsens malnutrition and sarcopenia.

Option by option

A. Long-term oral neomycin
Neomycin is absorbed enough to cause nephrotoxicity and ototoxicity with long-term use.
B. Strict dietary protein restriction
Protein restriction increases catabolism and muscle loss, which worsens ammonia handling.
C. A benzodiazepine antagonist infusion
Flumazenil has no role in maintenance prevention and is not an established treatment for encephalopathy.
D. Rifaximin (correct)
Correct. Rifaximin added to lactulose reduces recurrence.

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 D, Rifaximin. Lactulose is first-line for secondary prophylaxis of hepatic encephalopathy.

Why is "Long-term oral neomycin" not the answer?

Neomycin is absorbed enough to cause nephrotoxicity and ototoxicity with long-term use.

Why is "Strict dietary protein restriction" not the answer?

Protein restriction increases catabolism and muscle loss, which worsens ammonia handling.

Why is "A benzodiazepine antagonist infusion" not the answer?

Flumazenil has no role in maintenance prevention and is not an established treatment for encephalopathy.

What concept does this question test?

It tests Hepatology: hepatic encephalopathy prevention in General Medicine. Rifaximin, a non-absorbed antibiotic that reduces gut ammonia-producing bacteria, is added after a second episode and lowers recurrence and hospital admission. Protein restriction is not recommended because it worsens malnutrition and sarcopenia.

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 Hepatology: hepatic encephalopathy prevention?

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.