Hepatology: ascitic fluid interpretation: 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: ascitic fluid interpretation

Sample item

A 25-year-old woman has fever, weight loss and abdominal distension for 6 weeks. Ascitic fluid analysis shows albumin 2.6 g/dL (serum albumin 3.4 g/dL), protein 4.8 g/dL, lymphocytes 90% and adenosine deaminase markedly raised. What is the most likely diagnosis?

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

The answer and the reasoning

B. Tuberculous peritonitis

SAAG = serum albumin minus ascitic albumin = 3.4 minus 2.6 = 0.8 g/dL, which is below 1.1 and so not due to portal hypertension. A lymphocyte-predominant, protein-rich exudate with raised ADA in a young febrile patient indicates tuberculous peritonitis, which is treated with standard antituberculous therapy.

Option by option

  • A. Spontaneous bacterial peritonitis

    Spontaneous bacterial peritonitis is defined by neutrophils of 250 per mm3 or more, not a lymphocytic fluid.

  • B. Tuberculous peritonitis (correct)

    Correct. Lymphocytic, protein-rich ascites with high ADA in a young febrile patient is tuberculous peritonitis.

  • C. Budd-Chiari syndrome

    Budd-Chiari causes high-SAAG ascites with high protein, but ADA is not raised and fever with weight loss is not typical.

  • D. Cirrhosis with portal hypertension

    Cirrhotic ascites is typically low in protein and not lymphocyte-rich with high ADA.

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 B, Tuberculous peritonitis. SAAG = serum albumin minus ascitic albumin = 3.

Why is "Spontaneous bacterial peritonitis" not the answer?

Spontaneous bacterial peritonitis is defined by neutrophils of 250 per mm3 or more, not a lymphocytic fluid.

Why is "Budd-Chiari syndrome" not the answer?

Budd-Chiari causes high-SAAG ascites with high protein, but ADA is not raised and fever with weight loss is not typical.

Why is "Cirrhosis with portal hypertension" not the answer?

Cirrhotic ascites is typically low in protein and not lymphocyte-rich with high ADA.

What concept does this question test?

It tests Hepatology: ascitic fluid interpretation in General Medicine. 4 minus 2.6 = 0.8 g/dL, which is below 1.1 and so not due to portal hypertension. A lymphocyte-predominant, protein-rich exudate with raised ADA in a young febrile patient indicates tuberculous peritonitis, which is treated with standard antituberculous therapy.

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 Hepatology: ascitic fluid interpretation?

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.