Hepatology: Budd-Chiari syndrome: 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: Budd-Chiari syndrome

Sample item

A 32-year-old woman has abdominal pain, rapidly accumulating ascites and tender hepatomegaly. Ascitic protein is 3.8 g/dL. Ultrasound shows an enlarged liver with prominent caudate lobe. What is the best initial investigation?

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

The answer and the reasoning

D. Doppler ultrasound of the hepatic veins and inferior vena cava

Hepatic venous outflow obstruction causes the triad of pain, ascites and hepatomegaly, with caudate hypertrophy because its veins drain directly into the inferior vena cava. Doppler ultrasound shows absent or reversed flow in the hepatic veins and is the first test. Prothrombotic states such as polycythaemia vera (JAK2), PNH and pregnancy are sought, and anticoagulation is started.

Option by option

  • A. ERCP

    ERCP assesses the biliary tree and does not evaluate hepatic venous flow.

  • B. HIDA scan

    A HIDA scan evaluates gallbladder function and bile flow and is not relevant here.

  • C. Percutaneous liver biopsy

    Biopsy is invasive in a patient with ascites and coagulopathy and is not needed first.

  • D. Doppler ultrasound of the hepatic veins and inferior vena cava (correct)

    Correct. Doppler ultrasound is non-invasive and diagnostic in most cases.

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Doppler ultrasound of the hepatic veins and inferior vena cava. Hepatic venous outflow obstruction causes the triad of pain, ascites and hepatomegaly, with caudate hypertrophy because its veins drain directly into the inferior vena cava.

Why is "ERCP" not the answer?

ERCP assesses the biliary tree and does not evaluate hepatic venous flow.

Why is "HIDA scan" not the answer?

A HIDA scan evaluates gallbladder function and bile flow and is not relevant here.

Why is "Percutaneous liver biopsy" not the answer?

Biopsy is invasive in a patient with ascites and coagulopathy and is not needed first.

What concept does this question test?

It tests Hepatology: Budd-Chiari syndrome in General Medicine. Doppler ultrasound shows absent or reversed flow in the hepatic veins and is the first test. Prothrombotic states such as polycythaemia vera (JAK2), PNH and pregnancy are sought, and anticoagulation is started.

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: Budd-Chiari syndrome?

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.