Nephrology: peritoneal dialysis peritonitis: 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 · Nephrology: peritoneal dialysis peritonitis

Sample item

A 52-year-old man on continuous ambulatory peritoneal dialysis has abdominal pain and notices cloudy effluent. The dialysate cell count shows 800 white cells per microlitre with 90% neutrophils. He is haemodynamically stable. What is the most appropriate management?

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

The answer and the reasoning

B. Send effluent for culture, then give empirical intraperitoneal antibiotics covering Gram-positive and Gram-negative organisms while keeping the catheter

Peritonitis is diagnosed by cloudy effluent with more than 100 white cells per microlitre and over 50% neutrophils. After sending effluent for culture (inoculated into blood culture bottles), empirical antibiotics are given by the intraperitoneal route to reach high local concentrations, covering both Gram-positive and Gram-negative organisms and then tailored to culture. Catheter removal is reserved for refractory, relapsing, fungal or faecal peritonitis.

Option by option

  • A. Perform an emergency laparotomy to look for visceral perforation

    Laparotomy is considered only for suspected perforation, with multiple organisms or faecal effluent.

  • B. Send effluent for culture, then give empirical intraperitoneal antibiotics covering Gram-positive and Gram-negative organisms while keeping the catheter (correct)

    Correct. Culture-guided intraperitoneal therapy treats most episodes without losing the catheter.

  • C. Stop dialysis and give oral antibiotics for 5 days

    Oral antibiotics do not achieve adequate peritoneal levels and stopping dialysis is unnecessary.

  • D. Remove the catheter immediately and switch permanently to haemodialysis

    Removing the catheter is reserved for refractory, relapsing or fungal peritonitis, not for an uncomplicated first presentation.

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 B, Send effluent for culture, then give empirical intraperitoneal antibiotics covering Gram-positive and Gram-negative organisms while keeping the catheter. Peritonitis is diagnosed by cloudy effluent with more than 100 white cells per microlitre and over 50% neutrophils.

Why is "Perform an emergency laparotomy to look for visceral perforation" not the answer?

Laparotomy is considered only for suspected perforation, with multiple organisms or faecal effluent.

Why is "Stop dialysis and give oral antibiotics for 5 days" not the answer?

Oral antibiotics do not achieve adequate peritoneal levels and stopping dialysis is unnecessary.

Why is "Remove the catheter immediately and switch permanently to haemodialys…" not the answer?

Removing the catheter is reserved for refractory, relapsing or fungal peritonitis, not for an uncomplicated first presentation.

What concept does this question test?

It tests Nephrology: peritoneal dialysis peritonitis in General Medicine. After sending effluent for culture (inoculated into blood culture bottles), empirical antibiotics are given by the intraperitoneal route to reach high local concentrations, covering both Gram-positive and Gram-negative organisms and then tailored to culture. Catheter removal is reserved for refractory, relapsing, fungal or faecal peritonitis.

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 Nephrology: peritoneal dialysis peritonitis?

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.