Liver: Budd-Chiari syndrome: practice question

A General Surgery 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 Surgery · Liver: Budd-Chiari syndrome

Sample item

A 29-year-old woman has abdominal pain, tender hepatomegaly and rapidly developing ascites over 2 weeks. Ultrasound shows an enlarged caudate lobe, and she has a raised haemoglobin and platelet count. What is the best initial investigation?

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

The answer and the reasoning

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

Budd-Chiari syndrome is hepatic venous outflow obstruction, commonly from thrombosis caused by a myeloproliferative neoplasm (JAK2 mutation), pregnancy or oral contraceptives. Caudate hypertrophy occurs because its veins drain directly to the inferior vena cava. Doppler ultrasound showing absent or reversed hepatic vein flow is the first-line investigation.

Option by option

  • A. Liver biopsy as the first test

    Biopsy is invasive, risky with ascites and coagulopathy, and is not the first test.

  • B. HIDA scan

    A HIDA scan evaluates biliary excretion and gallbladder function, not hepatic venous flow.

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

    Correct. Doppler shows absent or abnormal hepatic vein flow in Budd-Chiari syndrome.

  • D. Serum alpha-fetoprotein

    AFP is a tumour marker and does not diagnose venous thrombosis.

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 Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Doppler ultrasound of the hepatic veins and inferior vena cava. Budd-Chiari syndrome is hepatic venous outflow obstruction, commonly from thrombosis caused by a myeloproliferative neoplasm (JAK2 mutation), pregnancy or oral contraceptives.

Why is "Liver biopsy as the first test" not the answer?

Biopsy is invasive, risky with ascites and coagulopathy, and is not the first test.

Why is "HIDA scan" not the answer?

A HIDA scan evaluates biliary excretion and gallbladder function, not hepatic venous flow.

Why is "Serum alpha-fetoprotein" not the answer?

AFP is a tumour marker and does not diagnose venous thrombosis.

What concept does this question test?

It tests Liver: Budd-Chiari syndrome in General Surgery. Caudate hypertrophy occurs because its veins drain directly to the inferior vena cava. Doppler ultrasound showing absent or reversed hepatic vein flow is the first-line investigation.

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 Liver: Budd-Chiari syndrome?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.