Gastroenterology: 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 · Gastroenterology

Sample item

A man with alcoholic cirrhosis and ascites develops fever and diffuse abdominal tenderness. What is the most appropriate next step in management?

AIncrease the dose of diuretics and review in a weekBUpper gastrointestinal endoscopyCDiagnostic paracentesis with ascitic fluid cell count and cultureDPlain abdominal radiograph only

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

The answer and the reasoning

C. Diagnostic paracentesis with ascitic fluid cell count and culture

Fever and abdominal pain in a patient with cirrhotic ascites suggest spontaneous bacterial peritonitis. It is confirmed by ascitic fluid neutrophil count, and fluid should be cultured. Diagnostic paracentesis should be done promptly in any cirrhotic patient with ascites who is ill.

Option by option

A. Increase the dose of diuretics and review in a week
More diuretic does not address infection and may precipitate kidney injury.
B. Upper gastrointestinal endoscopy
Endoscopy would look for varices or ulcers, which do not explain fever with abdominal tenderness.
C. Diagnostic paracentesis with ascitic fluid cell count and culture (correct)
Correct. Ascitic fluid analysis confirms infection and guides antibiotic therapy.
D. Plain abdominal radiograph only
A plain film cannot diagnose peritoneal infection of ascitic fluid.

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 C, Diagnostic paracentesis with ascitic fluid cell count and culture. Fever and abdominal pain in a patient with cirrhotic ascites suggest spontaneous bacterial peritonitis.

Why is "Increase the dose of diuretics and review in a week" not the answer?

More diuretic does not address infection and may precipitate kidney injury.

Why is "Upper gastrointestinal endoscopy" not the answer?

Endoscopy would look for varices or ulcers, which do not explain fever with abdominal tenderness.

Why is "Plain abdominal radiograph only" not the answer?

A plain film cannot diagnose peritoneal infection of ascitic fluid.

What concept does this question test?

It tests Gastroenterology in General Medicine. It is confirmed by ascitic fluid neutrophil count, and fluid should be cultured. Diagnostic paracentesis should be done promptly in any cirrhotic patient with ascites who is ill.

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 Gastroenterology?

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.