Gastrointestinal surgery: tuberculous peritonitis: 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 · Gastrointestinal surgery: tuberculous peritonitis

Sample item

A 24-year-old woman from a rural area has two months of low-grade fever, weight loss and ascites. Ascitic fluid is a lymphocytic exudate with a serum-ascites albumin gradient below 1.1. Which test best confirms the cause?

AMantoux skin testBAscitic fluid Ziehl-Neelsen smear aloneCSerum CA-125 levelDLaparoscopic peritoneal biopsy showing caseating granulomas

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

The answer and the reasoning

D. Laparoscopic peritoneal biopsy showing caseating granulomas

A lymphocytic low-gradient exudate points to tuberculous peritonitis. Laparoscopic visualisation with biopsy gives the highest yield; fluid smear has low sensitivity, and CA-125 is raised in both tuberculosis and ovarian cancer.

Option by option

A. Mantoux skin test
A positive Mantoux shows exposure and does not prove abdominal disease.
B. Ascitic fluid Ziehl-Neelsen smear alone
The smear of ascitic fluid is positive in only a small minority of cases.
C. Serum CA-125 level
CA-125 is raised in peritoneal tuberculosis too, so it cannot confirm it.
D. Laparoscopic peritoneal biopsy showing caseating granulomas (correct)
Correct. Direct biopsy showing caseating granulomas confirms the diagnosis.

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 Surgery question

What is the answer to this General Surgery question?

The best answer is D, Laparoscopic peritoneal biopsy showing caseating granulomas. A lymphocytic low-gradient exudate points to tuberculous peritonitis.

Why is "Mantoux skin test" not the answer?

A positive Mantoux shows exposure and does not prove abdominal disease.

Why is "Ascitic fluid Ziehl-Neelsen smear alone" not the answer?

The smear of ascitic fluid is positive in only a small minority of cases.

Why is "Serum CA-125 level" not the answer?

CA-125 is raised in peritoneal tuberculosis too, so it cannot confirm it.

What concept does this question test?

It tests Gastrointestinal surgery: tuberculous peritonitis in General Surgery. Laparoscopic visualisation with biopsy gives the highest yield; fluid smear has low sensitivity, and CA-125 is raised in both tuberculosis and ovarian cancer.

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 Gastrointestinal surgery: tuberculous peritonitis?

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.