Cirrhosis: ABFM practice questions

6 board-style questions on cirrhosis in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 58-year-old man with alcoholic cirrhosis (Child-Pugh class B) and known ascites presents with increasing abdominal distension, diffuse abdominal tenderness, and mild confusion over 3 days. He is afebrile with a heart rate of 98 bpm and blood pressure of 105/65 mmHg. Diagnostic paracentesis yields cloudy fluid with a serum-ascites albumin gradient (SAAG) of 1.8 g/dL, ascitic fluid total protein of 1.0 g/dL, and an ascitic fluid absolute polymorphonuclear (PMN) cell count of 420 cells/mm3. Gram stain shows no organisms. What is the most appropriate immediate management?

  1. Schedule a transjugular intrahepatic portosystemic shunt (TIPS) procedure
  2. Await ascitic fluid culture results before initiating any antibiotics
  3. Start IV cefotaxime empirically for spontaneous bacterial peritonitis
  4. Increase oral diuretic doses and repeat paracentesis in 48 hours

Sample question 2

A 60-year-old woman with hepatitis C-related compensated cirrhosis achieved sustained virologic response (SVR) after completing direct-acting antiviral therapy 2 years ago. She feels well, her liver function tests have normalized, and her most recent FibroScan shows a liver stiffness of 16 kPa. She asks if she still needs hepatocellular carcinoma (HCC) surveillance. What is the most appropriate recommendation?

  1. Switch to annual contrast-enhanced CT of the abdomen for HCC surveillance
  2. Perform a one-time liver MRI and discontinue surveillance if the result is normal
  3. Continue HCC surveillance with abdominal ultrasound with or without alpha-fetoprotein every 6 months
  4. HCC surveillance can be discontinued since she achieved SVR and her liver tests are normal

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