Liver Cirrhosis — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementLiver CirrhosisORE Part 1

A 50-year-old patient with liver cirrhosis and portal hypertension requires dental extraction. Which of the following is the most important pre-operative investigation?

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Correct answer: C — Coagulation screen (PT/INR) and full blood count

Explanation lettering: C = shown as A · A = shown as C

Answer: A. Coagulation screen (PT/INR) and full blood count are the most important pre-operative investigations for a patient with cirrhosis undergoing dental extraction. Cirrhosis impairs hepatic synthesis of clotting factors, causing prolonged PT/INR and thrombocytopenia—the primary drivers of bleeding risk in this population. These investigations directly assess haemostatic capacity and guide need for factor or platelet transfusion. Option B (liver function tests alone) reflects disease severity but does not measure coagulation parameters. Options C, D and E address metabolic, renal and respiratory factors respectively, but are not the immediate bleeding-risk priority. UK guidance emphasises haematological assessment before oral surgery in cirrhosis.

Reference: SDCEP (Scottish Dental Clinical Effectiveness Programme). Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd edition (2022), www.sdcep.org.uk; supported by international consensus on coagulation management in cirrhosis (ISTH/Roberts et al., J Thromb Haemost 2022; 20:39-47), https://companion.sdcep.org.uk/management-of-dental-patients-taking-anticoagulants-or-antiplatelet-drugs/assessing-bleeding-risk/patient-bleeding-risk-factors/