skip to main content

Cirrhosis with ascites — MCCQE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

ModerateEdemaCirrhosis with ascitesMCCQE Part 1

55-year-old man with alcohol use disorder presents with abdominal distension and ankle swelling. He has spider naevi, shifting dullness and mild jaundice. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Perform diagnostic paracentesis for new ascites and start sodium restriction/diuretics when appropriate

Perform diagnostic paracentesis for new ascites and start sodium restriction/diuretics when appropriate is best because new ascites in cirrhosis requires diagnostic paracentesis to exclude spontaneous bacterial peritonitis. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Do not assume ascites is uncomplicated until the fluid has been assessed.

Reference: Canadian Association for the Study of the Liver guidance