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Spontaneous bacterial peritonitis — SCE Acute Medicine MCQ

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EasySepsis and Infectious EmergenciesSpontaneous bacterial peritonitisSCE Acute Medicine

A 55-year-old man presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show cirrhosis with ascitic neutrophils above 250 cells per mm3. What is the most appropriate next step in management?

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Correct answer: B — Start intravenous cefotaxime or ceftriaxone and give albumin where indicated

The key discriminator is that cirrhosis with ascitic neutrophils above 250 cells per mm3, which makes Start intravenous cefotaxime or ceftriaxone and give albumin where indicated the single best answer. Start broad-spectrum intravenous antibiotics is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Give analgesia and antiemetic therapy and Give intravenous fluids with reassessment are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BSG/BASL ascites guideline