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Cirrhotic ascites — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Cirrhotic ascitesUSMLE Step 3

A 52-year-old woman with cirrhosis due to hepatitis C has increasing abdominal distention. Paracentesis shows ascitic fluid albumin 0.7 g/dL, serum albumin 2.8 g/dL, neutrophils 80/mm3, and culture is negative. She has no encephalopathy. Which of the following is the most appropriate next step in management?

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Correct answer: E — Start sodium restriction and spironolactone with furosemide

Uncomplicated cirrhotic ascites is managed initially with sodium restriction and diuretics; SBP requires neutrophils of at least 250/mm3.

Reference: AASLD cirrhosis ascites guidance