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Hepatic encephalopathy — USMLE Step 3 MCQ

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ModerateInternal Medicine (chronic management)Hepatic encephalopathyUSMLE Step 3

A 70-year-old woman with cirrhosis develops confusion and sleep reversal. Asterixis is present. She has no focal neurologic deficits. Serum sodium is 134 mEq/L, creatinine is 1.0 mg/dL, and stool guaiac is negative. Which of the following is the most appropriate at this time?

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Reveal the answer and explanation

Correct answer: B — Start lactulose and evaluate for precipitating causes

Hepatic encephalopathy is treated with lactulose while searching for triggers such as infection, bleeding, constipation, or medications.

Reference: AASLD hepatic encephalopathy guidance