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Resistant hypertension — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Resistant hypertensionUSMLE Step 3

A patient with cirrhosis undergoes uncomplicated removal of 8 L of ascites for refractory tense ascites. He is hemodynamically stable after the procedure. Which adjunct best reduces post-paracentesis circulatory dysfunction?

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Correct answer: C — Give concentrated albumin at 6–8 g per liter of ascites removed

The best answer is “Give concentrated albumin at 6–8 g per liter of ascites removed”. After large-volume paracentesis of at least 5 L, AASLD guidance supports concentrated albumin at 6–8 g per liter removed to reduce circulatory dysfunction, hyponatremia, and kidney injury. Crystalloid and plasma are not equivalent volume-expansion strategies.

Reference: AASLD: Management of Refractory Ascites in Cirrhosis: https://www.aasld.org/liver-fellow-network/core-series/clinical-pearls/management-refractory-ascites-cirrhosis