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Therapeutic paracentesis safety — SCE Acute Medicine MCQ

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ModerateProcedural Knowledge and Acute Management DecisionsTherapeutic paracentesis safetySCE Acute Medicine

A 62-year-old man is assessed on the acute medical unit. He has cirrhosis with fever and ascites. INR is 1.8 and platelets are 82 x10^9/L. A junior asks whether ascitic tap should wait for correction. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate investigation?

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Correct answer: C — Check coagulation and platelet count but do not delay necessary diagnostic tap

Check coagulation and platelet count but do not delay necessary diagnostic tap is the best answer because diagnostic paracentesis is generally safe in cirrhosis and should not be delayed for modest coagulopathy. CT angiography of the aorta is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Routine correction of INR in cirrhosis before low-risk procedures is often unnecessary.

Reference: BSG ascites guideline