skip to main content

Lupus nephritis — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardRheumatology/Allergy/ImmunologyLupus nephritisABIM Board

A 35-year-old woman presents with abdominal pain, tender hepatomegaly, and new ascites. Doppler ultrasonography shows thrombosis of all three hepatic veins, and testing identifies a JAK2-positive myeloproliferative neoplasm. She has no active bleeding, encephalopathy, or hemodynamic instability. What is the appropriate initial disease-directed strategy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Begin therapeutic anticoagulation and address the prothrombotic disorder

The best answer is “Begin therapeutic anticoagulation and address the prothrombotic disorder”. Budd-Chiari syndrome is managed with a stepwise escalation strategy. In a stable patient without a contraindication, therapeutic anticoagulation and treatment of the underlying prothrombotic disorder are initial disease-directed measures; ascites treatment is supportive. Short obstructive lesions may be recanalized, while TIPS is used when anticoagulation and medical therapy do not achieve adequate control. Liver transplantation is reserved for fulminant disease or failure of decompressive therapy.

Reference: Budd-Chiari syndrome: stepwise management: https://pmc.ncbi.nlm.nih.gov/articles/PMC6448720/