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Ascites with high SBP risk — USMLE Step 3 MCQ

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HardInternal Medicine (chronic management)Ascites with high SBP riskUSMLE Step 3

A 59-year-old man with compensated cirrhosis has tense ascites. Diagnostic paracentesis shows ascitic albumin 0.8 g/dL, serum albumin 2.8 g/dL, neutrophil count 42/mm3, and total protein 0.9 g/dL. Creatinine is 1.5 mg/dL and sodium is 128 mEq/L. Which of the following is the most appropriate next step in management?

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Correct answer: E — Primary prophylaxis for spontaneous bacterial peritonitis

Low ascitic protein plus renal dysfunction or hyponatremia increases SBP risk and supports primary antibiotic prophylaxis. Neutrophil count below 250/mm3 excludes current SBP.

Reference: AASLD Ascites and Spontaneous Bacterial Peritonitis Guidance