8-13 Board Review

A 58-year-old man with known cirrhosis presents with confusion and asterixis. Vitals are normal. Labs show elevated ammonia. He has abdominal distension but no tenderness. What is the most appropriate next step?

• Start IV ceftriaxone and albumin

• Administer lactulose and assess for precipitating factors

• Transfuse platelets and reverse INR

• Intubate immediately for airway protection

A 62-year-old man with cirrhosis presents with fever and abdominal pain. Paracentesis reveals 320 neutrophils/mm³. What is the diagnosis?

• Secondary peritonitis

• Hepatorenal syndrome

• Spontaneous bacterial peritonitis (SBP)

• Bowel obstruction

Which of the following is a diagnostic indicator for hepatorenal syndrome in a cirrhotic patient?

• Proteinuria >1 g/day

• Hypotension unresponsive to fluids, low urine sodium, and no structural kidney damage

• Urine sodium >40 mmol/L

• Elevated BUN with normal creatinine

Which of the following medications is commonly used to reduce portal hypertension in variceal bleeding?

• Nifedipine

• Octreotide

• Lactulose

• Furosemide

A 60-year-old cirrhotic male presents with hypotension, tachycardia, and fever. He has tense ascites. After resuscitation, what is the best next diagnostic step?

• Abdominal CT with contrast

• Emergent paracentesis

• Bedside ultrasound to measure IVC

• Stool occult blood test

A 42-year-old woman presents with intermittent right upper quadrant (RUQ) pain, especially after fatty meals. Vitals are normal. Ultrasound shows gallstones but no gallbladder wall thickening or pericholecystic fluid. What is the most likely diagnosis?

• Acute cholecystitis

• Choledocholithiasis

• Gallstone pancreatitis

• Biliary colic

A 60-year-old man presents with fever, RUQ pain, and jaundice. Vitals show T 102.5ºF, HR 110, BP 90/60. Labs reveal elevated bilirubin and alkaline phosphatase. What is the most likely diagnosis?

• Acute hepatitis

• Acute cholecystitis

• Ascending cholangitis

• Choledocholithiasis

Which of the following is the best next step for a stable patient diagnosed with uncomplicated acute cholecystitis in the ED?

• Start antibiotics and arrange outpatient follow-up

• Consult surgery and admit for cholecystectomy

• Discharge with oral NSAIDs and diet changes

• Perform ERCP

What ultrasound finding is most specific for acute cholecystitis?

• Gallstones without wall thickening

• Gallbladder wall thickening >3 mm

• Positive sonographic Murphy’s sign

• Pericholecystic fluid alone

A 47-year-old man presents with epigastric pain and vomiting. Labs show lipase 1500 U/L. Ultrasound reveals gallstones but no biliary ductal dilation. What is the most likely cause?

• Alcoholic pancreatitis

• Gallstone pancreatitis

• Peptic ulcer disease

• Acute hepatitis