← Back to Topics

ascites

Practice targeted AMC-style multiple-choice questions on ascites.

Related Topics

Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset jaundice and ascites. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Initiate systemic chemotherapy
B. Referral for liver transplant evaluation
C. Order a triple-phase CT scan of the abdomen
D. Perform a percutaneous liver biopsy
E. Start sorafenib therapy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 68-year-old male with a long history of alcohol-related cirrhosis and previous treatment for hepatitis C presents with increasing abdominal distension, fatigue, and a dull ache in the right upper quadrant. He denies acute pain or fever. On examination, he has mild jaundice, shifting dullness, and spider naevi. His vital signs are stable. Recent blood tests show albumin 28 g/L, INR 1.4, total bilirubin 45 µmol/L, ALT 65 U/L, AST 88 U/L, creatinine 90 µmol/L. Alpha-fetoprotein (AFP) is 850 µg/L (normal <10). An abdominal CT scan with contrast is performed, axial views of which are shown. Considering the patient's clinical presentation, laboratory results, and the findings on the provided imaging, what is the MOST appropriate immediate next step in the management of this patient?

A. Proceed directly to surgical resection of the lesion.
B. Schedule a follow-up CT scan in 3 months to monitor for growth.
C. Discuss the case at a multidisciplinary liver tumour board meeting to determine staging and treatment options.
D. Initiate systemic chemotherapy with sorafenib.
E. Obtain a percutaneous biopsy of the lesion for histological confirmation.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 70-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and a palpable liver mass. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next diagnostic step?

A. Quadruple-phase CT scan of the abdomen
B. Initiate systemic chemotherapy
C. Repeat ultrasound in 3 months
D. MRI of the abdomen with hepatobiliary contrast
E. Liver biopsy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with a history of chronic hepatitis C presents with right upper quadrant pain, weight loss, and jaundice. Vital signs are stable. Physical examination reveals hepatomegaly and mild ascites. Laboratory investigations include elevated alpha-fetoprotein (AFP). Imaging is performed as shown. Considering the clinical context and the findings demonstrated in the imaging, which of the following assessments is MOST crucial for determining the feasibility and type of definitive treatment for the identified lesion?

A. Confirmation of hepatitis C viral load
B. Assessment of underlying liver synthetic function (e.g., Child-Pugh score)
C. Evaluation for extrahepatic metastatic disease
D. Assessment of portal vein patency
E. Measurement of the lesion's maximum diameter
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Order a CT scan of the abdomen with IV contrast
B. Referral for liver transplant evaluation
C. Initiate systemic chemotherapy
D. Begin palliative care
E. Perform a percutaneous liver biopsy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 58-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and RUQ pain. His AFP is markedly elevated. A CT abdomen with IV contrast is performed, as shown. What is the MOST appropriate next step in confirming the suspected diagnosis?

A. Initiate systemic chemotherapy
B. Referral for liver transplantation evaluation
C. Repeat CT scan in 3 months
D. MRI of the abdomen with hepatobiliary contrast
E. Liver biopsy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 65-year-old male with new onset ascites and elevated ALP has the imaging shown. What is the MOST likely primary malignancy?

A. Colorectal
B. Cholangiocarcinoma
C. Gastric
D. Hepatocellular
E. Pancreatic
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Surveillance with serial AFP measurements and ultrasound
B. Referral for liver transplant evaluation
C. Percutaneous ethanol ablation
D. Surgical resection
E. Initiation of systemic chemotherapy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 70-year-old male with known gastric MANEC presents with worsening jaundice and ascites. The provided CT scan was performed. Which of the following serum markers would be MOST useful in monitoring disease progression in this patient?

A. Amylase
B. Chromogranin A
C. CEA
D. Alpha-fetoprotein
E. CA 19-9
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and a palpable liver mass. His AFP is 600 ng/mL. A contrast-enhanced ultrasound is performed. What is the MOST appropriate next step in confirming the diagnosis and guiding management?

A. Repeat AFP in 3 months
B. Initiate sorafenib therapy
C. Liver biopsy
D. Administer systemic chemotherapy
E. Perform a diagnostic paracentesis
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with a history of chronic hepatitis C presents with right upper quadrant pain, weight loss, and jaundice. Physical examination reveals hepatomegaly and mild ascites. Laboratory investigations include elevated alpha-fetoprotein (AFP) levels. Imaging is performed as shown. Considering the clinical context and the findings demonstrated in the imaging, which of the following factors is MOST critical in determining this patient's eligibility for potentially curative surgical resection?

A. Absolute value of serum alpha-fetoprotein
B. Genotype of hepatitis C virus
C. Tumour size and number
D. Patient's chronological age
E. Presence of clinically significant portal hypertension
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Hepatic metastases from a gastric mixed adenoneuroendocrine carcinoma (MANEC).
Image by Hellerhoff CC BY-SA 3.0 · Source

A 62-year-old male presents with a 3-month history of worsening upper abdominal pain, significant fatigue, and a 10 kg unintentional weight loss. His medical history includes long-standing peptic ulcer disease managed with proton pump inhibitors. On examination, he has mild hepatomegaly and trace ascites. Initial blood tests show elevated alkaline phosphatase and gamma-glutamyl transferase, with normal serum bilirubin and transaminases. A contrast-enhanced CT scan of the abdomen and pelvis is performed, and representative images are provided. Considering the clinical presentation and the findings demonstrated on the imaging, which of the following represents the MOST appropriate immediate next step in the management of this patient?

A. Commencement of empirical systemic chemotherapy
B. Urgent upper endoscopy with gastric biopsies
C. Immediate referral to palliative care services
D. Image-guided biopsy of a liver lesion
E. Referral for surgical assessment for liver metastasectomy
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset jaundice and abdominal distension. Ascites is confirmed on examination. The patient denies alcohol use. An ultrasound with contrast is performed, as shown. What is the MOST appropriate next step in management?

A. Referral for liver transplant evaluation
B. Order a triple-phase CT scan of the abdomen
C. Initiate empiric antibiotic therapy for spontaneous bacterial peritonitis
D. Administer intravenous albumin and diuretics
E. Paracentesis for diagnostic and therapeutic purposes
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is elevated. A CT scan of the abdomen with and without contrast is performed, as shown. What is the MOST appropriate next step in management?

A. Start sorafenib therapy
B. Referral for liver transplant evaluation
C. Initiate systemic chemotherapy
D. Perform a percutaneous liver biopsy
E. Order a triple phase MRI of the liver
Mark this as a high-quality question
Mark this as a poor-quality or problematic question

A 50-year-old woman presents with increasing abdominal swelling and early satiety. Examination reveals ascites. Which investigation is most crucial to guide initial management?

A. Diagnostic paracentesis
B. Complete blood count
C. Abdominal ultrasound
D. Liver function tests
E. Serum albumin and ascitic fluid protein
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
Contrast-enhanced ultrasound of encephaloid hepatocellular carcinoma
Image by R. Badea, Simona Ioanitescu CC BY 3.0 · Source

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A. Referral for liver transplant evaluation
B. Initiate sorafenib therapy
C. Perform a percutaneous liver biopsy
D. Schedule a follow-up ultrasound in 3 months
E. Order a CT scan of the abdomen with IV contrast
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 65-year-old male with known cirrhosis secondary to chronic hepatitis B presents with increasing abdominal distension and fatigue. He has mild ascites. Liver function tests show bilirubin 35 umol/L, INR 1.3, albumin 30 g/L. AFP is 850 ng/mL. Imaging is performed as shown. Based on the imaging findings and clinical presentation, which of the following treatment modalities is MOST likely to be considered for this patient?

A. Initiation of systemic targeted therapy
B. Referral for liver transplantation assessment
C. Percutaneous radiofrequency ablation
D. Transarterial chemoembolisation
E. Surgical resection
Mark this as a high-quality question
Mark this as a poor-quality or problematic question
CT scan of hepatocellular carcinoma, without and with IV contrast
Image by Zhenyu Pan, Guozi Yang, Tingting Yuan, Lihua Dong, Lihua Dong CC BY 4.0 · Source

A 62-year-old male with chronic hepatitis C presents with right upper quadrant pain, weight loss, and mild ascites. Laboratory tests show elevated alpha-fetoprotein. Imaging is performed. Based on the clinical context and the findings depicted in the provided imaging, which of the following factors is MOST important in assessing this patient's suitability for potentially curative surgical management?

A. Evidence of portal venous thrombosis or invasion.
B. Absolute level of serum alpha-fetoprotein.
C. Patient's body mass index.
D. Maximum diameter of the hepatic lesion.
E. Specific viral load of hepatitis C RNA.
Mark this as a high-quality question
Mark this as a poor-quality or problematic question