Hepatobiliary Disease USMLE Step 1 Practice Question
A 48-year-old man with a 10-year history of nonalcoholic fatty liver disease complicated by cirrhosis presents to the clinic with progressive dyspnea, lower extremity edema, and abdominal distension over the past 3 weeks. His wife notes he has been increasingly fatigued and reports orthopnea. Vital signs: BP 128/76 mmHg, HR 102 bpm, RR 24/min, SpO2 91% on room air. Physical examination reveals anasarca, hepatomegaly, ascites, bilateral basilar crackles, and a prominent S3 gallop. Laboratory studies show serum albumin 2.1 g/dL, total bilirubin 3.2 mg/dL, INR 1.8, creatinine 1.0 mg/dL (baseline 0.9), and BNP 520 pg/mL. Abdominal ultrasound confirms cirrhosis with patent portal vein. He denies fever, abdominal pain, or recent alcohol use. Which of the following best explains his acute clinical deterioration?
Answer choices
- ASpontaneous bacterial peritonitis with systemic inflammatory response
- BPortal vein thrombosis with acute splanchnic congestion
- CHepatorenal syndrome Type 1 with oliguria and rising creatinine
- DProgressive hepatic decompensation with worsening synthetic function alone
- ESuperimposed heart failure with elevated filling pressures and pulmonary edemaCorrect answer
- FSevere hypoalbuminemia causing oncotic pressure loss without cardiopulmonary involvement
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