American Board of Internal Medicine (ABIM) Certification Practice Exam

An SAAG of less than 1.1 g/dL with total protein greater than or equal to 2.5 g/dL suggests which of the following?

1. Infections or malignancy

2. Cirrhosis

3. Cardiac ascites

4. Hypotension

The correct answer is: Infections or malignancy

A serum-ascites albumin gradient (SAAG) of less than 1.1 g/dL typically indicates the presence of ascites caused by conditions that do not involve portal hypertension. When the total protein in the ascitic fluid is greater than or equal to 2.5 g/dL, this further narrows down the differential diagnoses. In this context, the combination of a low SAAG and high protein concentration in the ascitic fluid is often seen in cases of infections, such as tuberculosis or malignancies, including cancer-related ascites. High protein content in the context of a low SAAG suggests that the ascitic fluid is likely exudative, which is characteristic of infections and malignant conditions rather than transudative processes like those seen with liver cirrhosis or cardiac causes. Thus, an SAAG of less than 1.1 g/dL with high protein levels strongly suggests the possibility of infections or malignancies causing the ascites, making this the correct choice.