American Board of Internal Medicine (ABIM) Certification Practice Exam

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In patients with ascites, what is a contraindication for TIPS based on MELD score?

  1. Greater than 10

  2. Greater than 15 to 18

  3. Greater than 20

  4. Greater than 25

The correct answer is: Greater than 15 to 18

In the context of Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedures, the Model for End-Stage Liver Disease (MELD) score plays a crucial role in determining candidacy for the intervention. TIPS is typically indicated for patients with complications of portal hypertension, such as refractory ascites, but certain MELD score thresholds raise concerns about the appropriateness of the procedure. A MELD score greater than 15 to 18 is often viewed as a significant threshold with respect to the mortality risk associated with the procedure. Patients within this range may experience increased risks of liver failure following TIPS due to their underlying liver dysfunction. The procedure may not only fail to improve ascites management but could also exacerbate liver issues in individuals with high MELD scores, leading to a higher likelihood of post-procedural complications and mortality. Patients with a MELD score greater than 20 or 25 generally have more severe liver disease and are at an even higher risk for complications. However, the threshold identified in the question—greater than 15 to 18—represents an important intersection where the risks start to outweigh the potential benefits, making it a contraindication for TIPS. Choosing to perform TIPS in

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