American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following patients would most likely benefit from large-volume paracentesis?

1. Patients with heart failure

2. Patients with effective diuretic therapy

3. Patients with significant ascites and intolerable diuretics

4. Patients with Hepatic Encephalopathy

The correct answer is: Patients with significant ascites and intolerable diuretics

Large-volume paracentesis is typically performed in patients who present with significant ascites, especially when it is causing symptoms that are intolerable despite medical management. Ascites can result from various underlying conditions, including cirrhosis, heart failure, and malignancies, and while diuretics can often manage mild to moderate cases, they may not be effective for all patients. In cases where patients have significant ascites that is unmanageable with diuretics, a large-volume paracentesis can provide rapid symptom relief, improve comfort, and potentially decrease complications associated with ascites, such as infection. This procedure helps to remove excess fluid, thereby alleviating abdominal distension, discomfort, and any issues related to respiratory distress from diaphragm elevation due to fluid overload. Patients with heart failure might experience fluid retention, but they are generally better managed with diuretics and fluid restriction, which makes large-volume paracentesis less likely to be beneficial. Those on effective diuretic therapy usually have their ascites adequately controlled and may not require further intervention. Patients with hepatic encephalopathy require careful management of their underlying liver condition and fluid balance but may not directly benefit from paracentesis unless ascites is contributing significantly to their symptoms. Thus