Professional and Linguistic Assessments Board (PLAB) Practice Exam

What medication is commonly used in high doses to prevent ascites in chronic liver disease patients?

1. Furosemide

2. Spironolactone

3. Amiodarone

4. Acetazolamide

The correct answer is: Spironolactone

Spironolactone is commonly used in high doses for patients with chronic liver disease to help prevent ascites. This medication is a potassium-sparing diuretic that works by antagonizing aldosterone, a hormone that regulates sodium and water balance in the body. In chronic liver disease, particularly in conditions like cirrhosis, the liver's ability to produce proteins is diminished, leading to fluid retention and ascites due to increased hydrostatic pressure in the portal circulation and decreased oncotic pressure. Spironolactone helps promote the excretion of sodium and water while conserving potassium, alleviating fluid overload and reducing the build-up of fluid in the abdominal cavity. Its efficacy is enhanced in conjunction with a low-sodium diet and, if necessary, can be combined with other diuretics for more severe cases. In contrast, other medications listed do not have the same primary function for treating ascites due to liver disease. Furosemide, another diuretic, is less common as a first-line treatment in these patients due to the risk of electrolyte imbalance and is often used in conjunction with spironolactone. Amiodarone is an antiarrhythmic drug that does not have a role in managing asc