A 48-year-old man with a history cirrhosis secondary to hepatitis C presents to the emergency room with confusion, altered mentation, and erratic behavior. He is afebrile. His examination is notable for grossly normal motor strength throughout, hyperreflexia, asterixis, bulging flanks, and shifting dullness. His total bilirubin is 6 mg/dL, his creatinine is 1.8 mg/dL, and his prothrombin time is elevated. His white blood cell count is 11,000/µL with $85 \%$ neutrophils. His ammonia level is 30 µg/dL (normal 15-45 µg/dL). Which of the following statements is correct?

Correct Answer: B

Rationale: The correct answer is B because the patient's presentation with cirrhosis, altered mentation, and ascites is concerning for spontaneous bacterial peritonitis (SBP). Ascitic fluid should be sampled to confirm the diagnosis and guide appropriate antibiotic therapy. Choice A is incorrect because ammonia levels can fluctuate and do not rule out hepatic encephalopathy. Choice C is incorrect as aminoglycosides are not first-line for SBP. Choice D is incorrect because lactulose is used to treat hepatic encephalopathy, not SBP. Sampling ascitic fluid is crucial in this case to diagnose and treat SBP promptly and effectively.

Correct Answer: B

Rationale: The correct answer is B: Constipation. Antacids containing aluminum or calcium can lead to constipation due to their ability to slow down gut motility. This can cause difficulty in passing stool. Diarrhea (choice A) is not a common side effect of antacids. Weight gain (choice C) and dizziness (choice D) are also not typical side effects of antacids. Constipation is a well-known side effect of antacids, making choice B the correct answer in managing PUD.

Correct Answer: B

Rationale: The correct answer is B. H2RAs block acid secretion by inhibiting histamine. Histamine stimulates acid production by binding to H2 receptors on parietal cells. By blocking these receptors, H2RAs reduce acid secretion, providing relief in peptic ulcer disease (PUD). Choice A is incorrect because H2RAs do not neutralize gastric acid directly. Choice C is incorrect as H2RAs do not coat the stomach lining. Choice D is incorrect as H2RAs do not eradicate H. pylori, the bacteria commonly associated with PUD.

Correct Answer: D

Rationale: Both NSAIDs and aspirin inhibit prostaglandins, reducing mucosal protection and worsening PUD.

Correct Answer: C

Rationale: Sudden, sharp pain worsened by movement in a PUD patient suggests perforation, a medical emergency.