Block 5 Clinical Systems Quiz

Front 1

Define Primary Sclerosing Cholangitis.

Back 1

Progressive obliteration of intra and extra hepatic bile ducts is also known as what?

Front 2

What is the most common cause of cholecystitis?

Back 2

Calculi (stones) are the most common cause of what condition?

Front 3

What is the treatment for primary sclerosing cholangitis?

Back 3

Ursodeoxycholic acid with or without methotrexate can be used to treat what condition?

Front 4

What is Charcot's triad and what condition does it indicate?

Back 4

RUQ abdominal pain, fever, and jaundice are indicative of Primary Sclerosing Cholangitis. These symptoms are also known as what?

Front 5

Define choledocholithiasis.

Back 5

What is another name for a stone in the common bile duct?

Front 6

What condition is most commonly associated with Primary Sclerosing Cholangitis?

Back 6

Patients with what condition most often also have ulcerative colitis?

Front 7

What is a porcelain gallbladder?

Back 7

A calcified gallbladder wall is also known as what?

Front 8

What is the quality of pain associated with dissecting aneurysms?

Back 8

Tearing or crushing, mid-thoracic back pain is the quality of pain associated with what condition?

Front 9

What is the quality of pain associated with IBD/dyspepsia?

Back 9

What condition is associated with constant, dull quality of pain?

Front 10

What is the quality of pain associated with chronic peptic ulcer?

Back 10

What condition is associated with gnawing hunger quality of pain?

Front 11

What is the quality of pain associated with appendicitis?

Back 11

What condition is associated with diffuse pain shifting from the epigastric region to the RLQ?

Front 12

What is the quality of pain associated with acute cholecystitis?

Back 12

What condition is associated with diffuse pain near RUQ shifting to the scapula?

Front 13

What is the quality of pain associated with acute bowel obstruction?

Back 13

What condition is associated with diffuse periumbilical pain shifting circumferentially to the entire abdominal area?

Front 14

What is the quality of pain associated with pancreatitis?

Back 14

What condition is associated with shifting left upper quadrant pain?

Front 15

What is the quality of pain associated with acute sigmoidal diverticulitis?

Back 15

What condition is associated with shifting left lower quadrant pain?

Front 16

What two conditions should you think of when you see a distended abdomen?

Back 16

Ascites and acute bowel obstruction frequently present with what major feature in common?

Front 17

What sign will a patient with peritonitis exhibit?

Back 17

A patient with what condition will avoid any motion with flexing of the knees?

Front 18

An absence of bowel sounds indicates what condition?

Back 18

Ileus is indicated by what finding on auscultation?

Front 19

What is the quality of pain associated with peritoneal inflammatory reactions?

Back 19

Severe rebound tenderness with pain upon percussion can indicate what condition?

Front 20

Hyperactive bowel sounds indicates what condition?

Back 20

Bowel obstruction is indicated by what finding on auscultation?

Front 21

Multiple bruits can be heard in what condition?

Back 21

Ischemic bowel will have what finding on auscultation?

Front 22

What is the quality of pain associated with a perforated peptic ulcer?

Back 22

What condition is associated with diffuse pain and tenderness in all 4 quadrants?

Front 23

Injestion of what particular foods has been associated with Hepatitis A infection?

Back 23

Injestion of frozen strawberries, raw clams, raw seafood, and mexican green onions has been associated with what infection?

Front 24

What is the treatment for Hepatitis A?

Back 24

Supportive treatment with immune serum globulin is the treatment for which infection?

Front 25

What is the treatment for Hepatitis E?

Back 25

What type of hepatitis is usually self-limiting, and thus requires no treatment?

Front 26

What is the treatment for Hepatitis B?

Back 26

What type of hepatitis is treated with interferon-alpha, lamivudine/adefovir, along with immune serum globulin?

Front 27

What is the pattern of infiltration of hepatic cells in Alcoholic Steatosis?

Back 27

What condition results in hepatocyte death after infiltration of liver cells with TG's and pericellular infiltration with leukocytes?

Front 28

What is the rule of thumb when asking patients about alcohol consumption?

Back 28

When asking patients about _____, you should always double the patient's answer. If your patient is a single middle-aged male, you should triple it.

Front 29

Which infection is most common among inmates and IDU's?

Back 29

Hepatitis C infection is most common among what population?

Front 30

Hepatocellular Carcinoma is the 4th most common cancer worldwide and is most common among what population?

Back 30

Male chinese americans are the most common patient population for what infection?

Front 31

What is the most common cause of drug induced hepatitis?

Back 31

Acetominophen is the most common cause of what condition?

Front 32

What is the cause of damage in Acetominophen induced hepatitis?

Back 32

NAPQ1 is the cause of damage in what condition?

Front 33

What is the antidote for acetominophen induced hepatitis?

Back 33

N-acetylcysteine is the treatment for what condition?

Front 34

What is the purpose of administering activated charcoal during suspected acetominophen overdose?

Back 34

What substance slows gastric emptying and helps absorb acetominophen during overdose?

Front 35

What is a common side effect of TB treatment?

Back 35

INH induced hepatitis is a common side effect during treatment of what condition?

Front 36

List the common causes in drug/toxin induced hepatitis.

Back 36

Acetominophen
INH
Halothane
Amoxacillin
Antivirals

These substances often cause what condition?

Front 37

What is the course of Non-Alcoholic Steato Hepatitis (NASH)?

Back 37

Which 2 stage metabolic disease begins with a pre-existing metabolic abnormality which is soon compounded by development of insulin resistance?

Front 38

Which forms of Hepatitis have chronic carrier states?

Back 38

Hep B and Hep C have what feature in common?

Front 39

Which condition has a suprisingly decreased incidence in smokers?

Back 39

Primary Sclerosing Cholangitis has a decreased incidence in which patient population?

Front 40

A patient presents to the ER with acute onset of pain which radiates to his right scapula. He has been vomitting since his last fatty meal. BP, temp, HR, WBC, ALP, amylase are all elevated. ALT and bilirubin are normal. He exhibits gaurding, but no rebound and no jaundice. What is your diagnosis?

Back 40

What would a patient with biliary tract obstruction look like upon presentation?

Front 41

Your patient presents with RUQ pain, fever, jaundice, intense itching. You do a cholangiogram and find beading of the bile ducts. Blood work shows elevated ALP, bilirubin, as well as ANCA, ANA, and anticardiolipin. What do you suspect?

Back 41

What would the patient with Primary Sclerosing Cholangitis show for blood work and presentation?

Front 42

Fat soluble vitamin deficiency is common in patients with what condition?

Back 42

Primary Sclerosing Cholangitis patients often have deficiencies of what vitamins?

Front 43

What is the definition of cirrhosis?

Back 43

The irreversible end result of fibrous scarring and hepatocellular regeneration is also known as what?

Front 44

A regeneration nodule of <3cm is usually indicative of what type of cirrhosis?

Back 44

Alcoholic cirrhosis patients would be expected to have what type of nodule?

Front 45

A regeneration nodule of >3cm is frequently associated with what type of cirrhosis?

Back 45

Chronic active hepatitis (post-necrotic) cirrhosis has what type of regeneration nodules?

Front 46

How is liver function impaired in cirrhosis?

Back 46

Fibrous scarring disrupts normal hepatic architecture and distorts the vascular bed, leading to portal HT and intrahepatic shunting in what condition?

Front 47

What is the key to diagnosing Fulmitant Hepatic Failure?

Back 47

The diagnosis of what condition is based upon having elevated bilirubin, prothrombin time, and transaminases?

Front 48

Patient presents with painful urination and reddish discoloration of the urine. She has been having chills, nausea, vomitting, and abdominal pain. Her WBC's and platelets are low. What do you suspect?

Back 48

Fulmitant Hepatic Failure can present with what symptoms?

Front 49

What is the priority in treatment of Fulmitant Hepatic Failure?

Back 49

Preventing a rise in intracranial pressure is paramount to preventing coma, or brain herniation leading to death, in what condition?

Front 50

What is the treatment for Fulmitant Hepatic Failure?

Back 50

What condition can be treated with Lactulose and protein restriction?

Front 51

How does Lactulose help patients with FHF?

Back 51

What treatment acts as an osmotic laxative? It is also metabolized by colonic bacteria, which decreases GI pH and stimulates the conversion of ammonia to NH3 ion that can be excreted in stool.

Front 52

What is special about Encephalopathy that is associated with FHF?

Back 52

What condition responds to treatment only when liver function improves and is associated with hypoglycemia and cerebral edema?

Front 53

What is the most sensitive marker for liver damage?

Back 53

AST and ALT are the most sensitive markers for what?

Front 54

If GGTP is the only enzyme that is elevated, what can you assume?

Back 54

No further evaluation is necessary if GGTP is in what state?

Front 55

5'Nucleotidase measures what?

Back 55

Measurement of what enzyme indicates cholestasis and damage to the intra/extra hepatic biliary system?

Front 56

Which enzyme level are interchangable in combination with elevated ALP to determine biliary or extrabiliary origin?

Back 56

GGTP and 5'Nucleotidase are _____ and checked in combination with what other enzyme? What do the results indicate?

Front 57

Elevations in what isoenzyme of LDH indicate an issue with liver or muscle?

Back 57

LDH-4 and LDH-5 isoenzymes indicate issues with what tissues specifically?

Front 58

What is indicated by low levels of albumin?

Back 58

Cirrhosis or malnutrition can be indicated by low levels of what in the blood?

Front 59

What is indicated by elongated Prothrombin Time?

Back 59

Vit K deficiency or liver disease with decreased hepatic synthetic capacity is indicated by what lab value?

Front 60

Decreases in what clotting factors are indicated by an elongated prothrombin time?

Back 60

Factor 7, 10, 5, prothrombin or fibrinogen deficiencies will result in what lab value?

Front 61

Elevated ALP alone can indicate what conditions? Elevated ALP and GTTP can indicate what conditions?

Back 61

Renal or intestinal damage is indicated by what lab value? Liver damage is specifically indicated when the above lab value is seen in combination with what other enzyme?

Front 62

Define Late Onset Hepatic Failure.

Back 62

Onset of encephalopathy 8 wks post-jaundice, post-hepatic injury, with no prior history of liver disease. What is it?

Front 63

What is responsible for the decreased consciousness seen in FHF?

Back 63

Elevations is GABA neurotransmitter are responsible for which symptom of FHF?

Front 64

Which conditions may present similarly to FHF?

Back 64

Reye's Syndrome and Acute Fatty Liver of Pregnancy may present much like what condition?

Front 65

What is the most common complication of liver failure?

Back 65

Hypoglycemia is the most common complication of what condition?

Front 66

What is the treatment for Hypoglycemia during liver failure?

Back 66

IV dextrose while monitoring electrolytes and pH is the treatment for what condition?

Front 67

What is the leading cause of death in FHF?

Back 67

Infection is the leading cause of death in what condition?

Front 68

Why are frequent cultures recommended for patients in FHF?

Back 68

Infection can present without fever or leukocytosis in patients with what condition?

Front 69

Which patients have the best prognosis for a liver transplant?

Back 69

Patients with FHF from acetominophen or Hep A/B have the best prognosis for what?

Front 70

What is the most common cause of GI bleed in liver patients?

Back 70

Gastric erosions are the most common cause of what in liver patients?

Front 71

How do you define one unit of FFP?

Back 71

The amount of fresh frozen plasma that can be obtained from one bag of whole blood transfusion is also known as what?

Front 72

Why do you give mannitol for treatment of cerebral edema?

Back 72

Mannitol is used to treat what condition, because it acts as an osmotic agent to draw H2O out of the brain?

Front 73

What medication negates the measurement of urine to estimate fluid resuscitation?

Back 73

When treating patients with mannitol, what measurement is affected, and how?

Front 74

What is the most common location for diverticula?

Back 74

What condition is most commonly located in the colon of patients over 40 years old?

Front 75

What is the difference between diverticula and diverticulitis?

Back 75

What terms describe (1) the small protruding sacs of inner lining of the intesitines, and (2) the inflammation of those sacs?

Front 76

What is Meckle's diverticulum?

Back 76

What is a congenital protruding sac of the wall of the small bowel which may contain stomach or pancreatic tissue?

Front 77

What is the most common cause of hemorrhoids?

Back 77

Straining during a bowel movement is the most common cause of what condition?

Front 78

What is the definition of hematemesis and what does it indicate?

Back 78

Bright red blood or coffee ground vomit is also known as? It indicates bleeding from the stomach or higher.

Front 79

What is the definition of melena and what does it indicate?

Back 79

Black tarry stools often indicate an upper GI bleed that has been digested. What is another name for this?

Front 80

What is the definition of hematochezia and what does it indicate?

Back 80

Bright red blood from the rectum indicates a lower GI bleed or brisk upper GI bleed, and is also known by what name?

Front 81

How would you treat a cirrhosis patient with an upper GI bleed?

Back 81

Which patients should be given FFP along with packed RBC's to replace blood volume during acute GI bleed?

Front 82

What is the cause of Zollinger Ellison Syndrome?

Back 82

Gastrin secreting tumors of the pancreas can cause severe ulceration of the stomach and small bowel (upper GI) in what condition?

Front 83

What procedure is useful for ruling out an upper GI bleed?

Back 83

Passing an NG tube can be useful to rule out the possibility of what?

Front 84

What is a quantitative stool assessment?

Back 84

What test measures the amount of fat in stool by collecting for 72 hours while on a 100 fat grams per day diet?

Front 85

What is a qualitative assessment?

Back 85

The SUDAN Stain is what type of assessment which, when positive, is evidence of steatorrhea?

Front 86

What procedure would you use to diagnose Whipple's or Amyloidosis?

Back 86

A biopsy of the distal duodenum or proximal jejunum is diagnostic of which two diseases?

Front 87

The results of what procedure are suggestive of Celiac Sprue or Chron's disease?

Back 87

A biopsy of the distal duodenum or proximal jejunum is suggestive of which two diseases?

Front 88

A D-xylose test can be used to distinguish between what conditions? How?

Back 88

Pseudomalabsorption is indicated during which test if bacterial uptake is present? Mucosal malabsorption is more likely if uptake of this substance is low.

Front 89

What is the Schilling Test for?

Back 89

What test documents decreased absorbtion of Vit B12 by radiolabeling the nutrient?

Front 90

What causes damage in Celiac Sprue?

Back 90

An inappropriate T-cell response causes damage in what condition?

Front 91

Almost all patients with Dermatitis Herpetiformis have evidence of what?

Back 91

Celiac disease is present in almost all patients with what condition?

Front 92

Patient presents with a skin rash w/ puritic papulovesicles over the extensor surfaces of the extremeties, trunk, scalp, and neck. What is it?

Back 92

How does Dermatitis Herpetiformis look?

Front 93

What feature is diagnostic of celiac sprue?

Back 93

IgG and IgA antigliandin antibodies are associated with what condition?