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64 Cards in this Set
- Front
- Back
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The liver takes part in the metabolism of all except?
-carbohydrates -fats -sugars -proteins |
sugars
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All of the following vitamins are stored in the liver except which?
A B6 B12 D |
not B6
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Iron is usually stored in the liver as __?
transferrin ferritin iron |
ferritin
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The excretory functions of the liver include the removal of __, hormones and drugs.
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bile
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T/F
RUQ pain r/t biliary colic comes and goes, typically does not last longer than 24 hours. |
False; this is a misnomer, biliary colic pain is typically constant.
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"Dragging" abdominal pain can be a feature of __. Lim, pg 300.
-cholelithiasis -cholecystitis -hepatomegaly -hepatosplenomegaly |
hepatomegaly
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Bilirubin comes from....
-rbc's -bile -hemoglobin -urobilinogen |
hemoglobin (or myoglobin)
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An unpleasant taste in the mouth classically occurs in pt's with __?
-cirrhosis -hepatitis -pancreatitis |
hepatitis
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All plasma proteins except part of gamma globulin are produced in the liver; thus, assessment of the synthetic fcn of the liver includes the measurement of serum albumin and the __ profile.
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coagulation
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Koilonychia (spoon shaped nails) suggests __?
-cirrhosis -hypertriglyceridemia -iron deficiency anemia -folate deficiency |
iron deficiency anemia
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Leukonychia (pale nails) is indicative of __?
-anemia -hypothyroidism -hypoalbuminemia -alcoholic liver disease |
hypoalbuminemia
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Dupuytren's contractures may be associated with __?
-Hepatitis B -Viral Hepatitis -Alcohol excess -Primary biliary sclerosis |
Alcohol excess
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Dialated arterioles with small radiating vessels in the distribution of the superior vena cava may be seen and usually indicate __ disease. Could be due to excessive estrogen.
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liver
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Hereditary hemorrhagic telangiectasia is associated with which of the following?
-AVM in the liver -biliary obstruction -portal hypertension -A & B -all of the above |
all of the above
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Gynecomastia occurs in __ d/t excessive estrogen levels.
-cirrhosis -hepatitis -HIV/AIDS |
cirrhosis
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Peripheral edema occurs with low __.
-protein -albumin -sodium -calcium |
albumin
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The liver is best palpated during ....
-inspiration -expiration |
inspiration as the liver will move inferiorly during inspiration
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once palpable, the spleen is __x's its normal size.
-twice -three -four |
twice its normal size
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__ to percussion of the flanks suggests the presence of ascites.
-tympany -dullness -resonance |
dullness
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__ is described as: when the pt is rolled, the fluid will shift with gravity and the dullness in the flank that is superior will disappear.
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shifting dullness
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Usually at least __ is present when shifting dullness is elicited.
1L 2L 3L 4L |
2 L
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Absence of bowel sounds suggests __ or __.
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paralytic ileus
large volume ascites |
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Pale stools and dark urine occur with __.
-pre-hepatic illness -hepatic illness -post-hepatic (obstructive) illness |
post-hepatic (obstructive) illness
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Dark sticky stool (melena) suggests __ GI bleed.
upper lower |
upper
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Testicular atrophy occurs in the setting of __.
-alcoholic cirrhosis -hepatitis -chronic liver disease -acute liver disease |
chronic liver disease
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The only tests in the standard liver profile that may reflect the true fcn or reserve of the liver are the __ and __.
-PT and PTT -Protein and albumin -albumin and PT |
albumin and PT
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T/F
Low levels of serum albumin may indicate a poor liver synthetic fcn and correlate with the severity of chronic liver disease. |
true story
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Serum albumin levels are also affected by which of the following?
nutrition renal disease catabolic states all of the above |
all of the above
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T/F
The liver synthesizes most clotting factors including the vitamin K dependent factors. |
true
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Liver impairment can lead to deficiency of claotting factors and a prolonged __.
INR PTT PT bleeding time |
PT
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Which will show itself first? Low serum albumin or prolonged PT.
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As vitamin K clotting factors have a shorter half-life than albumin, the prolonged PT arises before the drop in serum albumin.
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__ and __ are intracellular enzymes that are released during hepatic necrosis. Pick 2.
AST GGT ALT Alk Phos |
AST and ALT
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Which is less specific since it can also be released from the heart and skeletal muscle?
AST ALT |
AST. Neither thou correlate well with prognosis or severity of liver disease; the monitoring of the trends is more useful.
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Alk. Phos production is also stimulated by bile acids, and alk. phos. can be markedly elevated with there is obstruction to __.
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bile acid flow
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__ is found in hepatocytes and the biliary epithelium. It is the most sensitive (not specific) indicator of hepatobiliary disease.
-AST -GGT -ALT -Bilirubin |
GGT.
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The source of an elevated alk. phos. level is more likely to be hepatic when there is an accompanying rise in __.
Bili GGT AST LDH |
GGT
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All of the following are liver enzymes except?
-AST -ALT -bilirubin |
bilirubin is not, it is a pigment produced by the breakdown of red cells.
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Bilirubin is normally bound to __, conjugated by the liver, and excreted as __.
-albumin/bile -protein/LDH -Alk Phos/bile |
albumin & bile
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t/f
LDH is not a specific marker of liver disease as it is elevated by many conditions. |
true
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t/f
LDH is useful as a marker in ischemic and hemotological diseases of the liver. |
true
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In acute liver failure the metabolic fcn becomes impaired, resulting in __.
-metabolic acidosis -lactic acidosis -respiratory acidosis |
lactic acidosis; the liver normally metabolizes lactate, producing carbon dioxide.
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Other than albumin, what other proteins are produced within the liver?
-fibrin -fibrinogen -transferrin -globulins A & C all of the above |
all of them
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Bile acids are useful in the assessment of __ related liver disease.
-cirrhotic -pregnancy -hepatic -sclerotic |
pregnancy
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What liver conditions can result in pancytopenia?
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portal hypertension and sypersplenism
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Alcohol excess is assoc. with __ deficiency.
-B 12 -iron -folate -vitamin A |
folate (will show pancytopenia and high MCv
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Which of the following is elevated in alcohol-related liver disease and non-alcoholic steatohepatitis?
-IgA -IgM -IgG -IgE |
IgA
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Which of the following is elevated in primary biliary cirrhosis?
-IgA -IgM -IgG -IgE |
IgM
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Which of the following is elevated in autoimmune hepatitis?
-IgA -IgM -IgG -IgE |
IgG
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Which of the following is associated with autoimmune hepatitis?
-anti-smooth muscle antibody -antimitochondrial antibody -antinuclear antibody |
anti-smooth muscle and ANA.
If you suspect primary biliary cirrhosis you check antimitochondrial antibody |
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you should perform Copper studies if you are suspiscious of what disease?
-Mirizzi's -Wilson's -hepatocellular carcinoma |
Wilson's disease
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CA 19-9 is elevated in all of the following malignancies except?
-cholangiocarcinoma -pancreatic -cholangitis -hepatocellular carcinoma -B & D -all of the above |
all of the above
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__ are elevated in some patients with hepatocellular carcinoma and liver inflammations such as hepatitis.
CA 19-9 CEA 125 AFP |
AFP
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When investigating encephalopathy, what lab test should you be checking?
-serum ammonia -serum potassium -serum Fe level |
ammonia will be elevated in liver dysfcn d/t failure of the breakdown of ammonia and is believed to have a role in the pathogenesis of hepatic encephalopathy
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What diagnostic test is usually the first line imaging modality for the liver and why?
-ct -mri -us |
u/s as it is radiation free and relatively inexpensive. u/s can readily image the size and texture of the liver and detect any focal lesion of more than 1 cm.
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which form of imaging is capable of detecting hepatocellular carcinoma thru new contrast agents such as manganese which is taken up by hepatocytes?
-ct -mri -u/s |
mri
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In a pt. with elevated PT, what is administered prior to any invasive procedure?
-vitamin K -coumadin -whole blood -ffp |
ffp
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In a pt. with a significant risk of bleeding who needs a liver biopsy, which method is preferred?
-percutaneous -transvenous -laparoscopic -open liver biopsy |
transvenous if bleeding risks
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__ is an endoscopic procedure to examine the biliary tree and pancreatic ducts.
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ERCP
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Is ERCP therapeutic or diagnostic?
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both, besides diagnosing problems it can be sued for crushing and extracting stones, dilating strictures and placing stents
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Platelets are required to be given preprocedurally if a pt's platelet count is below?
-100 -75 -60 -45 |
<60
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What is the most common complication assoc. with ERCP?
-pancreatitis -cholangitis -hemorrhage -bowel perforation |
acute pancreatitis
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Chronic liver dx pt's may have secondary hyperaldosteronism, this can lead to what, __ state.
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potent salt-retaining state
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Portal hypertension and hypoalbumnemia contribute to the formation of __ in liver disease pts.
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ascites
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Where are the best sites to perform a paracentesis in a pt with ascites?
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in the flanks, below the level of the umbilicus and lateral to the inferior epigastric artery. Or alternatively, the midline can be used.
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