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51 Cards in this Set
- Front
- Back
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Q100. Test marker that indicates cirrhosis with hepatocellular CA
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A100. Increased Alpha-fetoprotein
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Q101. Definition: Autoimmune disease causing destruction of the intrahepatic ducts
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A101. Primary Biliary Cirrhosis
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Q102. Dx: 40-yo woman with scleroderma is admitted with jaundice, pruritis and xanthomas; What is the serologic hallmark?
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A102. Primary Biliary Cirrhosis; (Anti-mitochondrial Ab)
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Q103. (2) autoimmune disorders assoc with Primary Biliary Cirrhosis
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A103. Scleroderma; Sjogren's syndrome
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Q104. What drug Tx will slow the progression of Primary Biliary Cirrhosis?; What is only cure?
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A104. Ursodiol (synthetic bile acid); Cure: Liver Transplant
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Q105. MCC of Portal HTN worldwide
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A105. Schistosomiasis
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Q106. Signs of Portal HTN; (5)*
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A106. CHASE:; Caput medusa;; Hemorrhoids;; Ascites;; Splenomegaly;; Esophageal Varices
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Q107. Tx for Portal HTN; (4)
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A107. Propranolol to reduce pressure;; Portosystemic shunt surgery;; TIPS - shunt b/t hepatic and portal veins;; Liver transplant
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Q108. Dx: Liver disease, joint pain, Diabetes, cardiomyopathy, skin hyperpigmentation and infertility. First test?; what is the confirmatory test?
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A108. Hereditary Hemochromatosis; first test: Fasting Transferrin saturation; Confirmatory: HFE Gene and C282Y mutation (eliminates the need for liver Biopsy in HH)
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Q109. GI functions of Somatostatin; (6)
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A109. Inhibits:; Visceral blood flow; Gastric acid secretion; Gastric motility; Gallbladder emptying; Pancreatic enzyme and bicarbonate secretion; Intestinal absorption of glucose, water, AA, and triglycerides
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Q110. Hepatic encephalopathy is precipitated by what?; (3)*
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A110. PIG:; Protein (dietary) increase;; Infection;; GI bleed
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Q111. Signs/Symptom of Hepatic Encephalopathy; (3)
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A111. Fetor Hepaticus (Corpse breath);; Asterixis;; Mental status change or coma
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Q112. In a patient with bleeding esophageal varices, after stabilizing IV fluids, what is the next step?
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A112. Octreotide
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Q113. Tx for Hepatic encephalopathy; (3)
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A113. Protein restriction;; Lactulose (to change NH3 to NH4 so it cant cross BBB); Neomycin (for gut bacteria that make NH3)
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Q114. MCC of Spontaneous Bacterial Peritonitis (bug)
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A114. E. coli
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Q115. Dx: Patient with ascites, fever, chills, abdominal pain with rebound, may progress to sepsis
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A115. Spontaneous Bacterial Peritonitis
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Q116. Dx test for Spontaneous Bacterial Peritonitis; Tx?
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A116. Test: Paracentesis (abdominal tap); Tx: Gram-negative coverage (Cefuroxime)
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Q117. Definition: Systemic infection of the liver due to viral agents, toxins, or alcohol
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A117. Hepatitis
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Q118. Mode of transmission of Hepatitis: A, B, C, D, E, G
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A118. A and E - fecal-oral route; B, C, D, G - sex and blood
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Q119. Which forms of hepatitis are associated with:; 1. IV drug use (2); 2. Unprotected sex; 3. Overseas travel (2)
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A119. 1. HBV and HCV; 2. HBV; 3. HAV and HEV
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Q120. What (2) toxins cause hepatitis?
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A120. Acetaminophen; Aflatoxin
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Q121. *Viral class for:; 1. HAV; 2. HBV; 3. HCV; 4. HDV; 5. HEV; Which is the only DNA virus?
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A121. Please Help Find Danielle's Cat:; 1. Picorna; 2. Hepadna; 3. Flavi; 4. Delta; 5. Calici; HBV is DNA (the rest are RNA)
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Q122. Meaning of HAV antibodies; (2)
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A122. HAV IgM = Acute infection; HAV IgG = Immunity from prior infection
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Q123. Prevention of HAV?; Tx of HAV?
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A123. Prevention: Anti-HAV Ig is 90% effective if given within (2) weeks of exposure; Tx: symptomatic
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Q124. How is hepatotoxicity from Acetaminophen prevented if detected early?
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A124. N-acetylcysteine
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Q125. Meaning of HBV antibodies in order of detection (4)*; Which signifies the "window period"?; Which indicates immunity?
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A125. SAGing BAG-E / Camels May / Spit and Gag:; HBsAg positive = infection is present; HBeAg = Chronic hepatitis; Anti-HBc IgM = infection is acute (window period); Anti-HBs IgG = past infection or vaccine (indicates immunity)
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Q126. Exposure scenarios: What is Tx to a newborn exposed with Hepatitis B?; Adult infected blood exposure?
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A126. Newborn: Give HBIG and vaccine; Other: Test for HBV, if negative give HBIG only
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Q127. Tx for HBV; What does HBV give patient a risk of developing?
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A127. Lamivudine; Risk: Hepatocellular cancer
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Q128. Meaning of "HCV antibody"
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A128. Anti-HCV IgG = indicates chronic or past infection
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Q129. Tx for HCV; (2)
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A129. Interferon; Ribavirin
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Q130. What do 25% of the chronic HCV patients develop?; (2)
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A130. Cirrhosis; and/or Hepatocellular CA
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Q131. Dx: Medical student develops fever, jaundice and fatigue 2 weeks after returning from a trip to India
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A131. Hepatitis E
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Q132. A young female is diagnosed with liver disease, but does not drink, have inflammatory bowel disease or infectious hepatitis. Next test?; if positive, what is the Dx?; What additional immune marker is assoc with it?
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A132. Next test: Anti-Smooth Muscle Ab (ASMA); Dx: Autoimmune Hepatitis; Additional immune marker: Anti-Liver/Kidney Microsome type 1 Ab (anti-LKM1 Ab)
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Q133. Indications for Liver transplantation; (5)
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A133. Cirrhosis;; Primary Sclerosing Cholangitis;; Chronic Hepatitis;; Hepatocellular CA;; Hepatic Vein Thrombosis
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Q134. What must match with donor liver?; (2)
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A134. Size and ABO; (not Rh or HLA)
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Q135. (3) medications for Immunosuppression of Liver recipients
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A135. Cyclophosphamide;; OKT3;; Tacrolimus
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Q136. What stimulates the gallbladder contraction (specifically)
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A136. Fat and Amino Acids in the proximal duodenum causes release of CCK
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Q137. Dx: Middle-aged female patient presenting with pruritis and an elevated Alkaline phosphatase with a normal Bilirubin. What is the best initial test?; what is the most accurate test?
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A137. Dx: Primary Biliary Cirrhosis; initial test: Anti-mitochondrial Ab test; most accurate: Liver Biopsy
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Q138. Risk factors for cholelithiasis; (8 F's); Two others?
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A138. Female;; Fat;; Forty;; Fertile;; Fibrosis (Cystic);; Familial;; Fasting;; F-Hgb (Sickle cell); Also: DM and Oral contraceptives
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Q139. Dx: RUQ pain that lasts 2-6 hours, most often after fatty meal, N/V, RUQ tenderness without guarding or rebound
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A139. Cholelithiasis
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Q140. What labs are elevated with gallstones?
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A140. Alkaline phoshatase; Bilirubin; (direct more then indirect)
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Q141. when should HIDA scan be answered?; (2)
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A141. 1. Gallstones and US Murphy's sign without Gallbladder edema; 2. Gallbladder edema and US Murphy's sign without Gallstones (if Dx is obvious, then do not answer HIDA scan)
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Q142. First Dx test of choice for gallstones?
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A142. Ultrasound
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Q143. Out of the (3) types of gallstones, name them in least common to most.
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A143. 1. Cholesterol (10%); 2. Pigment (20%); 3. mixed (70%)
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Q144. When are Radiolucent cholesterol gallstones seen?; (3)
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A144. rapid weight loss;; Oral contraception;; Ileal disease
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Q145. When are radiodense pigment gallstones seen?
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A145. Hemolysis
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Q146. Treatment of gallstones in order; (1 med; 2 procedures)
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A146. 1. Chenodeoxycholate; 2. Lithotripsy; 3. Cholesystectomy
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Q147. Dx: Patient has high fever, chills, RUQ abdominal pain and jaundice. She has a history of ULCERATIVE COLITIS and is complaining of pruritus with a negative hepatitis profile and a negative US. Next step?
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A147. Dx: Primary Sclerosing Cholangitis; next step: ECRP
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Q148. (4) bugs that can cause cholecystitis
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A148. BEEK:; Bacteriodes; E.coli; Enterococcus; Klebsiella
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Q149. Dx: RUQ pain often longer then 6 hours, possible guarding and rebound, fever, tachycardia, + Murphy's sign
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A149. Cholecystitis
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Q150. Sign: the arrest of inspiration while palpating the RUQ. what is the Dx if positive?
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A150. Murphy's sign; Dx: Acute cholecystitis
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