Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
51 Cards in this Set
- Front
- Back
|
The most common cause of cirrhosis in the United States |
alcohol |
|
|
The other causes of cirrhosis |
1. primary biliary cirrhosis, 2. sclerosing cholangitis, 3. alpha-1 antitrypsin deficiency, 4. hemochromatosis, |
|
|
The most common reason to need a liver transplantation |
chronic hepatitis C |
|
|
267. How to determine the etiology of acute hepatitis from history and presentation alone? |
Note: patients with acute hepatitis will all present in a very similar way. You cannot accurately determine the etiology of acute hepatitis from history and presentation alone. |
|
|
268. Presentation of all patients with acute hepatitis?
|
1. Jaundice
2. fatigue 3. weight loss 4. dark urine caused by bilirubin in the urine |
|
|
269. what two types of hepatitis are more likely to present with serum sickness phenomena like joint pain, urticaria, and fever?
|
Hepatitis B and C. |
|
|
270. treatment of acute hepatitis B?
|
No treatment is available.
|
|
|
271. Treatment of acute hepatitis C?
|
Interferon and ribavirin.
|
|
|
272. Significance of hepatitis E?
|
a. Is most severe in pregnant women. |
|
|
273. what type of hepatitis is associated with Polyarteritis Nodosa (PAN)? |
Hepatitis B.
|
|
|
274. what type of hepatitis is associated with cryoglobulinemia?
|
Hepatitis C.
|
|
|
275. what is the only acute hepatitis that can be treated?
|
Hepatitis C.
|
|
|
276. what lab finding low all patients with acute hepatitis have?
|
a. Elevated conjugated (direct) bilirubin.
b. This will lead to bilirubin in the urine or urobilinogen. c. Unconjugated bilirubin, such as that associated with hemolysis, is not water–soluble and will not pass into the urine. |
|
|
277. To what is unconjugated bilirubin attached?
|
Albumin
|
|
|
278. which type of transaminase is elevated in viral hepatitis?
|
ALT.
|
|
|
279. Which type of transaminase is elevated in drug–induced hepatitis, including alcohol?
|
AST
|
|
|
280. most accurate test for Hepatitis A, C, D, and E?
|
a. Serology.
b. IGM levels acutely rise, and IgG levels rise in the recovery phase. |
|
|
281. What is the first test to become abnormal in acute hepatitis B?
|
a. Surface antigen.
b. Elevation in ALT, e–antigen, and symptoms all occur after the appearance of hepatitis B surface antigen. |
|
|
282. Which of the following are found in acute hepB (Surface antigen, e–antigen, core antibody, surface antibody)?
|
a. Surface antigen: ++
b. e–antigen: ++ c. Core antibody:++ d. Surface antibody: – |
|
|
283. Which of the following are found in Window Period (Surface antigen, e–antigen, core antibody, surface antibody)?
|
a. Surface antigen: –
b. e–antigen: – c. Core antibody: ++ d. Surface antibody: – |
|
|
284. Which of the following are found in vaccinated hep B (Surface antigen, e–antigen, core antibody, surface antibody)?
|
a. Surface antigen: –
b. e–antigen: – c. Core antibody:– d. Surface antibody: ++ |
|
|
285. Which of the following are found in Recovered Hep B infection(Surface antigen, e–antigen, core antibody, surface antibody)?
|
a. Surface antigen: –
b. e–antigen: – c. Core antibody: ++ d. Surface antibody: ++ |
|
|
286. Definition of Chronic Hep B?
|
a. Based on persistence of the surface antigen beyond 6 months.
b. Gives the same serologic pattern as acute hepatitis B. |
|
|
287. Which of the following are found in Which of the following are found in acute hepB (Surface antigen, e–antigen, core antibody, surface antibody)?
|
a. Surface antigen:
b. e–antigen: c. Core antibody: |
|
|
288. Surface antibody: acute hep B on track for Chronic hepB (Surface antigen, e–antigen, core antibody, surface antibody)?
|
a. Surface antigen: +
b. e–antigen: + c. Core antibody: + d. Surface antibody: – |
|
|
289. Which of the following are found in chronic hepB (Surface antigen, e–antigen, core antibody, surface antibody)?
|
a. Surface antigen: +
b. e–antigen: + c. Core antibody: + d. Surface antibody: – |
|
|
290. What do the following 3 tests indicate: Hepatitis B polymerase, e antigen, and Hepatitits B PCR for DNA?
|
a. These 3 tests are essentially equal in meaning.
b. They are indicate active viral replication. |
|
|
291. What is the best initial test for Hepatitis C?
|
a. Hepatitis C antibody.
b. This test CANNOT tell the level of activity of the virus. |
|
|
292. What is the most accurate method of determining the degree of viral replication and activity of HEP C disease?
|
a. Hepatitis C PCR for RNA.
b. PCR RNA is also the most accurate way of determining response to therapy. |
|
|
293. What is the most accurate way of determining the serious of Hep C disease?
|
a. Liver biopsy.
b. The patient can have 10 years of active viral replication with relatively little liver damage. c. Use the biopsy to determine the extent of damage to the liver. |
|
|
294. Treatment principles for Chronic Hep B?
|
a. The patient with surface antigen, e–antigen, and DNA polymerase or PCR for DINA is the patient most likely to benefit from antiviral therapy.
b. Look for >6 months of positive serology. |
|
|
295. Drugs used to treat chronic hep B?
|
1. Lamivudine
2. Adefovir 3. Entecavir 4. Telbivudine 5. Tenofovir 6. Interferon |
|
|
296. AE of Interferon?
|
a. Flulike symptoms
b. Arthralgia c. Myalgia d. Fatigue e. Thrombocytopenia f. Depression. |
|
|
297. Treatment of Chronic Hep C?
|
a. Combine interferon with ribavirin and boceprevir or telaprevir.
|
|
|
298. What is the most common AE of ribavirin?
|
a. Anemia
|
|
|
299. for adults, what are the strongest indications for vaccination for both hepatitis A and B (. Vaccination for both hepatitis A and B is now universally done in childhood).
|
1. Chronic liver disease– someone with cirrhosis or another cause of liver disease who develops hepatitis A or be is at much greater risk of fulminant hepatitis.
2. Household contacts of those with hepatitis A or B 3. men who have sex with men 4. chronic recipients of blood products 5. injection drug users b. specific indication for hepatitis A vaccine? 1. Travelers c. specific indication for hepatitis B vaccine? 1. Healthcare workers 2. patients on dialysis |
|
|
300. a healthcare worker gets stuck with a needle, contaminated with blood from a person with chronic hepatitis B. The healthcare worker has never been vaccinated. What is the most appropriate action?
|
a. Give hepatitis B immunoglobulin and hepatitis B vaccine.
b. The same recommendation would be made for a child onto a mother with chronic hepatitis B. c. if the person had already been vaccinated, then you would check for levels of protective surface antibody. d. If hepatitis B surface antibody were already present, then no further treatment would be necessary. |
|
|
301.What would be the prophylaxis for hepatitis C?
|
Note: there is no vaccine and no postexposure prophylaxis for hepatitis C.
|
|
|
302. Symptoms of cirrhosis (regardless of the cause)?
|
1. Edema from low oncotic pressure
2. gynecomastia 3. palmar erythema 4. splenomegaly 5. thrombocytopenia caused by splenic sequestration. 6. Encephalopathy 7. ascites 8. esophageal varices |
|
|
303. Treatment of edema from low oncotic pressure secondary to cirrhosis?
|
Spironolactone and diuretics |
|
|
304. treatment of encephalopathy secondary to cirrhosis?
|
Lactulose or neomycin. |
|
|
305. Treatment of ascites secondary to cirrhosis? |
Spironolactone
|
|
|
306. treatment of esophageal varices?
|
a. Propranolol will prevent bleeding
b. perform banding of the varices if they bleed. |
|
|
307. When should you perform a paracentesis for ascites?
|
a. New ascites
b. pain, fever, or tenderness |
|
|
308. Diagnostic testing for ascites?
|
a. Perform an ascitic fluid albumin level.
b. If the ascites fluid albumin level is low, the difference between the ascites in the serum level above human will be very great. c. This is a serum–to–ascites albumin gradient (SAAG) |
|
|
309. What is the implication of a serum–to–ascites albumin gradient (SAAG) >1.1? |
1. Portal hypertension from cirrhosis or |
|
|
What is the implication of a serum–to–ascites albumin gradient (SAAG) <1.1? |
Cancer and infections |
|
|
310. diagnosis of spontaneous bacterial peritonitis (SBP)?
|
>500 WBC or >250 neutrophils |
|
|
311. treatment of SBP?
|
Cefotaxime. |
|
|
What is the benefit of prompt Tx. of SBP? |
Cefotaxime and ceftriaxone are the drugs of choice for SBP and albumin infusion decreases risk of hepatorenal syndrome. |
|
|
312. Diagnosis of alcoholic cirrhosis?
|
a. Diagnosis of exclusion. |
