Ou Im Absolutes Set 3

Front 1

If pt has increased AST>ALT what is the differential?

Back 1

etoh

Front 2

If pt has increased ALT>ASt what is in the differential?

Back 2

viral and toxic causes

Front 3

if pt has massive elevation of ALT and ASt in the thousands what should you think?

Back 3

fulminant failure
LDH will be high too especially if shock liver

Front 4

Pt has high alk phos and GGT- what is cause?

Back 4

cholestatic

Front 5

on boards if patient has an elevated indirect hyperbilirubinemia what is usually the cause?

Back 5

hemolytic anemia possibly lupus

Front 6

direct bilirubin
1. if <15% of total what is the cause?
2. if 15-50% of total what is the cause?
3. if greater than 50% what is the casue?

Back 6

1. prehepatic
2. hepatic
3. post hepatic

Front 7

What ab are seen in the following diseases?
1. primary biliary cirrhosis?
2. thryoid
3. lupoid/autoimmune hepatitis?
4. Lupus

Back 7

1. anti-mitochondrial ab
2. anti-microsomal ab
3. anti-smooth muscle ab, LKM-1 ab
4. Anti smith ab

Front 8

differential if pt has high AFP?

Back 8

hepatoma

Front 9

if pt has high CEA what should you think?

Back 9

colon cancer with mets to liver

Front 10

what is #1 cause of indirect hyperbilirubinemia in US?

Back 10

gilberts
(bilirubin doubles after fasting?)- number 11 on hosk sheet

Front 11

Waht does urine Na and urine osmol look like in hepatorenal failure?
What is the treatment?

Back 11

low urine Na and normal urine osmol
tx is albumin/bicarb +octreotide and midodrine

Front 12

what is mcc of fulminant liver failure?

Back 12

tylenol od

Front 13

Acites + fever= SBP
1. what will fluid look like?
2. if high lymphocytes dx?
3. If RBCs?

Back 13

1. WBC>300 and high neutraphils
2. TB
3. cancer, ruptured adenomas from OCPs, or peliosis hepatitis from anabolic steroids

Front 14

What is empiric treatment for SBP?

Back 14

ceftriaxone

Front 15

What is the common cause (on boards) for peliosis hepatitis? and what dz is assocaited with it?

Back 15

bacillary angiomatosis cause by bartonella henselae
associated with AIDS

Front 16

end stage cirrhosis treatments
1. for varices?
2. for ascites?
3. For encephalopathy?
4. What will the labs show?

Back 16

1. propanolol
2. spironolactone +lasix
3. lactulose (+ rifampin has been shown to be effective)
4. pancytopenia and hypersplenism

Front 17

In hep B pts with serum sickness like illness what triad is seen?

Back 17

cryoglobulinemia
menbranous glomerulonephritis
polyarteritis nodosa

Front 18

How is HEp A transmitted?

Back 18

fecal/oral route
travelers, shellfish
will get serum immune globulin to exposures

Front 19

Who gets Hep B and how to detect it?

Back 19

medical causes, MSM, IVDU
"e" antigen is an ineffective particle. there is a serologic gap in which only anti-HepBc IgM is postive

Front 20

What is the treatment for Hep B?

Back 20

interferon and lamivudine

Front 21

Who should get Hep B vaccine?

Back 21

all patients less than 60 with DM

Front 22

What is the mcc of Hep C?
What is the chance of chronicity?
What is the mc genotype in US

Back 22

IVDU
50% chance of chronicity (unlike only 10% chance with hep b)
type 1- poor prognosis

Front 23

Who should be screened for Hep C and what is the gold standard screening?

Back 23

all pts born between 1945-1965 and screen with quantitative HCV RNA by PCR

Front 24

What is the treatment for hep C?

Back 24

interferon and ribavirin

Front 25

on boards if you see "peicemeal necrosis and bridging necrosis" what does that mean and what should be done?

Back 25

Chronic active hep C, needs treatment

Front 26

What is treatmetn for chronic immune hepatitis?

Back 26

steroids and azathioprine

Front 27

what is non alcoholic steatohepatitis associated with and what is the treatment?

Back 27

DM, obesity, high lipids
tx is weight loss

Front 28

1. What is the cause of Budd-Chiari?
2. Who commonly presents with it?
3. How to dx it?
4. What conditions are associated with causing this?

Back 28

1. hepatic vein thrombosis (not portal vein)
2. women on OCPs with abdominal pain and enlarged liver
3. doppler or CTA
4. paroxysmal nocturnal hemoglobinuria and polycythemia rubra vera

Front 29

On boards- pt presents with ulcerative colitis, high alk phos, high cholesterol, itching, high GGTP, and elevated direct bilirubin. What is dx and tx?

Back 29

sclerosing pericholangitis and need ERCP

Front 30

Hemochromatosis
1. What gene is associated?
2. What does Iron, iron sat and ferritin look like?
3. what are classic organs effected?
4. What is treatment?

Back 30

1. HFE gene
2. High iron, high iron sat, high ferritin
3. Ass. with cirrhosis, restrictive cardiomyopathy, pancreatic involvement and psuedogout
4. phlebotomy

Front 31

If pt with liver dz has thrombocytopenia what else should you look at

Back 31

splenomegaly which can also cause pancytopenia and hemolytic anemia

Front 32

is enlarged liver seen in portal vein thrombosis?

Back 32

no (only is hepatic vein thrombosis)

Front 33

What bb are best for esophageal varices?

Back 33

propanolol and nadolol

Front 34

Pt is a middle aged female with itching, high cholesterol, high direct bili, and elevated alk phose/GGTP.
1. Dx?
2. ab associated with this?
3. treatment?
4 what is the "overlap syndrome"

Back 34

1. Primary biliary cirrhosis
2. anti-mitochondrial antibody
3. URSO-deoxycholic acid
4. associated with autoimmune hepatitis

Front 35

Wilsons dz
1. cause
2. lab abnormality from liver?
3. classic finding?
4. treatment

Back 35

1. excess copper
2. ceruloplasmin is decreased which is a liver protien
3. Kayser-Fleischer ring
4. penicillamine

Front 36

If pt presents with hepatic cysts that have septatiosn or wall irregularity what should be done.

Back 36

resection because of high risk of malignancy

Front 37

Pancreatitis.
1. mcc (2)
2. other causes (3)
3. classic signs on exam
4. dx?

Back 37

1. alcohol and gallstones
2. TG, thiazides, HIV drugs
3. Gray turners and cullen sign *know that it can cause ARDS and pleural effusions
4. CT is better than US

Front 38

if amylase and lipase are elevated one week after acute pancreatitis what should be considered and treatment?

Back 38

psuedocyts and need to call surgeon

Front 39

since amylase and lipase are not elevated in chronic pancreatitis, what other labs can be checked?

Back 39

trypsin or trypsinogen level should be low
rx- is pain control and pancreatic enzymes

Front 40

if pt has recurrent salmonella sepsis what should be considered?

Back 40

gallbladder

Front 41

What are common causes of cholangitis?

Back 41

klebsiella and E. Coli

Front 42

Why does Na have to be corrected when hyperglycemia and how do you correct it?

Back 42

water moves from intracellular to extracellular in hyperglycemia so dilutes the NA concentration .
--for every 100 above normal for blood sugar there is a 1.5 drop in Na+

Front 43

If measured osmolaltiy is greater than calculated osmolality = osmolol gap, what could be the causes?

Back 43

ethylene glycol, methanol, isopropyl, or etoh

Front 44

What are causes of depletional hyponatremia and what is the treatment?

Back 44

diuretics or addisons. Give normal saline

Front 45

What are causes of dilutional hyponatremia and what is the treatment?
--why does this happen?

Back 45

low albumin states and CHF
treat with fluid restriction and in CHF give lasix

--happens RAAS and aldosterone stimulates sodium and water resorption at 1:1 ratio and then ADH causes resorption of 2:1 water and Na

Front 46

What is tx of SIADH?

Back 46

water restriction, demeclocycline or ADH blocker tolvaptan

Front 47

In SIADH
1. Na concentration?
2. serum osmol?
3. urine osmol?
4. Urine NA?
5. Uric acid level??

Back 47

1. low
2. low
3. high
4. high
5. low

Front 48

What electrolyte abnormalites are seen in Addisons?

Back 48

High K
Low Na
NAGMA

Front 49

patient presents with high Na+, low K, and metabolic alkalosis and a high aldosterone to renin ratio. Dx?

Back 49

primary aldosteronism aka Conns

Front 50

Potassium levels-- would it be high or low with the followin?
1. alkalosis
2.rhabdo
3.insulin
4. beta-2 agonists
5. acidosis (DKA)
6. urination
7. dig toxicity
8. renal failure
9. emesis
10. Addison's
11. hemolysis
12.diarrhea
13. Type I/II RTA
14. Type 4 RTA
15. U waves
16. peaked T waves
17. spironolactone

Back 50

1. low K
2. high K
3. low K
4. Low K
5. high K
6. low K
7. high K
8. high K
9. low K
10. high K
11. high K
12. low K
13. low K
14. high K
15. low K
16. High K
17. High K

Front 51

for every drop in ph of 0.1 how much does K increase?

Back 51

0.6 mEq because of shift out of cells. So when you correct acidosis potassium drops quickly because it shifts back into cells

Front 52

Treatment of Hyperkalemia?

Back 52

1. calcium gluconate
2. D50, bicarb and insulin
3. lasix and kayexalate

*2-2-2-10 rule
2 amps of calcium gluconate , 2 amps of bicarb, 2 amps of D50 and 10 units of insulin

Front 53

State if the following causes resp alk or acidosis?
1. hyperventilation
2. PE
3. COPD
4. altitude
5 hypoventilation
6. salicylates/endotoxin

Back 53

1. alkalosis
2. alkalosis
3. acidosis
4. alkalosis
5. acidosis
6. alkalosis and a metabolic acidosis

Front 54

What are causes of non anion gap met acidosis?

Back 54

diarrhea and RTAs

Front 55

What causes type 1 RTA and where is it and what is the electrolyte problem?

Back 55

caused by ampho B, lithium, SLE or sickle cell
in the Distal tubule
cant secrete H+ in urine

Front 56

What causes RTA 2 and where is it and what is the electrolyte problems?
What acid base problem is seen

Back 56

myeloma, Fanconis, amyloidosis, heavy metals
in proximal tubule
cant reabsorb Bicarb
-- get a hypokalemic metabolic acidosis

Front 57

What is the only causes of metabolic acidosis that gives an alkaline urine (urine ph >5.4)

Back 57

RTA type 2

Front 58

What causes type 4 RTA, where is the deficit and what lab abnormalities are seen?

Back 58

seen in long time diabetics. sclerosed afferent arteriole and JG apparatus
low renin low aldosterone so low sodium and high K

Front 59

if hypoxemia and A-a gradient is normal what is most likely the cause?

Back 59

brain center with hypoventilation

Front 60

In restrictive lung dz--what is the FEV1 and FVC and FEV1/FVC and DLCO?

Back 60

low FEV1
low FVC
normal/high FEV1/FVC
low DLCO

Front 61

In obstructive lung disease what is the FEV1 and FVC and FEV1/FVC and DLCO?

Back 61

low FEV1
low FVC
low FEV1/FVC (<70%)
DLCO is low
but will have increased TLC and RV compared to restrictive