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61 Cards in this Set
- Front
- Back
If pt has increased AST>ALT what is the differential?
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etoh
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If pt has increased ALT>ASt what is in the differential?
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viral and toxic causes
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if pt has massive elevation of ALT and ASt in the thousands what should you think?
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fulminant failure
LDH will be high too especially if shock liver |
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Pt has high alk phos and GGT- what is cause?
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cholestatic
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on boards if patient has an elevated indirect hyperbilirubinemia what is usually the cause?
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hemolytic anemia possibly lupus
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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? |
1. prehepatic
2. hepatic 3. post hepatic |
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What ab are seen in the following diseases?
1. primary biliary cirrhosis? 2. thryoid 3. lupoid/autoimmune hepatitis? 4. Lupus |
1. anti-mitochondrial ab
2. anti-microsomal ab 3. anti-smooth muscle ab, LKM-1 ab 4. Anti smith ab |
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differential if pt has high AFP?
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hepatoma
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if pt has high CEA what should you think?
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colon cancer with mets to liver
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what is #1 cause of indirect hyperbilirubinemia in US?
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gilberts
(bilirubin doubles after fasting?)- number 11 on hosk sheet |
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Waht does urine Na and urine osmol look like in hepatorenal failure?
What is the treatment? |
low urine Na and normal urine osmol
tx is albumin/bicarb +octreotide and midodrine |
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what is mcc of fulminant liver failure?
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tylenol od
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Acites + fever= SBP
1. what will fluid look like? 2. if high lymphocytes dx? 3. If RBCs? |
1. WBC>300 and high neutraphils
2. TB 3. cancer, ruptured adenomas from OCPs, or peliosis hepatitis from anabolic steroids |
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What is empiric treatment for SBP?
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ceftriaxone
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What is the common cause (on boards) for peliosis hepatitis? and what dz is assocaited with it?
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bacillary angiomatosis cause by bartonella henselae
associated with AIDS |
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end stage cirrhosis treatments
1. for varices? 2. for ascites? 3. For encephalopathy? 4. What will the labs show? |
1. propanolol
2. spironolactone +lasix 3. lactulose (+ rifampin has been shown to be effective) 4. pancytopenia and hypersplenism |
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In hep B pts with serum sickness like illness what triad is seen?
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cryoglobulinemia
menbranous glomerulonephritis polyarteritis nodosa |
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How is HEp A transmitted?
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fecal/oral route
travelers, shellfish will get serum immune globulin to exposures |
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Who gets Hep B and how to detect it?
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medical causes, MSM, IVDU
"e" antigen is an ineffective particle. there is a serologic gap in which only anti-HepBc IgM is postive |
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What is the treatment for Hep B?
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interferon and lamivudine
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Who should get Hep B vaccine?
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all patients less than 60 with DM
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What is the mcc of Hep C?
What is the chance of chronicity? What is the mc genotype in US |
IVDU
50% chance of chronicity (unlike only 10% chance with hep b) type 1- poor prognosis |
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Who should be screened for Hep C and what is the gold standard screening?
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all pts born between 1945-1965 and screen with quantitative HCV RNA by PCR
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What is the treatment for hep C?
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interferon and ribavirin
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on boards if you see "peicemeal necrosis and bridging necrosis" what does that mean and what should be done?
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Chronic active hep C, needs treatment
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What is treatmetn for chronic immune hepatitis?
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steroids and azathioprine
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what is non alcoholic steatohepatitis associated with and what is the treatment?
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DM, obesity, high lipids
tx is weight loss |
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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? |
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 |
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On boards- pt presents with ulcerative colitis, high alk phos, high cholesterol, itching, high GGTP, and elevated direct bilirubin. What is dx and tx?
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sclerosing pericholangitis and need ERCP
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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? |
1. HFE gene
2. High iron, high iron sat, high ferritin 3. Ass. with cirrhosis, restrictive cardiomyopathy, pancreatic involvement and psuedogout 4. phlebotomy |
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If pt with liver dz has thrombocytopenia what else should you look at
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splenomegaly which can also cause pancytopenia and hemolytic anemia
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is enlarged liver seen in portal vein thrombosis?
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no (only is hepatic vein thrombosis)
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What bb are best for esophageal varices?
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propanolol and nadolol
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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" |
1. Primary biliary cirrhosis
2. anti-mitochondrial antibody 3. URSO-deoxycholic acid 4. associated with autoimmune hepatitis |
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Wilsons dz
1. cause 2. lab abnormality from liver? 3. classic finding? 4. treatment |
1. excess copper
2. ceruloplasmin is decreased which is a liver protien 3. Kayser-Fleischer ring 4. penicillamine |
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If pt presents with hepatic cysts that have septatiosn or wall irregularity what should be done.
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resection because of high risk of malignancy
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Pancreatitis.
1. mcc (2) 2. other causes (3) 3. classic signs on exam 4. dx? |
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 |
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if amylase and lipase are elevated one week after acute pancreatitis what should be considered and treatment?
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psuedocyts and need to call surgeon
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since amylase and lipase are not elevated in chronic pancreatitis, what other labs can be checked?
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trypsin or trypsinogen level should be low
rx- is pain control and pancreatic enzymes |
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if pt has recurrent salmonella sepsis what should be considered?
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gallbladder
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What are common causes of cholangitis?
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klebsiella and E. Coli
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Why does Na have to be corrected when hyperglycemia and how do you correct it?
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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+ |
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If measured osmolaltiy is greater than calculated osmolality = osmolol gap, what could be the causes?
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ethylene glycol, methanol, isopropyl, or etoh
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What are causes of depletional hyponatremia and what is the treatment?
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diuretics or addisons. Give normal saline
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What are causes of dilutional hyponatremia and what is the treatment?
--why does this happen? |
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 |
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What is tx of SIADH?
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water restriction, demeclocycline or ADH blocker tolvaptan
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In SIADH
1. Na concentration? 2. serum osmol? 3. urine osmol? 4. Urine NA? 5. Uric acid level?? |
1. low
2. low 3. high 4. high 5. low |
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What electrolyte abnormalites are seen in Addisons?
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High K
Low Na NAGMA |
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patient presents with high Na+, low K, and metabolic alkalosis and a high aldosterone to renin ratio. Dx?
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primary aldosteronism aka Conns
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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 |
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 |
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for every drop in ph of 0.1 how much does K increase?
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0.6 mEq because of shift out of cells. So when you correct acidosis potassium drops quickly because it shifts back into cells
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Treatment of Hyperkalemia?
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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 |
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State if the following causes resp alk or acidosis?
1. hyperventilation 2. PE 3. COPD 4. altitude 5 hypoventilation 6. salicylates/endotoxin |
1. alkalosis
2. alkalosis 3. acidosis 4. alkalosis 5. acidosis 6. alkalosis and a metabolic acidosis |
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What are causes of non anion gap met acidosis?
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diarrhea and RTAs
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What causes type 1 RTA and where is it and what is the electrolyte problem?
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caused by ampho B, lithium, SLE or sickle cell
in the Distal tubule cant secrete H+ in urine |
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What causes RTA 2 and where is it and what is the electrolyte problems?
What acid base problem is seen |
myeloma, Fanconis, amyloidosis, heavy metals
in proximal tubule cant reabsorb Bicarb -- get a hypokalemic metabolic acidosis |
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What is the only causes of metabolic acidosis that gives an alkaline urine (urine ph >5.4)
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RTA type 2
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What causes type 4 RTA, where is the deficit and what lab abnormalities are seen?
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seen in long time diabetics. sclerosed afferent arteriole and JG apparatus
low renin low aldosterone so low sodium and high K |
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if hypoxemia and A-a gradient is normal what is most likely the cause?
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brain center with hypoventilation
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In restrictive lung dz--what is the FEV1 and FVC and FEV1/FVC and DLCO?
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low FEV1
low FVC normal/high FEV1/FVC low DLCO |
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In obstructive lung disease what is the FEV1 and FVC and FEV1/FVC and DLCO?
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low FEV1
low FVC low FEV1/FVC (<70%) DLCO is low but will have increased TLC and RV compared to restrictive |