What is the most common cause of acute liver failure in the US
Tylenol overdose
100
Antidote for Tylenol Overdose
N-Acetylcysteine
100
When should you correct coagulopathy in liver failure patients?
Only with active bleeding or in anticipation of procedures with high bleeding risk
100
What is the more modern scoring system used to stratify transplant candidacy?
MELD
100
Boards buzzwords:
Traveler returns home with abdominal pain, vomiting, diarrhea, and fever. They foolishly went swimming while abroad. What do they have?
Schistosomiasis.
200
Which is more common overall: acute liver failure or acute-on-chronic liver failure
Acute-on-chronic
200
What is the primary antidote for Amanita phalloides poisoning?
Penicillin
200
What is the lab criteria that defines SBP?
WBC > 1000/mm^3, Neutrophils > 250/mm^3, or Bacteria on gram stain
(High yield for in-service!)
200
How many grades of hepatic encephalopathy are there?
Four
200
What do you titrate lactulose therapy for outpatient hepatic encephalopathy use to?
Number of stools per day
(Your consultants *will* ask you how often their patients are having BMs)
300
Which of the various hepatitis viruses is least likely to progress to chronic disease?
Hepatitis A
300
What treatment options are available for portal vein thrombosis? Name 2 for full credit.
Assuming medication compliance, what are some common reasons for the progression of hepatic encephalopathy? (2 for full credit)
Dietary change (increased protein load), antibiotic exposure (change in gut flora), occult GI bleed (reasbsorbtion of protein from digested blood)
300
What does the modern score used to determine transplant candidacy predict?
Short term mortality
300
What is the presumed mechanism for the development of SBP?
Gut translocation from edematous bowel into ascites fluid
400
What genetic disease may present as fulminant hepatic failure that is associated with a characteristic ocular physical exam finding?
Wilson's Disease
400
Following a TIPS procedure, 25% of patients will develop what classic complication?
Hepatic Encephalopathy
400
In a critically ill liver failure patient with altered mental status, what two neurologic catastrophes are they at risk for?
Cerebral edema/herniation syndromes and spontaneous ICH
400
Describe the presentations of the grades of hepatic encephalopathy
I - General Apathy
II - Lethargy, drowsiness, variable orientation, asterxis
III - Stupor, hyperreflexia
IV - Coma
(III and IV likely require intubation for airway protection)
400
What class of commonly used pain medications are contraindicated in cirrhotics?
NSAIDS (Tylenol is safe, but total daily dose should not exceed 2g)
500
Polycythemia vera is associated with what mechanical cause of liver failure?
Budd-chiari syndrome
500
What is the loading dose for the key drug in Tylenol overdose treatment?
NAC, 150 mg/kg IV over the first hour
500
Name four dangerous differentials for altered mental status in a liver failure patient BESIDES hepatic encephalopathy
Sepsis
Sodium imbalance
ICH (spontaneous or traumatic)
Renal failure (Uremia)
Failure to metabolize drugs leading to accumulation
Hypoglycemia
Nutritional encephalopathies (Wernicke's, etc)
Side note: If it is hepatic encephalopthy, consider occult GI bleed leading to increased protein absorbtion
500
What are the components of the updated MELD score?
Serum bilirubin, creatinine, INR, sodium, dialysis status
(Full credit for old MELD score: bili/Cr/INR)
500
What is the 30 day mortality rate following a first time occurrence of spontaneous bacterial peritonitis?