Week 12 REVIEW

Hepatitis

100

Name 2 viruses that can cause viral hepatitis other than the hepatitis A/B/C/D/E viruses.

CMV, EBV, HHV-6, Yellow fever virus, Parvovirus B19, etc

200

A woman with HBsAg-, anti-HBsAg+, anti-HBcAg-, anti-HBeAg-, HBV DNA- means... a) HepB carrier b) immunized against HepB c) infected HepB and highly transmissible d) recently infected with HepB

b)

300

Out of hepA, B, C, D, E, which ones are fecal-oral in terms of transmission route? Which one is the DNA virus? Which ones can cause chronic hepatitis?

Fecal-oral: Hep A and E RNA virus: Hep A, Hep C, Hep D, Hep E DNA virus: Hep B Chronic hepatitis: Hep B, Hep C, Hep D,

400

26 yo, female, non-smoker, non-alcoholic drinker, presents with fever, malaise and icterus. She claimed to have eaten raw oysters 3 weeks ago. Physical exam reveals mildly enlarged liver with tenderness to palpation. Lab results show markedly increased AST and ALT, and increased IgM and anti-hepatitis A titers. Which one of the following is the most likely result after this infection? a) cirrhosis b) complete resolution c) establishment of a chronic carrier state d) fulminant hepatitis e) heaptocellular carcinoma

b) complete resolution

500

Define NAFLD, NAFL, and NASH.

NAFLD: non-alcoholic fatty liver disease; presence of hepatic steatosis when no other causes for secondary hepatic fat accumulation are present; can be with or without inflammation and fibrosis NAFLD is subdivided into NAFL (non alcoholic fatty liver) and NASH (non alcoholic steatohepatitis) NAFL: hepatic steatosis is present without evidence of significant inflammation; hepatocellular injury and fibrosis are absent NASH: hepatic inflammation is present; heaptocyte injury is present

Exocrine Pancreas

100

What is the prognosis for pancreatic carcinoma?

most die in 1 year; 1 year survival <10%

200

Name the 2 types of necrosis in pancreatitis

Liquefactive necorsis and fat necrosis

300

How does the presentation of pancreatic carcinoma arising from the head of the pancreas differ from the body/tail?

Head: obstructive jaundice, pale stools Body/tail: diabetes mellitus

400

Causes of Acute Pancreatitis (hint: GETSMASHED)

Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyperlipidemia/hypercalcemia, ERCP, Drugs (azathioprine, diuretics)

500

Serum amylase and lipase are good indicators for both acute and chronic pancreatitis. True or false? Justify your answer.

False. Serum amylase and lipase are good indicators for acute pancreatitis. They are not very good indicators for chronic pancreatitis if the vast majority of pancreas is destroyed. They will not be made. Therefore the levels will not be elevated.

Jaundice/Cirrhosis

100

Name the 3 types of jaundice.

prehepatic/hemolytic, intrahepatic/hepatocellular, posthepatic/obstructive

200

Name 3 signs you would see due to portal hypertension.

esophageal varices, hemorrhoids, caput medusae

300

What does INR stands for and what does it measure?

International Normalized Ratio. It measures the ratio between the patients PT against a standardized PT.

400

How high does the bilirubin level has to go to in order for you to see jaundice?

>50umol/L

500

Name the 5 components for the calculation of Child-Pugh Score in assessing liver function.

Ascites severity, hepatic encephalopathy, bilirubin, INR, albumin

Gallbladder

100

44, female, 4 children, obese. Presents in ER with RUQ pain, malaise, jaundice and Murphy's sign positive. What disease is most likely the cause of her symptoms/signs?

Acute cholecystitis

200

What is the difference between cholesterol stones and bilirubin stones in terms of color and how they show up on X-ray?

Cholesterol stones appear yellow while bilirubin stones appear black. Cholesterol stones are usually radiolucent (don't show up on X ray unless calcified). Bilirubin stones are usually radiopaque.

300

Define cholangitis, cholecystitis, cholelithiasis, and choledocholithiasis.

Inflammation of common bile duct=cholangitis inflammation of gallbladder=cholecystitis stones in the gallbladder=cholelithiasis stones in the common bile duct=choledocholitiasis

400

45 yo female, presents with jaundice, pruritus and periocular and intradigital xanthomas; lab results indicate significantly increased ALP and positive test for antimitchondrial antibodies; The most likely cause of her symptom is... a) primary sclerosing cholangitis b) secondary biliary cirrhosis c) choledocholithiasis d) primary biliary cirrhosis

d)

500

I am associated with ulcerative colitis. I am p-ANCA positive. I present with obstructive jaundice. I have increased risk for cholangiocarcinoma. I have periductal fibrosis with an "onion-skin" appearance.

What is primary sclerosing cholangitis.

Others

100

I am present in the eyes of people with Wilson's disease.

What is Kayser-Fleisher rings

200

I am a drug. I am given to children with Kawasaki syndrome, but not with viral illness because they will have Reye syndrome.

What is Aspirin.

300

Name 3 signs indicative of estrogen build up in patients with chronic liver disease.

Palmar erythema, spider nivae, gynecomastia, hair loss

400

I am a tumor marker for hepatocelluar carcinoma

What is alpha fetoprotein.

500

I am a fatal disease. If you have me, it means you have no glucuronyl transferase. Therefore, UCB will build up in your body, especially in your basal ganglia.

What is Crigler-Najjar syndrome.