5. CIS Clinical Approach to Pt Presenting with Yellowing Skin/Eyes

Question 1

Patient presents with sinus tachy, fever, petechiae on lower extremities post antibiotics, HGB is 8, elevated indirect bilirubin, elevated LDH and decreased haptoglobin, urine 3+ protein/blood, smear shows schistocytes and dec. platelets… dx?

Answer 1

Hemolytic Uremic Syndrome

Question 2

What is associated with ulcerative colitis, direct hyperbilirubinemia, and beads on a string on ERCP?

Answer 2

Primary Sclerosing Cholangitis

Question 3

Pt presents with growing stomach, shifting dullness to percussion and jaundice, what is performed first to definitively give us the diagnosis?

Answer 3

Abdominal Ultrasound

Question 4

if a paracentesis show PMN of greater than 250, what is this indicative of?

Answer 4

Spontaneous Bacterial Peritonitis

Question 5

What is mixed cryoglobulinemia associated with?

Answer 5

HCV

Question 6

An alcoholic presents to the clinic with encephalopathy, jaundice, elevated AST/ALT/ALP/ prolonged INR, glucose is 65 and is given. The patient has worsening confusion and strange movements of his eyes, why?

Answer 6

GIVE THIAMINE w GLUCOSE in alcoholics otherwise it will cause causes wenicke syndrome

Question 7

In acetominophen toxicity, the AST/ALT levels will be 5000+, with high ammonia as well. what is the best treatment for a patient presenting with this?

Answer 7

N-Acetylcysteine (Rumach-Matthew)

Question 8

If there is alcoholic hepatitis confirmed with a glascow score of greater than 9, what can be given?

Answer 8

Pentoxifylline

Question 9

Primary sclerosing cholangitis MC causes cholagiocarcinoma while autoimmune hepatitis (ANA+, smooth muscle abs, high AST/ALT, w hashimoto thyroiditis) is most apt to get what cancer?

Answer 9

Hepatocellular Carcinoma

Question 10

Which hepatitis is most common in the immunocompromised who are traveling or get a transplant, it is waterborne -fecal-oral transmission and can be spread via pets?

Answer 10

Hepatitis E Virus

Question 11

What inherited disorder is associated with panacinar emphysema, micronodular liver, PAS positive eosinophilic cytoplasmic MAGENTA globules in the hepatocytes, with homozygous PiZZ deficiency?

Answer 11

A1-Anti trypsin Deficiency

Question 12

50y/o female with recurrent UTIs, smoker, hair dresser, labs show hyperchloresterolemia, elevated ALP, all the rest are normal, patient also has xanthelasma…. dx?

Answer 12

Primary Biliary Cirrhosis (AMA-antimT abs, and ISOLATED ALP level elevated)

Question 13

if SAAG score is greater than 1.1, what does that indicate?

Answer 13

intrahepatic problem
 (SAAG<1.1 is a extrahepatic issue)

Question 14

Patient with depression, jaundice, personality disorder, indirect hyperbilirubinemia, anemia, elevated LDH, and low haptoglobin…dx?

Answer 14

Wilson Disease - Kayser Fleischer Ring in cornea, copper deposit

Question 15

When could a hepatojugular reflex be used?

Answer 15

Shock liver d/t hypoperfusion