Exam 4 - Hepatology Isaacs

Question 1

cirrhosis results in _____ albumin, _____ INR

a. inc; inc
b. dec; dec
c. inc; dec
d. dec; inc

Answer 1

d. dec; inc

Question 2

how many grams of acetaminophen can result in hepatotoxicity?

Answer 2

8 grams or more

Question 3

reversal agent for acetaminophen DILI

Answer 3

NAC +/- activated charcoal

Question 4

NAC indication: based on conc of acetaminophen (> ____ hours after ingestion) and timing since ingestion

Answer 4

4

Question 5

oral NAC dose (loading and maintenance)

Answer 5

140 mg/kg loading dose followed by 70 mg/kg q4h x 72 hours

Question 6

_______ is used to confirm diagnosis of cirrhosis

Answer 6

biopsy

Question 7

what is MELD and what does it predict?

Answer 7

Model for End-Stage Liver Disease, predicts 3 month-mortality risk and used in transplant prioritization

Question 8

non-pharm ascites sodium restriction

Answer 8

< 2 g/day

Question 9

avoid which drug class in pts with cirrhosis

Answer 9

NSAIDs

Question 10

two first line drugs for ascites management; what is the usual dosing ratio?

Answer 10

spironolactone 100: furosemide 40

Question 11

which class of drugs for ascites inc potassium?

a. spironolactone
b. furosemide

Answer 11

a. spironolactone

Question 12

we should supplement albumin in pts who had > ____ liters of fluid removed via paracentesis

a. 1
b. 2
c. 5
d. 10

Answer 12

c. 5

Question 13

replacing albumin in pts who had > 5 L fluid removed via paracentesis

Answer 13

25% albumin IV and give 6-8 g albumin per L removed

Question 14

DI is a 52 year old male with cirrhosis, who presented to the hospital with tense ascites and is in acute kidney injury (baseline SCr ~1, admission SCr 2.2). Due to the AKI, paracentesis is performed and 8L are removed. How much albumin should be given to DI?

a. Albumin 5% 500 mL IV once
b. Albumin 5% 1 L IV once
c. Albumin 25% 200 mL IV once
d. Albumin 25% 300 mL IV once

Answer 14

c. Albumin 25% 200 mL IV once

(don’t use albumin 5%; replace with 6-8 g/L
8 L * 6 g = 48 g albumin
8 L * 8 g = 64 g albumin
25% of 200 mL = 50 g which is in range
25% of 300 mL = 75 g)

Question 15

variceal bleeding occurs in pts with _______

Answer 15

cirrhosis

Question 16

T or F: NSBBs or EVL for variceal bleeding prophylaxis showed dec variceal and GI bleeding, but no mortality benefit

Answer 16

T

Question 17

two options for primary prophylaxis of variceal bleeding

Answer 17

NSBB or EVL monotherapy (not in combo)

Question 18

NSBB beta 1 antagonism

a. dec HR, dec CO
b. splanchnic vasoconstriction

Answer 18

a. dec HR, dec CO

Question 19

NSBB beta 2 antagonism

a. dec HR, dec CO
b. splanchnic vasoconstriction

Answer 19

b. splanchnic vasoconstriction

Question 20

3 NSBBs for variceal bleeding primary prophylaxis

Answer 20

nadolol
propranolol
carvedilol

(NPC)

Question 21

NSBBs for primary prophylaxis of variceal bleeds:

adjust dose every ___ days until goals achieved
HR goal ___-___ bpm
SBP > _____ mmHg

Answer 21

3
55-60
90

Question 22

gold standard to control variceal bleeding

Answer 22

Endoscopic Variceal Ligation (EVL)

Question 23

tx of variceal bleeding immediately upon presentation (3 things to know; slide 54)

Answer 23

blood transfusions
octreotide
antibiotic prophylaxis

Question 24

octreotide is recommended for ___-___ days, but is frequently stopped _____ hours after EVL

Answer 24

2-5; 24

Question 25

primary antibiotic prophylaxis for active variceal bleeding

Answer 25

ceftriaxone of max 7 days

Question 26

ceftriaxone side effect

Answer 26

diarrhea

Question 27

T or F: vitamin K is recommended in pts with cirrhosis

Answer 27

F

Question 28

secondary prophylaxis for varices (2 things)

Answer 28

EVL every 1-4 weeks
NSBBs indefinitely (until decompensated)

Question 29

primary and secondary prophylaxis for varices: what are the HR and BP goals?

Answer 29

HR: 55-60 bpm
BP: SBP > 90 mmHg

Question 30

SBP stands for

Answer 30

spontaneous bacterial peritonitis

Question 31

SBP diagnosis

Answer 31

therapeutic paracentesis; PMNs > 250

Question 32

does this pt have SBP?

1000 WBCs
30% neutrophils

Answer 32

1000(0.3) = 300. Greater than 250, so they do have SBP

Question 33

SBP antibiotic tx

Answer 33

ceftriaxone for 5-7 days

Question 34

_______ has been shown to decrease mortality and AKI/HRS in patients with SBP
-Day 1: _____ g/kg x 1 (within ___ hours of diagnosis)
-Day 3: _____ g/kg x 1

Answer 34

albumin
1.5
6 hours
1

Question 35

2 antibiotics for SBP secondary prophylaxis

Answer 35

Bactrim
Ciprofloxacin

Question 36

are antibiotics for SBP secondary prophylaxis dosed once or twice daily?

Answer 36

once daily

Question 37

recurrence of SBP within 1 year is ____ %

a. 5%
b. 20%
c. 50%
d. 70%
e. 95%

Answer 37

d. 70%