Liver

Question 1

Defining feature of acute liver failure

Answer 1

Coagulopathy
Encephalopathy with raised icp
Jaundice

Question 2

Defining features of chronic liver failure

Answer 2

Jaundice
Ascites and SBP
Varices
Encephalopathy without raised ICP
hepatorenal syndrome

Question 3

Timing of acute liver failure

Answer 3

Hyperacute less than 7 days
Acute 7 to 28 days
Sub acute 5 to 12 weeks

Question 4

Grade 1 encephalopathy

Answer 4

Trivial lack of awareness
Euphoric, anxiety
Short attention span
Impaired addition

Question 5

Grade 2 encephalopathy

Answer 5

Lethargy or apathy
Minimal disorientation to time and place
Subtle personality change
Impaired subtraction

Question 6

Grade 3 encephalopathy

Answer 6

Somnolence, semi stupour
Responds to verbal
Confusion
Grossly disorientated

Question 7

Grade 4 encephalopathy

Answer 7

Coma, unresponsive to verbal or pain

Question 8

Kings criteria for paracetamol overdose

Answer 8

pH less than 7.3 after fluid resus

OR

Encephalopathy grade 3/4
PT > 100 (INR 6.5)
Creatinine > 300

OR

lactate greater than 3 at 12 hours
Lactate grater than 3.5 4 hours
After fluid resus

Question 9

Kings criteria non paracetamol

Answer 9

PT>100
(INR 6.5)

Or any three of 
PT>50 INR 3.5
Non hep A/B aetiology
Age less than 10 or greater than 40
Bilirubin greater than 300
Jaundice prior to encephalopathy for more than 7 days

Question 10

Components of the Child Pugh score

Answer 10

Bilirubin
Albumin
INR
Ascites
Encephalopathy

Question 11

Types of hepatic encephalopathy as said by international society for hepatic encephalopathy and nitrogen metabolism

Answer 11

Type A relates to acute liver failure
Type B relates to Porto-systemic bypass
Type C relates to cirrhosis

Question 12

Is it variceal or non variceal bleeding that is most common

Answer 12

Non-variceal

80%

Question 13

Components of Glasgow Blatchford score

Answer 13

Urea
Hb
Systolic bp 
Presence of: pulse more than 100
Malaena 
Syncope 
Hepatic failure
Cardiac failure

Question 14

Components of rockall score

Answer 14

Age
Shock
Co morbidity
Diagnosis
Evidence of bleeding

Question 15

Grading of varices

Answer 15

1 small epitheliasied and disappear on insufflation
2 everything in between
3 large varices occluding the lumen

Question 16

Which balloon is inflated first in sengstaken

Answer 16

Gastric

Question 17

Does the oesophageal balloon always need inflating

Answer 17

No

Question 18

Volume of air into gastric balloon of sengstaken

Answer 18

250ml

Question 19

Length of insertion of sengstaken

Answer 19

50 to 55cm

Question 20

Weight of traction on sengstaken

Answer 20

500g

Question 21

Maximum time for sengstaken

Answer 21

12 hours

If using oesophageal balloon deflate for five minutes every hour

Question 22

Criteria for ranson score

Answer 22

Admission
Age over 55
AST greater than 250
Glucose more than 11.2
LDH Greater than 350

24 hours
Fall in Hct more than 10%
PaO2 less than 8
BE 4
Fluid sequestration of more than 6 litres
Rise in urea more than 1.8

Question 23

Glascow Imrie score for pancreatitis

Answer 23

Oxygenation
Age
Wcc 
Calcium
Urea
LDH 
Albumin
Glucose

Question 24

Normal intra abdominal pressure

Answer 24

5-7mmHg

Question 25

Grades of intra abdominal hypertension

Answer 25

1- 12-15 2 16-20 3 21-25 4 more than 25

Question 26

Grade 1 intra ab hypertension

Answer 26

12-15 mmHg

Question 27

Grade 2 intra ab hypertension

Answer 27

16-20

Question 28

Grade 3 intra ab hypertension

Answer 28

21-25

Question 29

Grade 4 intra ab hypertension

Answer 29

Greater than 25

Question 30

Equation of abdominal perfusion pressure

Answer 30

APP = MAP - IAP

Question 31

Definition of abdominal compartment syndrome

Answer 31

intra abdominal hypertension greater than 20 plus associated organ failure

Question 32

At what intra abdominal pressure does renal perfusion reduce

Answer 32

15 mmHg

Question 33

At what intra abdominal pressure does anuria occur

Answer 33

Greater than 30mmHg

Question 34

Calorie requirements by schofield formula

Answer 34

25 kcal/kg/day if under 65 20 if over 65 More in burns

Question 35

Carbohydrate needs in Itu

Answer 35

3-4g/kg per day | Should by 60% of the non protein carbs

Question 36

Fat needs on Itu

Answer 36

0.7 to 1.5g/kg Should be 40 percent of non protein calories

Question 37

Protein needs

Answer 37

1-1.5g/kg 1.5-2 In burns

Question 38

Protein needs In burns

Answer 38

1.5 to 2 g/kg

Question 39

Water needs

Answer 39

30mls per kg

Question 40

Sodium needs

Answer 40

1-2 mmol per kg

Question 41

Potassium needs

Answer 41

0.7 to 1 mmol/kg

Question 42

Calcium needs

Answer 42

0.1 mmol/kg

Question 43

Magnesium needs

Answer 43

0.1mmol/kg

Question 44

Phosphate needs

Answer 44

0.4mmol/kg