mock questions Flashcards
what would a low serum ascites gradient indicate?
infection (less commonly - ectopic pregnancy)
how is hep B most commonly transmitted?
sex
what would indicate a chronic hep B infection?
lack of IgM, presence of IgG
what can cause prehepatic jaundice?
gilbert’s syndrome, B12 anaemia
what can cause intrahepatic jaundice?
liver cirrhosis, hepatitis
what can cause post hepatic jaundice?
pancreatic cancer, gallstones, bile duct strictures
what would be found in the blood of a pre or intrahepatic cause of jaundice?
high unconjugated bilirubin
what would be found in the blood of a post hepatic cause of jaundice?
high conjugated bilirubin
what would the symptoms of prehepatic jaundice be?
pallor, fatigue, exertional breathlessness
what would the symptoms of intrahepatic jaundice be?
anorexia, fatigue, nausea, abdo pain
what would the symptoms of post hepatic jaundice be?
RUQ pain, pale stools, dark urine, puritis, steatorrgoes, hepatomegaly
what cancer marker might be present in someone with hepatocellular carcinoma and a family history of liver cancer?
alpha-fetoprotein
the risk of which cancers would be increased with the presence of the alpha-fetoprotein cancer marker?
hepatocellular, testicular, ovarian
what are the risk factors for developing hepatocellular cancer?
family history of liver, testicular or ovarian cancers, alpha-fectoprotein cancer marker, chronic hep B or C infection, heavy alcohol use, DM, obesity
what are the aetiological causes of acites?
inflammation, low protein, malignancy
what is a complication that could happen as a result of acites?
spontaneous bacterial peritonitis
how should a patient be managed with spontaneous bacterial peritonitis?
empirical antibodies, use SEPSIS6 if sepsis occurs
what is the gold standard investigation for NAFLD?
liver ultrasound - Diffuse fatty infiltration and abnormal echotexture
biopsy - needed for diagnosis
what is the first line investigations for NAFLD?
enhances liver fibrosis test: assessing the level of fibrosis in the liver (<7.7 non-mild; >7.7-9.8 moderate; >9.8 severe)
LFTs - Increased AST + ALT. Ratio close to 1. If AST>ALT in a 2:1 ratio -> ALD
Increased bilirubin, ALP, GGT
FBC - Anaemia or thrombocytopenia
A 30 year old female presents with constant RUQ pain with associated fever, nausea and vomiting. On examination the doctor applies pressure to the RUQ and asks the patient to breathe in. Suddenly the patient shouts in pain.
what is the likely diagnosis?
acute cholecystitis - due to no jaundice and murphys sign
what is murphys sign?
elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive
e.g. On examination the doctor applies pressure to the RUQ and asks the patient to breathe in. Suddenly the patient shouts in pain.
Mary is a 50 y.o lady who presents to her GP with generalized itching across her body over 2-weeks. Over this time, she has feeling increasingly tired and has no energy to do the things she used to do. She denies any changes to her bowel habits, weight loss or blood coming out from anywhere. However, she said that her husband has been commenting that she looks yellower recently. What antibody is likely to be found in this patient?
anti-mitochondrial antibodies
what does a presence of anti-mitochondrial antibodies suggest?
primary biliary cholangitis
what are the signs of PBC?
female, >45, history of autoimmune conditions, lethargy, itching, hepatomegaly, AMA antibodies, raised LFTs, low albumin
what is the treatment for PBC?
Ursodeoxycholic acid + steroids + cholestyramine
If severe: Liver transplantation
C282Y mutation =
haemochromatosis
George is a 56 y.o gentleman complaining of tiredness. This has been going on for a week and during this time he noticed that he appears more tanned even without leaving his house. His glucose levels are raised.
Genetic testing shows the presence of C282Y mutations. Both his levels for transferrin and ferritin is raised.
haemochromatosis
when would you treat haemochromatosis?
if transferrin and ferritin are raised together, then treat with phlebotomy then iron-chelating drugs
A 20 year old gentleman has shown up to his GP due to a recurrence of jaundice. He has mentioned he’s become more itchy lately and has developed a pain in his upper right abdomen. He is quite into his fitness and has mentioned he has noticed some muscle atrophy and weight loss. After further investigations, alternating strictures and dilated portions of the hepatic ducts are seen on ERCP.
primary sclerosing cholangitis
what conditions is PSC associated with?
IBD, colon cancer and bile duct cancer
how is PSC diagnosed?
MRI bile ducts
how is PBC diagnosed?
AMA and /or raised ALP in blood tests
John is a 22 y.o medical student. He noticed that for the past week, he had been having difficulties with picking up his pen and buttoning up his shirt. He has also been shaking involuntarily and thinks it gets worse when he is stressed. He has also noticed that his limbs are pretty stiff and that his movements are slow. His friends have said that he eyes seem to have taken on a different colour. What is the most likely diagnosis?
wilson’s disease
A 56 year old woman comes to A+E complaining of increased abdominal pain which seems to be worse 20 minutes after a meal. She mentioned that her stools have become more smellier than usual and tend to float. She tells you that this has happened before and that she is worried that this could be due to her alcohol habit. Under further investigations you notice her blood sugars are substantially elevated.
chronic pancreatitis
what vitamin deficiencies would someone with chronic pancreatitis most likely have?
fat soluble vitamins - ADEK
what are the signs of chronic pancreatitis?
pain worse following a meal, steatorrhoea, DM - due to damage to the beta cells, after 20 years
how is chronic pancreatitis diagnosed?
CT or MRI - pancreatic duct dilation, calcification, atrophy or pseudocysts
Endoscopic Ultrasound
Fecal elastase tests -> Decreased elastase
how is chronic pancreatitis treated?
Alcohol + smoking cessation
Pain management
Pancreatin + omeprazole
Hepatitis A IgM : negative
Hep B anti- HBs antibody: positive
Hepatitis C Abs test: positive.
what is the likely diagnosis?
acute hepatitis C infection with previous vaccination to hepatitis B
describe the hepatitis C pathogen
positive sense single stranded RNA virus
describe the hepatitis D pathogen
Negative sense single-stranded RNA virus
describe the hepatitis B pathogen
Double stranded DNA virus
Mason is a 30 y.o banker who recently developed a productive cough. The cough just came on and he is unsure of any triggers. He gets breathless on exertion. He smokes 1 pack every day. He overhears the doctors saying that his condition might be due to a deficiency of an enzyme in his blood.
O/E: Hepatomegaly and hyperinflated chest. Both parents had emphysema before the age of 50.
what is the diagnosis?
alpha-antitripsin deficiency
how is alpha-antitripsin deficiency inherited?
autosomal recessive
confusion, alcoholic, liver failure =
B1 deficiency
what would a AST>ALT with a 2:1 ratio indicate?
alcoholic hepatitis / alcoholic liver disease
raised ALP levels in an otherwise well 60 year old women?
postmenapause
what would be suggestive of obstructive lung disease and liver disease?
alpha-antitripsin deficiency
what does N-acetyl cysteine do?
given in paracetamol overdoses
Replenishes the supply of glutathione that conjugates NAPQI to non-toxic compounds
what is charcot’s triad?
fever, jaundice, abdominal pain
present in ascending cholangitis
what can charcot’s triad develop into?
reynold’s pentad - adding confusion and hypotension
what is the gold standard investigation for ascending cholangitis?
contrst enhansed dynamic CT scan
what is ERCP and what can it lead to?
Endoscopic retrograde cholangiopancreatography, or ERCP = iatrogenic chronic pancreatitis
what can having both PSC and IBD lead to?
increase the risk of colorectal and biliary system cancers so require annual colonoscopies
what are the signs of haemochromatosis?
fatigue, weakness, non-specific abdominal pain erectile dysfunction, arrhythmias, irritability, skin bronzing and hepatomegaly
what would be tested when haemochromatosis is suspected?
serum transferrin and serum ferritin
what are kayser-fleocher rings?
copper deposits - wilson’s disease
what would suggest ascending cholangitis rather than biliary colic?
fever and rigors
what is the gold standard investigation for wilson’s disease?
liver biopsy
what blood test is most indicative of liver damage?
raised ALT
what blood marker would be raised the most in alcohol induced liver problems?
gamma-glutamyl transferase - Gamma-GT
what can wernicke’s encephalopthy lead to?
wernicke-korsakoff syndrome - includes memory loss
Which benzodiazepine may be used to manage the effects of alcohol
withdrawal?
Chlordiazepoxide
how does delirium tremens present?
severe agitation, delusions and hallucinations, tremor, tachycardia, hypertension, hyperthermia, ataxia, arrhythmias, confusion
