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