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Pharm - Cirrhosis

Total questions: 41

Worksheet time: 21mins

Name
Class
Date
1.

What is NOT a potential etiology of cirrhosis?

a)

Chronic excessive ETOH intake

b)

Vascular disease (Hemangioma, scleroderma)

c)

Meds (Amiodarone)

d)

Metabolic Liver Disease (NAFLD, hemochromatosis, Wilson's Disease)

e)

Immunologic Disease (autoimmune hepatitis, primary biliary cirrhosis)

2.

What is the correct order of the general pathophysiology of cirrhosis?

a)

1. Fibrosis

2. Vasodilation & vasoconstriction

3. Chronic inflammation

4. Complications

b)

1. Chronic inflammation

2. Fibrosis

3. Vasodilation & vasoconstriction

4. Complications

c)

1. Vasodilation & vasoconstriction

2. Fibrosis

3. Chronic inflammation

4. Complications

d)

1. Chronic inflammation

2. Vasodilation & vasoconstriction

3. Fibrosis

4. Complications

3.

What is the correct order of the general pathophysiology of cirrhosis?

a)

1. Healthy

2. Cancer

3. Cirrhosis

4. Fibrosis

b)

1. Healthy

2. Cirrhosis

3. Fibrosis

4. Cancer

c)

1. Fibrosis

2. Healthy

3. Cancer

4. Cirrhosis

d)

1. Healthy

2. Fibrosis

3. Cirrhosis

4. Cancer

4.

Fibrosis generally results from chronic hepatic injury which causes hepatic stellate cells (HSC) to undergo activation process. Which of the following is NOT true regarding this process?

a)

Only reversible if HSCs are still present by the time cirrhosis stage is reached

b)

Lose vitamin A

c)

Secrete fibrogenic factors (fibrocytes, fibroblasts, and collagen)

d)

Become highly proliferative

5.

What is the correct order of the fibrosis specific pathophysiology?

a)

1. Increased portal pressure

2. Vasodilation/ cytokine release - Shunting to bypass liver

3. Resistance to blood flow

4. Constricting compensatory actions (RAAS)

b)

1. Vasodilation/ cytokine release - Shunting to bypass liver

2. Resistance to blood flow

3. Increased portal pressure

4. Constricting compensatory actions (RAAS)

c)

1. Constricting compensatory actions (RAAS)

2. Vasodilation/ cytokine release - Shunting to bypass liver

3. Resistance to blood flow

4. Increased portal pressure

d)

1. Resistance to blood flow

2. Increased portal pressure

3. Vasodilation/ cytokine release - Shunting to bypass liver

4. Constricting compensatory actions (RAAS)

6.

All of the following labs are increased with cirrhosis, EXCEPT one that is decreased. Which one is decreased?

a)

LFTs

b)

PT/INR

c)

PLT

d)

Bilirubin

e)

Ammonia

7.

All of the following labs are decreased with cirrhosis, EXCEPT one that is increased. Which one is increased?

a)

Na and K

b)

AlkPhos

c)

PLT

d)

Coagulation Factors

e)

Albumin

8.

Scoring system used to describe severity and prognosis of cirrhosis.

a)

Child-Pugh

b)

Meld

9.

Scoring system that predicts mortality in pts with cirrhosis and is used for liver transplant prioritization.

a)

Child-Pugh

b)

Meld

10.

What is NOT used to calculate the Child-Pugh severity score?

a)

Albumin

b)

Bilirubin

c)

Ascites

d)

Dialysis

e)

Encephalopathy

11.

What is NOT used to calculate the MELD score?

a)

Creatinine

b)

Bilirubin

c)

Ascites

d)

Dialysis

e)

Sodium

12.

Pt is diagnosed with Child-Pugh class B cirrhosis. HVPG of 9 mmHg. A baseline EGD is done that shows small varicies with red wale marks. What is your PRIMARY PROPHYLAXIS treatment?

a)

Non-selective beta blocker (Nadolol, Propanolol)

b)

Octreotide IV or subQ

c)

Endoscopic variceal ligation (EVL)

d)

Vasopressin IV

e)

Ceftriaxone

13.

Pt is diagnosed with Child-Pugh class A cirrhosis. HVPG of 9 mmHg. A baseline EGD is done that shows medium or large varices What is your PRIMARY PROPHYLAXIS treatment?

a)

Non-selective beta blocker (Nadolol, Propanolol)

b)

Octreotide IV or subQ

c)

Endoscopic variceal ligation (EVL)

d)

Vasopressin IV

e)

Ceftriaxone

14.

Pt is diagnosed with Child-Pugh class C cirrhosis. HVPG of 9 mmHg. A baseline EGD is done that shows medium or large varicies with red wale marks. The PRIMARY PROPHYLAXIS treatment can be ___ OR ___. (choose 2)

a)

Non-selective beta blocker (Nadolol, Propanolol)

b)

Octreotide IV or subQ

c)

Endoscopic variceal ligation (EVL)

d)

Vasopressin IV

e)

Ceftriaxone

15.

What is NOT a predictor of bleeding for portal HTN and varices?

a)

Child-Pugh Class A or B

b)

Presence red wale marks or red spots on varices

c)

Medium or large variceal size (> 5mm)

d)

Presence of ascites

e)

Previous variceal bleeding

16.

How often should you repeat an EGD for a pt with cirrhosis that has NO varices?

a)

Q 2-3 YRS

b)

Q 1-2 YRS

c)

Annually

17.

How often should you repeat an EGD for a pt with cirrhosis that has SMALL varices?

a)

Q 2-3 YRS

b)

Q 1-2 YRS

c)

Annually

18.

How often should you repeat an EGD for a pt with cirrhosis that has LARGE/DECOMPENSTAED varices?

a)

Q 2-3 YRS

b)

Q 1-2 YRS

c)

Annually

19.

What HVPG value is NOT correctly matched with its severity?

a)

Normal = 3-10 mmHg

b)

Portal HTN > 5 mmHg

c)

Varices may arise 8-10 mmHg

d)

Rupture may happen > 12 mmHg

20.

What is the MOST common LETHAL complication of cirrhosis?

a)

Ascites

b)

SBP

c)

Varices

d)

Hepatic encephalopathy

21.

What is the MOST common complication of cirrhosis?

a)

Ascites

b)

SBP

c)

Varices

d)

Hepatic encephalopathy

22.

Pt with cirrhosis who just finished vasoactive drug therapy for a variceal bleed needs SECONDARY PROPHYLAXIS. What is your treatment?

a)

Non-selective beta blocker (Nadolol, Propanolol) Alone

b)

Octreotide IV or subQ

c)

Endoscopic variceal ligation (EVL) Alone

d)

Vasopressin IV

e)

EVL + Non-selective beta blocker

23.

Pt with Child-Pugh class B cirrhosis presents with hematuria and melena. HVPG of 12 mmHg. EGD shows varicies > 5 mm with red wale marks. What is generally the correct order of your treatment?

a)

1. Fluid resuscitation

2. Vasoactive therapy (Ocretotide/ Vasopressin)

3. EGD

4. ABX (Ceftriaxone)

5. EVL

b)

1. Vasoactive therapy (Ocretotide/ Vasopressin)

2. Fluid resuscitation

3. EGD

4. ABX (Ceftriaxone)

5. EVL

c)

1. EVL

2. ABX (Ceftriaxone)

3. EGD

4. Vasoactive therapy (Ocretotide/ Vasopressin)

5. Fluid resuscitation

d)

1. EGD

2. Fluid resuscitation

3. Vasoactive therapy (Ocretotide/ Vasopressin)

4. ABX (Ceftriaxone)

5. EVL

24.

A pt with cirrhosis presents with abd distension and bulging flanks with dullness. Abd US is done and labs are drawn. A diagnostic abd paracentesis with fluid analysis is done which confirms ascites. What is NOT included in the non-pharm treatment?

a)

Balloon tamponade

b)

Lifestyle: D/C alcohol and restrict Na

c)

TIPS

d)

Large volume paracentesis

e)

Consider liver transplant

25.

A pt with cirrhosis presents with abd distension and bulging flanks with dullness. Abd US is done and labs are drawn. A diagnostic abd paracentesis with fluid analysis is done which confirms ascites. What is the pharmacologic treatment?

a)

Furosemide alone

b)

Spironolactone alone

c)

Furosemide + Spironolactone

d)

Non-selective beta blocker (Nadalol, Propanolol)

e)

Octreotide

26.

What is the fixed ratio for diuretic use in management of ascites in cirrhosis pts? (Furosemide:Spironolactone)

a)

16:400

b)

160:100

c)

40:400

d)

40:100

27.

Pt presents with ascites and a diagnostic abd paracentesis with fluid analysis is done. SAAG value comes back as > 1.1-2.5. What does this suggest?

a)

Portal HTN

b)

Cardiac cause

c)

Another cause

28.

Pt presents with ascites and a diagnostic abd paracentesis with fluid analysis is done. SAAG value comes back as > 2.5. What does this suggest?

a)

Portal HTN

b)

Cardiac cause

c)

Another cause

29.

Pt presents with ascites and a diagnostic abd paracentesis with fluid analysis is done. SAAG value comes back as < 1.1. What does this suggest?

a)

Portal HTN

b)

Cardiac cause

c)

Another cause

30.

Pt with cirrhosis presents with abd pain, increasing ascites, temperature of 100.4F, progressive encephalopathy, and N/V/D. Paracentesis shows PMN count > 250 cells/m3. What is the possible treatment? (choose 2)

a)

Non-selective beta blocker

b)

Ceftriaxone IV

c)

TMP/SMX PO

d)

Ceftotaxime IV

e)

Levofloxavin PO

31.

Pt with cirrhosis was just treated for SBP. What is your SECONDARY PROPHYLAXIS treatment? (CHOOSE 3)

a)

Ciprofloxacin PO

b)

Ceftriaxone IV

c)

TMP/SMX PO

d)

Ceftotaxime IV

e)

Levofloxavin PO

32.

Pt with cirrhosis and ascites presents with ascitic protein < 1.5 and ONE of the following: BUN ≥ 25, SCr ≥ 1.2, Na ≤ 130, Child-Pugh score of ≥ 9 with bilirubin ≥ 3. What is your PRIMARY PROPHYLAXIS treatment for SBP?

a)

Non-selective beta blocker

b)

Ceftriaxone IV

c)

TMP/SMX PO

d)

Ceftotaxime IV

e)

Levofloxavin PO

33.

Pt with cirrhosis presents with confusion, apathy, irritability, asterixis, somnolence, and loss of motor control. Labs show elevated ammonia. What is your 1st line treatment?

a)

Rifaximin

b)

Furosemide + Spironolactone

c)

Lactulose

d)

Ceftriaxone

34.

Pt with cirrhosis presents with confusion, apathy, irritability, asterixis, somnolence, and loss of motor control. Labs show elevated ammonia. What is your 2nd line treatment?

a)

Rifaximin

b)

Furosemide + Spironolactone

c)

Lactulose

d)

Ceftriaxone

35.

Pt with cirrhosis presents with confusion, apathy, irritability, asterixis, somnolence, and loss of motor control. Labs show elevated ammonia. What is NOT a dietary recommendation?

a)

Daily protein intake 1.2-1.5 g/kg/day

b)

Vegetable proteins preferred

c)

Branched chain amino acids preferred

d)

Indefinite restriction needed

36.

Hepatic encephalopathy treatment that is a non-absorbable disaccharide with MOA of decreasing absorption of ammonia in the gut.

a)

Vasoactive therapy (Octreotide, Vasopressin)

b)

Non-selective beta blocker (Nadolol, Propanolol)

c)

Lactulose

d)

Rifaximin

37.

Hepatic encephalopathy treatment that is an ABX that helps alter gut microbiota to create a more favorable microbiome and less nitrogen production.

a)

Vasoactive therapy (Octreotide, Vasopressin)

b)

Non-selective beta blocker (Nadolol, Propanolol)

c)

Lactulose

d)

Rifaximin

38.

Portal HTN and variceal treatment with MOA of decrease cardiac output and portal vein pressure along with decreasing splanchnic blood flow.

a)

Vasoactive therapy (Octreotide, Vasopressin)

b)

Non-selective beta blocker (Nadolol, Propanolol)

c)

Lactulose

d)

Rifaximin

39.

Portal HTN and variceal treatment with MOA of splanchnic vasoconstrictor that helps reduce blood flow to all splanchnic organs, which leads to decrease in portal pressure.

a)

Vasoactive therapy (Octreotide, Vasopressin)

b)

Non-selective beta blocker (Nadolol, Propanolol)

c)

Lactulose

d)

Rifaximin

40.

How does blood enter the liver?

a)

Portal vein

b)

Inferior vena cava

c)

Hepatic vein

d)

Cystic duct

41.

What is the safests and most effective option for controlling acute hemorrhage?

a)

TIPS

b)

EVL

c)

Sclerotherapy

d)

Balloon tamponade

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