CML case 3 and 4: cirrhosis and internal medicine

Question 1

Why do cirrhosis patients get pruritis?

Answer 1

Bile acids build up and deposit as bile salts in skin
Also increased levels of lysophosphatidic acid and autotaxin and increased levels of endogenous opioids can cause itching

Question 2

1st line treatment for cholestatic pruritis?

Answer 2

Bile acid sequestrant such as cholestyramine

Question 3

2nd line treatment for cholestatic pruritis?

Answer 3

rifampin

Question 4

3rd line treatment for cholestatic pruritis?

Answer 4

Opioid antagonist

Question 5

What labs are needed to calculate a patients MELD score?

Answer 5

CMP (need the bilirubin and creatinine) or LFTs

and INR

Question 6

Try to name 7 complications of cirrhosis

Answer 6

Variceal hemorrhage
Ascites
Spontaneous bacterial peritonitis
Hepatic encephalopathy
Hepatic hydrothorax
Hepatocellular carcinoma
Hepatopulmonary syndrome

Question 7

Treatment for esophageal varices?

How about prophylaxis?

Answer 7

Treatment: band ligation
Prophylaxis: nonselective beta blocker (carvedilol, labetalol)

Question 8

Treatment for ascites?

Answer 8

Diuretics (spironolactone/furosemide)
Paracentesis
Sodium restriction

Question 9

Empiric treatment for spontaneous bacterial peritonitis?

Answer 9

Cefotaxime

Question 10

Treatment for hepatic encephalopathy?

Answer 10

Lactulose or rifaximin

Question 11

Treatment for hepatic hydrothorax?

Answer 11

diuretics and sodium restriction

Question 12

Patients with cirrhosis need serial ultrasounds to screen for?

Answer 12

hepatocellular carcinoma

Question 13

Treatment for HCC?

Answer 13

Surgical resection/liver transplant

Question 14

Treatment for hepatopulmonary syndrome?

Answer 14

Liver transplant, long term oxygen

Question 15

Your COPD patient has had multiple COPD exacerbations in the past year and was recently hospitalized for a COPD exacerbation. You know his GOLD classification must be either ____ or ___

Answer 15

C or D

Question 16

Your patient has not had any COPD exacerbations in the past year. Their CAT score is 10. What is their GOLD category?

Answer 16

B

Question 17

Your COPD patient has had multiple COPD exacerbations in the past year and was recently hospitalized for a COPD exacerbation. His CAT score was 8. What is his GOLD category?

Answer 17

C

Question 18

Your COPD patient has had multiple COPD exacerbations in the past year and was recently hospitalized for a COPD exacerbation. His CAT score was 12. What is his GOLD category?

Answer 18

D

Question 19

Treatment for category B COPD?

Answer 19

LAMA (tiotropium) or LABA (arformoterol)

Question 20

Treatment for category C COPD?

Answer 20

LABA and ICS +/- LAMA

Question 21

Treatment for category D COPD?

Answer 21

LAMA + LABA + ICS

Question 22

All patients with prior MI should be taking?

Answer 22

High intensity statin

Question 23

At what CrCl do you discontinue metformin?

Answer 23

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