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Hepatology Flashcards

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1
Q

quid of amebic liver disease

A

tender liver mass on abdominal ct scan

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2
Q

rx of amebic abcess

A

metronidazole

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3
Q

patient with hepatic mass after traveling in endemic areas

A

amebic abcess

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4
Q

drug causing idiosyncratic reaction hepatitis(4)

A

halothane
phenytoin
isoniazid
@-methyl dopa

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5
Q

drugs causing cholestasis(4)

A

chlorpromazine
erythropoietine
anabolic steroids
nitrofurantoin

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6
Q

drugs causing fatty liver disease(3)

A

tetracycline
acid valproic
ARV

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7
Q

drugs causing granulomatous reaction(2)

A

allopurinol

phenylbutazone

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8
Q

2 ways for drugs to cause injury

A

toxic effect

idiosyncratic reaction

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9
Q

quid of toxic effect

A

reaction is dose dependent

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10
Q

example of toxic efffect(2)

A

tetracycline

acetaminophen

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11
Q

quid of idiosyncratic effect

A

reaction is dose independent

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12
Q

example of idiosyncratic effect(2)

A

isoniazid

ARV

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13
Q

clue for non alcoholic steato hepatitis NASH(4)

A

non drinker
serologic hepatitis negative
obese with high ALP
slightly increase SGOT,SGPT

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14
Q

link to have NASH

A

obesity

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15
Q

why obesity causes NASH

A

fat cells are not responsive to insulin and lipid is deposited in the liver

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16
Q

how ‘s ALT/AST in NASH

A

AST/ALT

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17
Q

dx of NASH

A

Liver biopsy

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18
Q

risk factor for NASH(5)

A 
obesity
diabete
hyperlipidemia
parenteral nutrition
medications
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19
Q

medication risk factor for NASH(5)

A 
corticosteroids
tamoxifen
amiodarone
diltiazem
HAART
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20
Q

quid of Murphy sign

A

RUQ pain worst during inspiration

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21
Q

clue for acute cholecystitis

A

pain in RUQ worsen with fatty liver meal

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22
Q

ALP in chlocystitis

A

normal

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23
Q

where ‘s stone in acute cholecystitis

A

in the cystic duct

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24
Q

RUQ pain with high ALP(2)

A

cholangitis
or
choledocolithiasis

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25
why you have fever in cholecystitis
secondary infection
26
why infection can happen in acute cholecystitis(2)
because of inflammatio you can have stasis and bacterial overgrowth risk of gangrene and perforation
27
what's the first step to address in case of variceal bleeding
2 large bore IV needles or central line
28
patien with acute pancreatitis develops palpable epigastric mass
pseudocyst formation
29
why amylase is elevated in pseudocyst
leak of amylase from the pseudocyst into the circulation
30
best image to Dx pseudocyst
US
31
rx of pseudocyst(2)
observation | resolve spontaneously
32
indication of drainage of pseudocyst(3)
more than weeks persistance infection > 5 cm
33
patient with high bilirubin direct and hgh ALP next step(3)
CT or US + antimitochondrial antibody
34
panacinar emphysema plus cirrhosis
@-1 antitrypsine deficiency
35
rx of @ antitrypsine deficiency
Alpha 1 anti trypsine factor
36
asymptomatic elevation of transaminase next step?
good history on risk factor
37
risk factor for hepatitis(5)
``` drug alcohol endemic area travel blod transfusion high risk sexual practices ```
38
Med causing high transaminase(5)
``` NSAIDS HMGco A reductase inhibitor antiepileptic drugs izoniazid herbal preparation ```
39
clue for acute pancreatitis(3)
epigastric pain rlieve by leaning forward occuring after binge eating
40
rx of acute pancreatitis(4)
conservatively analgesics fluid NPO
41
analgesics used in acute pancreatitis(2)
fentanyl | meperidine
42
most common type of gallstone in US
cholesterol stone
43
2 types of gallstone(2)
cholesterol | calcium bilirubinate
44
dx of choice of cholecystitis
US abdomen
45
rx for symptomatic cholecystitis
laparoscopic cholecystectomy
46
patient with microcytic anemia and firm hepatomegaly
metastatic cancer from colon
47
first site for matastasis pf colon cancer
hepatic
48
goal standard for metastatic hepatic colon cancer
abdomen CT scan
49
tinding in CT during metastatic hepatic colon cancer
cholestatic syndrome
50
PBC clue
antimitochondrial antibody type IGM
51
Biopsy of PBC(2)
destruction of intrahepatic bile ducts and cholestasis | medium size bile duct
52
first symptom of PBC and why?(2)
pruritis | because of cholestasis
53
conditions associated with PBC(5)
``` sjogren scleroderma celiac disease autoimmiune thyroid problem hypothyroidism ```
54
drug of choice fro PBC treatment
ursodeoxycholic acid
55
definitive rx of PBC and severe disease
liver transplant
56
jews with ictere
dubin jhonson
57
work up for dubin jhonson(2)
Normal AST/ALT | high bilirubin conjuguee
58
differentiate dubin jhonson from rotor
dark granular pigment seen in hepatocytes=Dubin jhonson
59
mechanism of gynecomastia in cirrhosis
excess of estrogen in the body
60
mechanism in testicular atrophy in cirrhosis
lot
61
why T3T4 are low in cirrhosis
no protein to bind T3T4
62
why TSH is normal in cirrhosis
because you lack thyroid binding globulin not T3T4
63
2 causes in cirrhosis causing hypogonadism(2)
hemochromatosis | alcohol
64
what causes hypogonadism(2)
primary hypogonadism | secondary due to hypothalamo hypophysaire dysfuction
65
why lung can have problem in cirrhosis
hapatic hydrothorax
66
why edema in cirrhosis
low albumin level
67
why hepatic hydrothorax in cirrhosis
defect of diaphragm allows ascites fluid to go in pleural space
68
patient with cirrhosis on diuretics develops pleural fluid effusion ,next step
TIPS | transjugular porto systemic shunt
69
cirrhosis and shortness of breath
pleural effusion
70
forst rx for hepatic hydrothorax(2)
diuretic | fluid restriction
71
Triad of charcot(3)
ictere fever RUQ pain
72
pentad of renold(3)
triad de charcot plus hypotension confusion
73
pentad of renold or charcot disease?
cholangitis
74
clue for acute cholangitis
high ALP
75
first step in rx of cholangitis
antibiotics
76
patient with cholangitis ,getting worse with antibiotics next step
surgical decompression
77
what'ts the best indicator of progression of HEP C infection in liver
biopsy
78
role of biopsy in HEP C infection(4)
stage of the disease rule out concommitant disease guide rx decision surveillance
79
electrolyte abnormality in cirrhosis
low K+
80
step of management of hepatic encephalopathy(4)
supportive care rx the precipitating cause correct volume and electrolyte problem lower ammonia
81
way to lower ammonia
lactulose
82
when you can add rifamixin in the rx of high ammonia in cirrhosis
when failure with lactulose after 48 h de rx
83
Burn Patient develops RUQ pain
acalculous cholecystitis
84
lactulose side effect
rifamixin
85
quid of acalculous cholecystitis
inflammation of gallbladder without calcul
86
conditions predisposing to acalculous cholecystitis(5)
``` severe burns severe trauma prolonged TPN prolonged fasting mechanical ventilation ```
87
complication of acalculous cholecystitis(3)
gangrene perforation emphysematous changes
88
initial work up for acalculous cholecystitis(3)
US abdomen more specific HIDA scan CT scan
89
IV drugs user with ascites
chronic liver disease
90
most common cause of chronic liver disease
alcohol | hep c
91
why splenomegaly in cirrhosis
because of portal HTA
92
rx of hepatitis B preferred drug(2)
tenofovir | entecavir
93
drug used in rx of hep B(4)
tenofovir entecavir interferon 3TC
94
Indication of rx(6)
acute liver disease clinical complications of cirrhosis advanced cirrhosis with with high HBV DNA Patient without cirrhosis but with positive HBe AG, HBV DNA>20000
95
why TDF and entecavir are prefered (2)
low risk of resistance | can be used in decompensated cirrhosis
96
cirrhosis and encephalopathy Rx
lactulose
97
cause of precipitation of cirrhosis(9)
``` infection hypoxia hypoglycemia hypovolemia porto systemic shunt excessive nitrogen load medication hypokaliemia metabolic alkalosis ```
98
medication percipitating cirrhosis
sedatives
99
cause of excessive nitrogen load
bleeding
100
4 phases in chronic infection caused by hepatitis B
immune tolerance imune clearance inactive carrier state reactivatio
101
clue for immune tolerance(4)
high antigene HBS High HBE antigene high HBV replication minimal destruction of hepatocytes
102
duree of immune phase
10 a 30 years
103
what happened in imune clearance phase
destruction of hepatocytes containing HBV
104
clue for this phase(2)
ALT high or normal | HBE antigene positive
105
meaning of HBe
active replication is occuring
106
what to do in the phase of ICP
``` serial ALT(q3-q 6 months) serial HBe Ag ```
107
why serial ALT and HBe in ICP
to fully document clearance
108
clue for inactive carrier(3)
Hbe ag - Hbe aB + Low HBV DNA
109
indication to conclude inactive carrier state(2)
>/ a 3 Normal ALT | 2 a 3 Normal HBV DNA
110
cue for reactivation of HepB(3)
high ALT high HBV fibrosis on biopsy
111
how to follow patient with chronic Hep B
serial ALT
112
what should be done to any patient with chronic hepatis
vaccination for Hep A and B
113
what should be done to any patient with hepatitis C infection
vaccination for Hep A and B
114
indication of rx in chronic Hep C(4)
age > 18 ans detectable serum RNA compensated liver disease liver biopsy with fibrosis
115
quid of compenated corrhosis(2)
INR normal
116
rx of chronic Hepatitis C(2)
Peginterferon plus ribarivirin
117
indication of protese inhibitor in rx of hepatitis C infection
HCV 1
118
contrindication of rx with protease inhibitor(3)
uncontrolled depression alcohol drug abuse
119
protease inhibitor used in HCV infection(2)
telaprevir | boceprevir
120
patient with cirrhosis high ALT and AST and brownish deposit around cornea
wilson disease
121
quid of keyser fleisher ring
brownish deposit around cornea
122
biopsy finding in wilson
hepato lenticular degeneration
123
why psychiatric problem in wilson
copper leak fromhepatocytes and deposit in basa ganglia
124
eye problem in wilson
keyser fleisher ring
125
dx test for wilson(3)
liver biopsy low ceruloplasmin low copper in urine
126
finding in liver biopsy
copper >250 Mcg
127
meaning of low ceruloplasmine
128
confirmatory dx test
keyser flesher ring
129
Rx of wilson(2)
Penicillamine or trientine plus ZN
130
when liver transplantation is indicated in wilson(2)
decompensated liver disease | fulminant hepatic failure
131
best rx of choledocholithiasis
laparoscopic cholecystectomy
132
in case of a patient refusing the surgical rx of choledocholithiasis(2)
ursodesoxycholic acid | avoid fatty foods
133
pancreatitis in non alcoholic patient
gallstone
134
Rx of pancreatitis in non alcoholic patient
cholecystectomy
135
mid epigastric pain with high lipase and amylase
acute pancreatitis
136
quid of hapatic adenoma
hepatic tumor in young female taking OCP
137
complication of hepatic adenoma(2)
intratumor hemorrage | malignant tranformation
138
biopsy in hepatic adenoma
enlarged heaptocytes containing glycogen and lipid deposits
139
rx of hepatic encephalopathy
serum ammonia level
140
why hyperandrogenism in aptient with cirrhosis
inabiloity of the liver to metabolise estrogen
141
effect of high estrogen in cirrhosis(5)
``` spider angioma gynecomastia little testicle palmar erythema decreased body haior ```
142
liver function(3)
metabolic synthetic excretoire
143
liver synthesis(3)
protein cholesterol clot factor
144
excretory role of liver
bile
145
metabolic role of liver(2)
detoxification of drug | and steroids
146
clue for amebic liver disease(4)
trip to mexico history of bloody diarrhea RUQ pain uniform cyst in right lobe
147
risk factor for gallbladder carcinoma(3)
chronic gallblader inflammation porcelain gallbaldder salmonella typhi carriage
148
chronic gallblader inflammation cause
stones
149
indication of cholecystectomy in gallbladder carcinoma
when ca is confined to gallbladder wall(lamina propria)
150
risk factor for porcelain gallblader
chronic inflammation by gallstones
151
complication of porcelain gallbladder
cancer
152
glomerulonephritis with low complement(4)
GNA MPGN Lupus Mixed cryoglobulinemia
153
link between Cryoglobulinemia and RA(2)
IGM will be targeted towards IGG | rhumatoid factor can be positive
154
quid or cryo
it's a vasculitis
155
target in cryo (4)
articulation skin rein foie
156
skin finding in mixed Cryo
purpura
157
first step in aptient with suspected mixed cryo
test for hepatitis C
158
confirmatory Dx for mixed Cryo(2)
kidney biopsy or skin biopsy
159
clue for porphyria cutanea tarda(3)
photosensitivity fragile skin erosion and vesicles on dorsum of the hands
160
disease causing porphyria cutanea tarda
mixed cryo
161
clue for Mixed Cryo
periodic increase of Tranaminases
162
complication of Mixed cryo(2)
cirrhosis | hepatocellular carcinoma
163
cause of Non alcoholic fatty liver disease in obese patient
insulin resistance
164
physiopatho af NAF liver disease(3)
high lipllysis in periphery high triglyceride synthesis high hepatic uptake of fatty acids
165
criteria for NAF liver disease(3)
steatohepattitis | viral serology -
166
patient with virl hepatitis develops high PT and decresed transaminases Dx
Fulminant hepatitis
167
decrease transaminase in the setting of viral hepatitis meaning?(2)
recovery | fulminant hepatitis
168
patient with positive HBS antibody (2)
vaccination | prior infection
169
first marker to be positive in Hep B
Hbs Ag
170
second marker to be positive in Hep B
anti hbc IGM
171
most specific marker to Dx acute Hep B
IGM HBC antibody
172
why Hbc ag can not be seen
it's sequestered within HBS ag coat
173
Meaning of HBe Ag
infectivity
174
Meaning of HBe Antibody
low infectivity
175
Meaning of HBc antibody
recovery
176
what are the 3 types of gallstones
cholesterol pigment stone mixed stone
177
quid of pigmented stones
calcium bilirubinate stones
178
why pregnant women are prone for cholesterol stones
hypomotility of gallbaldder
179
cause of gallbaldder hypomotility(4)
advanced age TPN prolonged fasting hypertriglyceridemia
180
5 causes of cholesterol gallstones formation
hypomotile gallbladder malabsorption of acid biliaire OCP Meds
181
Med causing cholesterol stones(3)
clofibrate octreoctide ceftriaxone
182
risk factor for pigmented stones(3)
hemolysis chronic biliairy tract infection parasitic infection
183
protective factor against stones(5)
``` NSAIDS Aspirin caffeine physical activity low carbohydrate diet ```
184
quid pof Hepatic shock
patient with low TA develops high AST/ALT with mild elevation of bilirubin
185
what happen in hepatic shock
ischemic hepatic injury
186
pregnant women develop Hep C infection next step(2)
Hep A vaccine | Hep B vaccine if not immune
187
clue for hepatic cyst (hydatic)(2)
thick wall cyst | egg shell calcification
188
cause of hepatic cyst
ecchinococus granulosis
189
what you should not do in hydatid cyst
aspiration of the cyst
190
why you should not aspirate in hydatid cyst
risk of hypersensitivity
191
rx in hydatid cyst
surgery under albendazole coverage
192
quid of fulminant hepatic failure
acute viral hepatitis complicated with encephalopathy
193
rx of FHF
orthotopic liver transplant
194
other way of considering FHF
hepatic encephalopathy within 8 weeks of acute liver disease
195
young person with high transaminase and neurologic finding resting tremor and muscular rigidity
wilson
196
FHF in pregnant women in 3 e trimestre
Hep E
197
all patients receiving blood before 1986
screen Hep B and C
198
all patients receiving blood before 1992
screen Hep C
199
after marrow transplantation pateint develops decreased bile ducts quantity in liver biopsy what disease has the same pattern
PBC
200
cause of ductopenia(8)
``` PBC hogkin sarcoidosis cmv infection HIV Med induced failing liver transplantation graft versus host disease ```
201
after marrow transplantation pateint develops decreased bile ducts quantity in liver biopsy dx
graft versus host disaese
202
most common cause of ductopenia
PBC
203
other name for ductopenia
vanishing bile duct syndrome
204
asian american with ictere bilirubin in urine
rotor
205
quid of bilirubin in urine
conjugated hyperbilurubinemia
206
bilirubin in gilbert
high conjugated hyper bilirubinemia
207
patient taking INH develops high transaminase
continue with RX | will resolve spntaneously
208
patient with multiple trou noir on CT scan
metastatic disease from colon cancer
209
primary cancer to metastase in liver(3)
colon cancer lung breast
210
clue for Ca in the United states
weight loss
211
test of choice for pancreatic cancer
CT abdomen
212
3 causes of decompensated liver with high transaminase | ALT>AST(3)
medication viral hepatitis shock liver
213
medication causing decompensated liver with high transaminase
acetaminophen
214
antidote of paracetamol intox
acetylcysteine
215
Transminase in severe hepatic injury
>1000
216
3 causes of ALT>AST(3
medication viral hepatitis shock liver
217
complication of elective cholecystectomy
sphincter d'oddy dysfunction
218
3 causes of ALT>AST(3
medication viral hepatitis shock liver
219
complication of elective cholecystectomy
sphincter d'oddy dysfunction
220
rx of sphincter d'oddy dysfunction
ERCP with sphicterotomy
221
patient after elective cholecystectomy has persistent RUQ pain DX?
sphincter d'oddy dysfunction
222
ratio AsT/ALT in alcoholic patient(2)
AST/ALT >2 or AST >ALT 2f
223
why in alcoholic patient AST >ALT
deficiency in pyridoxal 6 phosphate
224
quid of in pyridoxal 6 phosphate
cofactor of ALT
225
U/s in emphysematous cholecystitis (2)
circular linear shadows gaseaous in gallbladder | no gall stones
226
patient with RUQ pain ,abdominal xray showing air fluid level in the gallbladder
emphysematous cholecystitis
227
U/s in emphysematous cholecystitis
circular linear shadows gaseaous in gallbladder
228
cholecystitis with no gall stones
acalculous | emphysematous
229
cause of emphysematous cholecystitis
gas forming bacteria
230
clue for Hep A infection (2)
trip in Mexico or endemic area
231
risk factor for Emphysematous cholecystitis
diabetes
232
clue for Hep A infection
trip in Mexico
233
the most common malignant in liver
metastasis
234
patient alternance of dairrhea and constipation presenting with high ALP and multiple hepatic nodules on CT Dx?
Metastasis from colon cancer
235
Multiple nodules in Liver Next step
check GI for primary Cancer
236
transaminase in hepatic shock
ALT | AST > 1000
237
transaminase in post op cholestasis(2)
Normal AST ALT | High ALP
238
hepatic shock
ALT | AST > 1000
239
quid of asymptomatic gallstones
gallstones seen in US but no Symptom
240
rx for asymptomatic gallstone
nothing
241
rx for symptomatic gallstone
laparoscopic cholecystectomy
242
normal liver span
6-12 cm in the midclavicular line
243
3 types of hepatic liver disease linked with alcohol(3)
fatty liver alcoholic hepatitis alcoholic fibrosis /cirrhosis
244
clue for fatty liver in biopsy
steatosis
245
clue for alcoholic hepatitis in biopsy(4)
mallory body liver cell necrosis perivenular distribution of inflammation liver cell necrosis
246
what the 2 phases reversible with cessation alcohol
steatosis | hepatitis
247
clue for hypertriglyceridemia in a patient with suspected acute pancreatitis
xanthomas
248
quid of XAnthoma
yellow red papules on arms and shoulders
249
mechanism of xanthoma(2)
fat deposit on tendon | or in subcutaneous tissue
250
in acute pancreatitis what to always do
order profile lipidic
251
bleeding in liver failure(2)
varices | coagulopathy
252
manif of varices
hematemesis
253
manif of caogulopathy
epistaxis | bleeding from IV sites
254
management of coagulopathy
fresh frozen plasma
255
what cause coagulopathy in liver failure
all clot fator are formed in the liver except factor 8
256
why FFP is the best treatment in coagulopathy caused by liver failure
because it has all the clotting factor
257
screening test for acute Hep B(2)
IGm HBc antibody | HBs Ag
258
drug of choice for PBC
ursodeoxycholic acid
259
Dx differentiel in patient with indirect high bilirubinemia(4)
hemolysis gilbert criggler najar
260
=/ gilbert from criggler Najar type 1(2)
high bilirubin in Criggler Najar 20-25 | in gilbert 3 a 5
261
quid of SAAG
serum albumin ascire gradient
262
SAAG calculation
albumin serique-albumin ascites
263
SAAG> 1,1
hypertension portale
264
AES in patient with acute phase of hepatite B,patient pique non immune a hep B(2)
vaccine + | immunoglobulin
265
quid for acute phase of Hep B(4)
IgM anti HBc Hbs Ag HBe Ag DNA +
266
quid of window phase
IgM anti Hbc + | DNA positive
267
quid of recovery phase(4)
anti HBe antihbc iGG anti HB s DNA -
268
chronic carrier(2)
HBS ag | IGG anti HBC
269
acute flare of chronic
Hbs ag + HBe Ag IGG anti HBc DNA +
270
vaccinated patient
anti hbs ag
271
immune by contact with the virus
IgG anti HbC | anti HBS ag
272
PAS positive in hepatology
@-1 anti trypsine deficiency
273
Symptom of hypogonadism(3)
decraese libido eerctile dysfunvtion loss of axillary and pubic hair
274
indication of TIPS
refractory hydrothorax in cirrhosis
275
step in hepatic encephalopathy
search for precipitating cause
276
approach to chronic hepatitis C
Serial ALT to follow up
277
what's the next step after rx acute pancreatitis caused by gallstones
schedule cholecystectomy
278
clue helping in the Dx of cirrhosis encephalopathy
serum ammonia
279
when to make dx of gallbladder carcinoma(2)
per-op or post op
280
immunlogy in mixed cryo
IGM is directed towards IGG anti hepatite C virus
281
when to suspect Hep C infection
waxing and waning increase of transaminases
282
extrahepatic manif of chronic hep C(3)
mixed cryo porphyria cutanea tarda membranoproliferative glomerulonephritis
283
hepatitis induced by INH transaminase less than 100
continue with the rx

► Med Notes 2 (19 decks)

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