Repaso Quiz 2

Question 1

Difference NAFL and NASH

Answer 1

NAFL → only steatosis
NASH → steatosis + inflammation + liver injury

Question 2

How does insulin resistance cause NAFLD

Answer 2

Insulin resistance → increases lipolysis in adipose tissue → increased FFA into bloodstream → liver takes FFA and re-esterified to TGL → steatosis → excessive FFA cause oxidative stress → activates inflammatory cytokines → chronic inflammation activates stellate cells → fibrosis

Question 3

Dx NAFLD and its finding

Answer 3

Ultrasonography → diffuse echogenic pattern due to fat accumulation

Question 4

How do antidiabetic tx help insulin resistance

Answer 4

Activates PPRy which increases insulin resistance by enhancing adiponectin production

Question 5

Excessive alcohol consumption

Answer 5

4/day or 14/week men and 3/day or 7/week women

Question 6

Enzymes in alcohol metabolism

Answer 6

Alcohol dehydrogenase and microsomal ethanol oxidizing system (MEOS)

Question 7

Most common characterisic AFLD

Answer 7

Steatosis

Question 8

Drugs used to reduce alcohol consumption

Answer 8

Disulfiram → inhibit acetaldehyde dehydrogenase
Naltrexone → antagonist opioid receptor
Acamprosate → antagonist N-methyl-D-aspartate receptor

Question 9

Treatment for ascites

Answer 9

Loop diuretics and aldosterone antagonist

Question 10

Main prognostic marker for alcohol liver failure

Answer 10

Maddrey discrimination function (MDF)

Question 11

Mainstay tx for severe alcohol associated hepatitis

Answer 11

Glucocorticoids

Question 12

Viremia period of HAV

Answer 12

5-7 days

Question 13

Markers that indicate HAV immunization

Answer 13

Anti-HAV IgG and no anti-HAV IgM

Question 14

Mutations of HBV

Answer 14

Precore: HBeAg negative in chronic
S: babies with immunization
P: resistant to drugs

Question 15

Incubation period of HBV

Answer 15

4 weeks to 6 months

Question 16

Complication in children of HBV

Answer 16

Papular acrodermatitis of childhood

Question 17

Markers of chronic HBV

Answer 17

HBsAg, HBeAg, Anti-HBc IgG

Question 18

Histologic findings of HCV

Answer 18

Dense lymphocytic inflammatory infiltrate and hepatocellular steatosis

Question 19

How is ALT seen in HCV

Answer 19

ALT in saw-tooth pattern

Question 20

Markers of active and resolved HCV

Answer 20

Active → HCV RNA and anti-HCV antibodies
Resolved → Anti-HCV antibodies alone

Question 21

Treatment for HCV

Answer 21

Sofosbuvir (NS5B) and velpatasvir (NS5A) for 12 weeks OR
Glecaprevir (NS3/4 protease) and pibrentasvir (NS5A) for 8 weeks

Question 22

Histologic findings in HDV

Answer 22

Microvesicular steatosis and granular eosinophilic steatosis

Question 23

Superinfection with HDV with jaundice, black vomit, acute liver failure

Answer 23

Labrea fever

Question 24

Only approved tx of HDV

Answer 24

PEG-IFN-a

Question 25

Incubation period of HEV

Answer 25

2-10 weeks

Question 26

Mechanisms of diarrhea (6)

Answer 26

Enhanced mucosal secretion Impaired epithelium absorptive and digestive activity Increased permeability epithelial barrier Decreased absorptive surface Altered motility Increased intraluminal osmolarity

Question 27

Laxatives associated with diarrhea

Answer 27

Mg citrate, Mg hydroxide, polyethylene glycol 3350

Question 28

Characteristics of diarrhea depending on location

Answer 28

Small intestine/proximal colon → large volume, little urgency, no tenesmus Rectum/distal colon → low volume, dysentery, tenesmus, urgency/frequency

Question 29

Pathogens where there are leukocytes in stools

Answer 29

Shigella, EIEC, Campylobacter

Question 30

Gold standard for C diffile dx

Answer 30

Cytotoxicity assay of cultured fibroblasts

Question 31

Type of diarrhea depending on osmotic gap

Answer 31

Osmotic <50 (low) → secretory or functional diarrhea Osmotic >100 (high) → osmotic diarrhea

Question 32

Pathogenesis of V cholera

Answer 32

Toxin over activates adenyl cyclase → increase AMPc → loss of Cl, Na and H2O from intestinal epithelial cells

Question 33

Virulence factors of ETEC

Answer 33

Heat labile and heat stable toxin

Question 34

Characteristic of EPEC

Answer 34

In children, alters cytoskeleton

Question 35

Characteristics of EAEC

Answer 35

Inflammatory diarrhea Growth retardation