ABSITE EXAM QUESTIONS WITH
COMPLETE SOLUTIONS.
where in the liver are focal nodular hyperplasia (FNH) typically found? - ANSWERSnear
edge of liver
how does FNH look grossly? - ANSWERSwell circumscribed, lobulated, NO capsule
how does FNH look histologically? - ANSWERSdense, central stellate scar w/ septa
radiating outward & dividing tumor into nodules
what other lesion is it critical to distinguish FNH from? - ANSWERSfibrolamellar variant
of HCC
what are FNH findings on CT? - ANSWERSlate arterial phase: FNH is bright
homogeneous enhancement w/ hypodense central scar
delayed phase: hyperattenuation of central scar
FNH findings on MRI - ANSWERScentral scar that is hyperintense
contrast shows similar dist as CT
FNH findings on superparamagnetic iron oxide (SPIO) MRI? - ANSWERShypointense
but w/ bright central scar
what is most common benign liver tumor - ANSWERShemangioma
what is main blood supply of hemangioma? - ANSWERShepatic aa
gross appearance of hemangioma - ANSWERSspherical
well circumscribed
soft
easily compressible
microscopic appearance of hemangioma - ANSWERSmultiple large vascular channels
lined by single layer of endothelial cells supported by collagenous walls
what is Kasabach-Merritt syndrome - ANSWERSrare consumptive coagulopathy -->
sequestration of plts & clotting factors in a giant hemangioma
hemanigoma on CT - ANSWERSearly phase: low-density area w/ characteristic
peripheral enhancement
later on, contrast progresses to center
delayed enhanced: tumor is uniformly enhanced
,main distinction between hepatic adenoma (HA) & FNH? - ANSWERSHA does not have
bile ductules
FNH DOES have bile ductules
how does HA look grossly? - ANSWERSsolitary, round, well-circumscribed lesion
HA microscopically - ANSWERSmonotonous sheets of hepatocytes separated by
dilated sinusoids
CT findings for HA - ANSWERSshows early enhancement, often first in periphery w/
centripetal progression
how can you distinguish b/t HA & FNH on imaging? - ANSWERSSPIO-enhanced MRI
and/or scintigraphy w/ 99 m Tc-sulfur colloid --> HA has NO Kupffer cells
microscopic feature of HCC? - ANSWERSformation of giant cells
what AFP level indicates HCC? - ANSWERS>200 ng/mL (nl is 20 ng/mL)
CT findings for HCC - ANSWERSenhances in arterial phase & NOT in portal venous
phase, washout of contrast in delayed phase enhancement (hypointensity of nodule in
delayed phase compared to surrounding liver parenchyma)
what are Milan criteria? - ANSWERScriteria to be eligible for liver transplantation:
- single tumor w/ diameter < 5 cm or up to 3 tumors w/ diameter < 3 cm
- no extra-hepatic involvement
- no major vessel involvement
how do hepatic mets look on MRI T1 & T2 - ANSWERSlow-intensity on T1
intermediate intensity on T2
what chemo for unresectable hepatic colorectal mets? - ANSWERSFOLFOX (oxaliplatin
plus 5FU & leucovorin) w/ & w/o bevacizumab
source for pyogenic abscess of liver - ANSWERSdirect spread of bacteria from biliary
infection such as empyema of gallbladder OR cholangitis
ruptured appendicitis
diverticulitis
if source of liver abscess is biliary tree, what bugs do you have to tx for? -
ANSWERSenteric Gram neg bacilli
enterococci
what is the normal pressure in the portal vein? - ANSWERS3 to 5 mm Hg
,where in the liver is focal nodular hyperplasia usually found? - ANSWERSperiphery of
the liver
what is the proposed etiology for focal nodular hyperplasia? - ANSWERSembryonic
disturbance in liver blood flow
what are reversible causes that can cause cardiac arrest in ACLS? -
ANSWERShypovolemia
hypoxia
hydrogen ion (acidosis)
hypo/hyperkalemia
hypothermia
tension PTX
tamponade, cardiac
toxins
thrombosis (pulmonary)
thrombosis (coronary)
what is dopamine IV infusion rate as a vasopressor? - ANSWERS5-10 mcg/kg/min
what is epinephrine IV infusion rate as a vasopressor? - ANSWERS0.1-0.5 mcg/kg/min
what is norepinephrine IV infusion rate as a vasopressor? - ANSWERS0.1-0.5
mcg/kg/min
CAN be given for stable wide QRS tachycardia
what is adenosine IV dose in ACLS? - ANSWERSFirst dose: 6 mg rapid IV push
Second dose: 12 mg if required
CAN be given for stable wide QRS tachycardia
what is dose for sotalol IV? - ANSWERS100 mg (1.5 mg/kg) over 5 min
CAN be given for stable wide QRS tachycardia
when should sotalol be avoided? - ANSWERSprolonged QT
CAN be given for stable wide QRS tachycardia
1) what is dose of procainamide IV?
2) when do you stop procainamide?
3) what is max procanaimide?
4) what is maintenance dose?
5) when is it CI? - ANSWERS1) 20-50 mg/min
2) either arrhythmia suppressed, hypoTN, QRS duration inc > 50%, max dose of 17
mg/kg given
3) 17 mg/kg
4) 1-4 mg/min
5) prolonged QT or CHF
, what to give for symptomatic bradycardia? - ANSWERSFirst line: atropine IV
first dose: 0.5 mg bolus, repeat 3-5 minutes, max of 3 mg
if atropine fails, can do either transcutaneous pacing/dopamine/or epi
dopamine IV: 2-10 mcg/kg/min
epinephrine IV: 2-10 mcg/kg/min
pt w/ ab pain, ascites, hepatomegaly, CT w/ caudate lobe hypertrophy &
inhomogeneous contrast enhancement - ANSWERSBudd-Chiari syndrome
what might be found on CXR for a pyogenic liver abscess? - ANSWERSelevated right
hemidiaphragm
infiltrate at right lung base
right sided pleural effusion
how to tx pyogenic liver abscess? - ANSWERSdrainage & systemic abx
how to tx echinococcal cysts of liver? - ANSWERSDO NOT aspirate
cyst aspiration, scolicidal tx, pericystectomy
how can you test for echinococcal cysts of liver? - ANSWERSindirect hemagglutination
test
Casoni skin test
peripheral eosinophilia
most likely source of pyogenic liver abscess? - ANSWERSbiliary tree
which liver cell results in fibrosis of liver that causes cirrhosis? - ANSWERSIto cells (aka
hepatic stellate cells): differentiate into myofibroblast-like cell w/ high capacity for
fibrogenesis
most common cause of splenic vein thrombosis? - ANSWERSchronic pancreatitis
what is classic CT finding for amebic liver cyst? - ANSWERSsingle fluid collection in
right lobe w/ rim of peripheral edema
what is best method to prevent a first bleed in pt w/ known esophageal varices? -
ANSWERSendoscopic ligation
what is dopamine IV infusion rate as a vasopressor? - ANSWERS
surface of liver is covered by what & what is the name? - ANSWERSthin fibrous capsule
(Glisson's capsule)
what ligaments serves as landmark for border of left medial and left lateral liver
sections? - ANSWERSfalciform ligament
COMPLETE SOLUTIONS.
where in the liver are focal nodular hyperplasia (FNH) typically found? - ANSWERSnear
edge of liver
how does FNH look grossly? - ANSWERSwell circumscribed, lobulated, NO capsule
how does FNH look histologically? - ANSWERSdense, central stellate scar w/ septa
radiating outward & dividing tumor into nodules
what other lesion is it critical to distinguish FNH from? - ANSWERSfibrolamellar variant
of HCC
what are FNH findings on CT? - ANSWERSlate arterial phase: FNH is bright
homogeneous enhancement w/ hypodense central scar
delayed phase: hyperattenuation of central scar
FNH findings on MRI - ANSWERScentral scar that is hyperintense
contrast shows similar dist as CT
FNH findings on superparamagnetic iron oxide (SPIO) MRI? - ANSWERShypointense
but w/ bright central scar
what is most common benign liver tumor - ANSWERShemangioma
what is main blood supply of hemangioma? - ANSWERShepatic aa
gross appearance of hemangioma - ANSWERSspherical
well circumscribed
soft
easily compressible
microscopic appearance of hemangioma - ANSWERSmultiple large vascular channels
lined by single layer of endothelial cells supported by collagenous walls
what is Kasabach-Merritt syndrome - ANSWERSrare consumptive coagulopathy -->
sequestration of plts & clotting factors in a giant hemangioma
hemanigoma on CT - ANSWERSearly phase: low-density area w/ characteristic
peripheral enhancement
later on, contrast progresses to center
delayed enhanced: tumor is uniformly enhanced
,main distinction between hepatic adenoma (HA) & FNH? - ANSWERSHA does not have
bile ductules
FNH DOES have bile ductules
how does HA look grossly? - ANSWERSsolitary, round, well-circumscribed lesion
HA microscopically - ANSWERSmonotonous sheets of hepatocytes separated by
dilated sinusoids
CT findings for HA - ANSWERSshows early enhancement, often first in periphery w/
centripetal progression
how can you distinguish b/t HA & FNH on imaging? - ANSWERSSPIO-enhanced MRI
and/or scintigraphy w/ 99 m Tc-sulfur colloid --> HA has NO Kupffer cells
microscopic feature of HCC? - ANSWERSformation of giant cells
what AFP level indicates HCC? - ANSWERS>200 ng/mL (nl is 20 ng/mL)
CT findings for HCC - ANSWERSenhances in arterial phase & NOT in portal venous
phase, washout of contrast in delayed phase enhancement (hypointensity of nodule in
delayed phase compared to surrounding liver parenchyma)
what are Milan criteria? - ANSWERScriteria to be eligible for liver transplantation:
- single tumor w/ diameter < 5 cm or up to 3 tumors w/ diameter < 3 cm
- no extra-hepatic involvement
- no major vessel involvement
how do hepatic mets look on MRI T1 & T2 - ANSWERSlow-intensity on T1
intermediate intensity on T2
what chemo for unresectable hepatic colorectal mets? - ANSWERSFOLFOX (oxaliplatin
plus 5FU & leucovorin) w/ & w/o bevacizumab
source for pyogenic abscess of liver - ANSWERSdirect spread of bacteria from biliary
infection such as empyema of gallbladder OR cholangitis
ruptured appendicitis
diverticulitis
if source of liver abscess is biliary tree, what bugs do you have to tx for? -
ANSWERSenteric Gram neg bacilli
enterococci
what is the normal pressure in the portal vein? - ANSWERS3 to 5 mm Hg
,where in the liver is focal nodular hyperplasia usually found? - ANSWERSperiphery of
the liver
what is the proposed etiology for focal nodular hyperplasia? - ANSWERSembryonic
disturbance in liver blood flow
what are reversible causes that can cause cardiac arrest in ACLS? -
ANSWERShypovolemia
hypoxia
hydrogen ion (acidosis)
hypo/hyperkalemia
hypothermia
tension PTX
tamponade, cardiac
toxins
thrombosis (pulmonary)
thrombosis (coronary)
what is dopamine IV infusion rate as a vasopressor? - ANSWERS5-10 mcg/kg/min
what is epinephrine IV infusion rate as a vasopressor? - ANSWERS0.1-0.5 mcg/kg/min
what is norepinephrine IV infusion rate as a vasopressor? - ANSWERS0.1-0.5
mcg/kg/min
CAN be given for stable wide QRS tachycardia
what is adenosine IV dose in ACLS? - ANSWERSFirst dose: 6 mg rapid IV push
Second dose: 12 mg if required
CAN be given for stable wide QRS tachycardia
what is dose for sotalol IV? - ANSWERS100 mg (1.5 mg/kg) over 5 min
CAN be given for stable wide QRS tachycardia
when should sotalol be avoided? - ANSWERSprolonged QT
CAN be given for stable wide QRS tachycardia
1) what is dose of procainamide IV?
2) when do you stop procainamide?
3) what is max procanaimide?
4) what is maintenance dose?
5) when is it CI? - ANSWERS1) 20-50 mg/min
2) either arrhythmia suppressed, hypoTN, QRS duration inc > 50%, max dose of 17
mg/kg given
3) 17 mg/kg
4) 1-4 mg/min
5) prolonged QT or CHF
, what to give for symptomatic bradycardia? - ANSWERSFirst line: atropine IV
first dose: 0.5 mg bolus, repeat 3-5 minutes, max of 3 mg
if atropine fails, can do either transcutaneous pacing/dopamine/or epi
dopamine IV: 2-10 mcg/kg/min
epinephrine IV: 2-10 mcg/kg/min
pt w/ ab pain, ascites, hepatomegaly, CT w/ caudate lobe hypertrophy &
inhomogeneous contrast enhancement - ANSWERSBudd-Chiari syndrome
what might be found on CXR for a pyogenic liver abscess? - ANSWERSelevated right
hemidiaphragm
infiltrate at right lung base
right sided pleural effusion
how to tx pyogenic liver abscess? - ANSWERSdrainage & systemic abx
how to tx echinococcal cysts of liver? - ANSWERSDO NOT aspirate
cyst aspiration, scolicidal tx, pericystectomy
how can you test for echinococcal cysts of liver? - ANSWERSindirect hemagglutination
test
Casoni skin test
peripheral eosinophilia
most likely source of pyogenic liver abscess? - ANSWERSbiliary tree
which liver cell results in fibrosis of liver that causes cirrhosis? - ANSWERSIto cells (aka
hepatic stellate cells): differentiate into myofibroblast-like cell w/ high capacity for
fibrogenesis
most common cause of splenic vein thrombosis? - ANSWERSchronic pancreatitis
what is classic CT finding for amebic liver cyst? - ANSWERSsingle fluid collection in
right lobe w/ rim of peripheral edema
what is best method to prevent a first bleed in pt w/ known esophageal varices? -
ANSWERSendoscopic ligation
what is dopamine IV infusion rate as a vasopressor? - ANSWERS
surface of liver is covered by what & what is the name? - ANSWERSthin fibrous capsule
(Glisson's capsule)
what ligaments serves as landmark for border of left medial and left lateral liver
sections? - ANSWERSfalciform ligament
