Ques. 1 :

The clinical significance of Spider Angiomatoes and other condition that you can see Spider

Angiomatoes.

Ans :

Correlate C severity of Liver disease. Pregnancy & Malnutrition Cause : ↑ oestradial & free Testoster one.

Ques. 2 :

What are the Nail changes that occur in cirrohosis.

Ans :

1. MUEHRCKE’S NAIL Paired Horizontal white bands separated

by normal colour.

2. Terry’s NailProximal 2/3 of Nail plate appears white, Distal 1/3 is red.Probable cause : ↓ serum Albumen

Ques. 3 :

Caput Medusae when do you get and what are the veins taking part in the shunt.

Ans :

Cirrhosis of liver with portal hypertension.Portal venous system may be shunted through the periumbliul veins into the umblical vein then to the abdominal vein causing them to become prominent.

Ques. 4 :

Cause of Parotid Gland Enlargement

Ans :

Due to fatty infiltration, fibrosis & edema : Not due to ↑ function of gland.

Ques. 5 :

What vaccine in chromic liver disease is indicated?

Ans :

According to ACIP :

Hepatitis ‘A‘ Vaccine :

Immun Genicity : 95% of liver disease shows sero conversion compared to healthy – 98%

Safety :Well tolerated no special precaution neededDose : Two Doses.

Hepatitis ‘B’ Vaccine :

Recombinant HBV Vaccine Dose : 0, 1 & 2 months

Serco conversion :After 1st dose

Safety 94% :No adverse events

Hepatitis ‘C’ vaccine : No prophylactic or Therapeutic vaccine

Pneumococcal vaccineInfluenza vaccineDiphtheria and tetanus Meningococcal and Homophilous

influenza vaccine

Ques. 6:

Cirrotosis of liver C mild portal Hypertension, Hepatitis ‘B’ carrier and Hepatitis ‘C’ desire to have pregnancy - what advise you will give ?

Ans :

1. Do upper endoscopy to look for varices before pregnancy. If present, pregnancy is ↑ High risk for Hemorrhage. Prophylaxis with B Blocker may be continued during

pregnancy New Borns should be monitored for Hypoglycemic and Bradycardia . 2. spontaneous rupture of spleenic artery may occur during

pregnancy.

2. Reactivation of the virus and exacerbation of the disease during or after gestation are uncommon. Placenta Forms an excellent barrier against this virus. Major problem during delivery exposure to maternal blood in the birth caned.

3. Hepatic ‘C’ uneventful pregnancy

Ques. 7 :

What is the mechanism for vasodilatation in PHT

Ans :

↑level of circulating Vaso Dilators. Nitric Oxide is the primary mediators. vasodilatations in cirrohosis due to No synthase activity ↑

Ques. 8 :

Hall mark of Hepoto Renal Syndromes

Ans :

↑Renal vaso constrictions due to RAAS and SNS ↓ Peripheral vascular resistance HPE Kidney is normal

Ques. 9:

What do you mean by KamilSevela Technique ?

Ans :

•New Tech to measure the Borders of liver

• Place the stethoscope on the xiphoid process Scratch from below the Rt. nipple / Breast you clearly here the liver borders.

• First sound is when the liver appears & when the sound disappears it is the end of the liver.

Ques. 10 :

Explain the Special Maneuvers in Abdominal Examination ?

Ans :

Murphy’s Sign (Cholycystitis)Rebound TendernessPsoas SignObturator SignRovsing Sign (Pain in the Rt. Iliac Fossa on Palpation of Lt. Side of Abdomen) (Referred Tenderness)Carnett’s Sign (Pain when Tensing the ABD. Wall Mass)Pata Fros Sign (Pain when the pt is asked to Cough)