Q) A 60-year-old man with cirrhosis presents with refractory ascites requiring frequent large-volume paracentesis. He is evaluated for TIPS placement. Which of the following findings would be the strongest contraindication to proceeding with the procedure?
A) Serum bilirubin of 3.5 mg/dL B) MELD score of 18 C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg D) History of prior hepatic encephalopathy controlled on lactulose
#Theme from INI CET GI Mock test Liver
Correct Answer:
C) Right heart catheterization showing mean pulmonary artery pressure of 55 mmHg
Explanation:
A mean pulmonary artery pressure >45 mmHg is a contraindication to TIPS due to the risk of worsening right heart failure.
Bilirubin up to 3.5 and a MELD score <25 are relative risks but not absolute contraindications.
Prior controlled hepatic encephalopathy is not a strict contraindication, though the risk of recurrence post-TIPS is higher.
TIPS is often used in patients with refractory ascites when medical management fails.
Q ) During fluid resuscitation in a burns patient using Parkland’s formula, volume of fluid given in first 8 hours is ? A. 50% B. 25 % C. 75 % D. 100 %
TBSA% burn × weight (kg) × 4 = volume in mL
The first half is given in 8 hours and the second over 16 hours to complete the 24-hour resuscitation time frame.
Developed by Dr. Charles Baxter in the 1960s at the Parkland Memorial Hospital in Texas, this formula serves as a cornerstone in determining the initial fluid requirements to stabilize burn victims during the crucial early hours following injury.
Although the Parkland Formula offers a valuable framework for fluid resuscitation, it's important to note that individual patient variability, coexisting injuries, and evolving clinical conditions necessitate close monitoring and adjustment of the resuscitation plan. Over-resuscitation can lead to complications such as pulmonary edema, while under-resuscitation can result in inadequate tissue perfusion and organ failure.