MKSAP 18: GI and Hepatology UPDATED
ACTUAL Exam Questions and CORRECT
Answers
___ is a peripherally acting μ-opioid receptor antagonist that is FDA-approved for the treatment
of opioid-induced constipation in adults with chronic noncancer pain. - CORRECT
ANSWER - *Naloxegol* (oral)
- if starting naloxegol, stop current maintenance laxative before initiation of naloxegol and can
be added to the naloxegol after 3 days of mono therapy as needed
methylnatrexone, naloxegol, alvimopan have been approved for opiod-induced constipation
Patient has hepatitis B virus infection from birth.
+ Hep B surface antigen
+ Hep B e antigen
HBV DNA 20,000,000 IU/mL
AST and ALT are normal
Next step?
Treat or Liver US or Repeat liver chemistry in 6 months? - CORRECT ANSWER -
Patients with hepatitis B infection in the immune-tolerant phase require serial monitoring of
aminotransferase levels, *repeat liver chemistry in 6 months*
Hepatitis B virus, positive hep B e antigen (HbeAg), high viral load, normal AST/ALT - serial
monitoring
Antiviral therapy: acute liver failure, cirrhosis, if undergoing treatment with immunosuppressive
or chemo regiments, immune-active phase, HBeAg-positive and reactivation
,Which characteristics are associated with an increased risk for HCC in patients with hepatitis B
infection and indication for surveillance with US or cross-sectional imaging every 6 month? -
CORRECT ANSWER - 1. Cirrhosis
2. Asian descent plus male sex plus age older than 40
3. Asian descent plus female sex plus age older than 50
4. Sub-saharan african descent plus age older than 20
5. Persistent inflammatory activity (elevated ALT and HBV DNA level > 10,000 IU/mL for few
years
6. Family history of HCC
Treatment thresholds for hepatitis B? - CORRECT ANSWER - ALT level 2x ULN
HBV DNA level 20,000 IU/mL (HBeAg-positive, immune active phase)
HBV DNA at least 2000 IU/mL (HBeAg-negative, reactivation phase)
first line: entecavir or tenofovir
pegylated interferon for 48 weeks in patients with high ALT levels, low HBV DNA levels,
without cirrhosis (finite therapy, not pregnant, no psych disease, cardiac dx, sz, cytopenia, or
autoimmune disease)
Patient is having a colonoscopy with polypectomy when to stop aspirin? - CORRECT
ANSWER - *Do not discontinue aspirin*
Aspirin for secondary pox in patient with CV disease should be continued after colonoscopy with
polypectomy
d/c aspirin after polypectomy in patients without CV disease
48 year old female with AST 74, ALT 85, + Anti-smooth muscle antibody, DM2, HTN, BMI 31.
, US: hyperechoic and enlarged liver.
Dx? - CORRECT ANSWER - *NAFLD*
risks: obesity, DM, insulin resistance, HTN, HLD
75 year old male, progressive dysphagia for solid and liquids. Weight loss in 3 months. History
cigarette and alcohol use.
EGD: retained saliva, liquid, and food in the esophagus without mechanical obstruction.
Manometry: incomplete lower esophageal relaxation and aperistalsis.
Dx? - CORRECT ANSWER - *Pseudoachalasia* - tumor in the GEJ infiltrating the
myenteric plexus causing esophageal motor abnormalities, sxs barium-imaging and manometric
findings and endoscopic appearance similar to achalasia
Pseudoachalasia causes: amyloidosis and sarcoidosis, post-surgical (Nissen fundoplication or
bariatric surgery)
Pseudoachalasia:
- 6th decade of life
- short duration of sxs
- sudden and profound wt loss
35 year old with 1 year post-prandial diarrhea, episodic abdominal cramping relived with BM,
bloating. Only medication Loperamide.
tx?
- Alosetron
ACTUAL Exam Questions and CORRECT
Answers
___ is a peripherally acting μ-opioid receptor antagonist that is FDA-approved for the treatment
of opioid-induced constipation in adults with chronic noncancer pain. - CORRECT
ANSWER - *Naloxegol* (oral)
- if starting naloxegol, stop current maintenance laxative before initiation of naloxegol and can
be added to the naloxegol after 3 days of mono therapy as needed
methylnatrexone, naloxegol, alvimopan have been approved for opiod-induced constipation
Patient has hepatitis B virus infection from birth.
+ Hep B surface antigen
+ Hep B e antigen
HBV DNA 20,000,000 IU/mL
AST and ALT are normal
Next step?
Treat or Liver US or Repeat liver chemistry in 6 months? - CORRECT ANSWER -
Patients with hepatitis B infection in the immune-tolerant phase require serial monitoring of
aminotransferase levels, *repeat liver chemistry in 6 months*
Hepatitis B virus, positive hep B e antigen (HbeAg), high viral load, normal AST/ALT - serial
monitoring
Antiviral therapy: acute liver failure, cirrhosis, if undergoing treatment with immunosuppressive
or chemo regiments, immune-active phase, HBeAg-positive and reactivation
,Which characteristics are associated with an increased risk for HCC in patients with hepatitis B
infection and indication for surveillance with US or cross-sectional imaging every 6 month? -
CORRECT ANSWER - 1. Cirrhosis
2. Asian descent plus male sex plus age older than 40
3. Asian descent plus female sex plus age older than 50
4. Sub-saharan african descent plus age older than 20
5. Persistent inflammatory activity (elevated ALT and HBV DNA level > 10,000 IU/mL for few
years
6. Family history of HCC
Treatment thresholds for hepatitis B? - CORRECT ANSWER - ALT level 2x ULN
HBV DNA level 20,000 IU/mL (HBeAg-positive, immune active phase)
HBV DNA at least 2000 IU/mL (HBeAg-negative, reactivation phase)
first line: entecavir or tenofovir
pegylated interferon for 48 weeks in patients with high ALT levels, low HBV DNA levels,
without cirrhosis (finite therapy, not pregnant, no psych disease, cardiac dx, sz, cytopenia, or
autoimmune disease)
Patient is having a colonoscopy with polypectomy when to stop aspirin? - CORRECT
ANSWER - *Do not discontinue aspirin*
Aspirin for secondary pox in patient with CV disease should be continued after colonoscopy with
polypectomy
d/c aspirin after polypectomy in patients without CV disease
48 year old female with AST 74, ALT 85, + Anti-smooth muscle antibody, DM2, HTN, BMI 31.
, US: hyperechoic and enlarged liver.
Dx? - CORRECT ANSWER - *NAFLD*
risks: obesity, DM, insulin resistance, HTN, HLD
75 year old male, progressive dysphagia for solid and liquids. Weight loss in 3 months. History
cigarette and alcohol use.
EGD: retained saliva, liquid, and food in the esophagus without mechanical obstruction.
Manometry: incomplete lower esophageal relaxation and aperistalsis.
Dx? - CORRECT ANSWER - *Pseudoachalasia* - tumor in the GEJ infiltrating the
myenteric plexus causing esophageal motor abnormalities, sxs barium-imaging and manometric
findings and endoscopic appearance similar to achalasia
Pseudoachalasia causes: amyloidosis and sarcoidosis, post-surgical (Nissen fundoplication or
bariatric surgery)
Pseudoachalasia:
- 6th decade of life
- short duration of sxs
- sudden and profound wt loss
35 year old with 1 year post-prandial diarrhea, episodic abdominal cramping relived with BM,
bloating. Only medication Loperamide.
tx?
- Alosetron
