MKSAP 18 GI UPDATED ACTUAL Exam
Questions and CORRECT Answers
Opioid-induced constipation treatment? - CORRECT ANSWER - First-line laxative
therapies, including over-the-counter stool softeners, bulk laxatives (fiber supplements), a
stimulant laxative (bisacodyl), and an osmotic laxative (polyethylene glycol [PEG]), .
(laxative therapy should be stopped before the initiation of naloxegol and can be added to the
naloxegol after 3 days of monotherapy as symptoms dictate.)
Surfactants such as docusate sodium or docusate calcium are weak laxatives with an excellent
safety profile. As such, they are most appropriate for very mild, intermittent constipation. .
Manage aspirin use before and after polypectomy.? - CORRECT ANSWER -
Discontinuing aspirin is recommended after polypectomy in patients without established
cardiovascular disease who are using aspirin as primary prophylaxis. In patients with established
cardiovascular disease, such as this patient, the risks of a potential cardiovascular event outweigh
those of potential gastrointestinal bleeding.
Holding aspirin for a period of time after a polypectomy, such as 48 hours, has not been shown to
reduce postprocedure LGIB and may increase risk for a thromboembolic event in a patient with
established cardiovascular disease.
HBsAg +, HBeAg +, HBV DNA level is 20,000,000 IU/mL. ALT, AST Normal. Mangement? . -
CORRECT ANSWER - Repeat liver chemistry testing in 6 months is the most appropriate
next step in the management of this patient. The patient has hepatitis B virus (HBV) infection in
the immune-tolerant phase,
Obesity, diabetes mellitus, insulin resistance, hypertension, and hyperlipidemia, Anti-smooth AB
positive ? - CORRECT ANSWER - elevated alanine aminotransferase and aspartate
aminotransferase levels are within the typical range for patients with NAFLD. Alkaline
phosphatase (ALP) levels may be slightly elevated as well, typically less than 2 to 2.5 times the
upper limit of normal. The finding of a hyperechoic liver on ultrasonography is also consistent
, with NAFLD. Because other liver diseases may also result in hepatic steatosis, patients with
elevated liver chemistries and suspected nonalcoholic steatohepatitis should be evaluated to
exclude other causes of chronic liver disease.
anti-smooth muscle antibody test, the low titer alone is not diagnostic of autoimmune hepatitis.
Autoimmune hepatitis is typically accompanied by higher autoantibody titers and elevated γ-
globulin levels. It requires a liver biopsy to establish the diagnosis. Between 20% and 30% of
patients with NAFLD exhibit low-titer autoantibodies
75-year-old man is evaluated for progressive dysphagia of 8 months' duration for both solid food
and water, and the necessity to induce vomiting several times each month to relieve his
symptoms. He also has experienced chest pain and heartburn symptoms. He has lost 9 kg (20 lb)
since his symptoms began. He has a long history of cigarette and alcohol use
Upper endoscopic findings reveal retained saliva, liquid, and food in the esophagus without
mechanical obstruction. Manometry demonstrates incomplete lower esophageal relaxation and
aperistalsis. - CORRECT ANSWER - Pseudoachalasia is caused by a tumor at the
gastroesophageal junction infiltrating the myenteric plexus causing esophageal motor
abnormalities. Tumors capable of infiltrating the myenteric plexus include those of the distal
esophagus, gastric cardia, pancreatic, breast, lung, and hepatocellular. Patients with
pseudoachalasia are often in their sixth decade of life or older, have a short duration of
symptoms, and experience sudden and profound weight loss. Endoscopic ultrasonography can
exclude an infiltrating tumor, and guidelines recommend its use in patients with a strong
suspicion for malignancy.
Achalasia affects men and women equally, and occur between the ages of 30 and 60 years.
Typical achalasia has an insidious onset and long duration of symptoms, often measured in years,
before patients seek medical attention. This patient's age, short duration of symptoms, and rapid
weight loss argue against the diagnosis of achalasia
In patients requiring NSAIDs, an evidence-based treatment strategy to prevent recurrent NSAID-
induced peptic ulcers is the use of a ___________NSAID plus a proton pump inhibitor -
CORRECT ANSWER - cyclooxygenase-2 selective (COX-2)
The risk for gastroduodenal ulcers and ulcer complications is significantly lower in patients
taking COX-2 inhibitors compared with nonselective NSAIDs such as naproxen; however, in
high-risk patients, such as those with previous peptic ulcer disease, a COX-2 inhibitor alone is no
Questions and CORRECT Answers
Opioid-induced constipation treatment? - CORRECT ANSWER - First-line laxative
therapies, including over-the-counter stool softeners, bulk laxatives (fiber supplements), a
stimulant laxative (bisacodyl), and an osmotic laxative (polyethylene glycol [PEG]), .
(laxative therapy should be stopped before the initiation of naloxegol and can be added to the
naloxegol after 3 days of monotherapy as symptoms dictate.)
Surfactants such as docusate sodium or docusate calcium are weak laxatives with an excellent
safety profile. As such, they are most appropriate for very mild, intermittent constipation. .
Manage aspirin use before and after polypectomy.? - CORRECT ANSWER -
Discontinuing aspirin is recommended after polypectomy in patients without established
cardiovascular disease who are using aspirin as primary prophylaxis. In patients with established
cardiovascular disease, such as this patient, the risks of a potential cardiovascular event outweigh
those of potential gastrointestinal bleeding.
Holding aspirin for a period of time after a polypectomy, such as 48 hours, has not been shown to
reduce postprocedure LGIB and may increase risk for a thromboembolic event in a patient with
established cardiovascular disease.
HBsAg +, HBeAg +, HBV DNA level is 20,000,000 IU/mL. ALT, AST Normal. Mangement? . -
CORRECT ANSWER - Repeat liver chemistry testing in 6 months is the most appropriate
next step in the management of this patient. The patient has hepatitis B virus (HBV) infection in
the immune-tolerant phase,
Obesity, diabetes mellitus, insulin resistance, hypertension, and hyperlipidemia, Anti-smooth AB
positive ? - CORRECT ANSWER - elevated alanine aminotransferase and aspartate
aminotransferase levels are within the typical range for patients with NAFLD. Alkaline
phosphatase (ALP) levels may be slightly elevated as well, typically less than 2 to 2.5 times the
upper limit of normal. The finding of a hyperechoic liver on ultrasonography is also consistent
, with NAFLD. Because other liver diseases may also result in hepatic steatosis, patients with
elevated liver chemistries and suspected nonalcoholic steatohepatitis should be evaluated to
exclude other causes of chronic liver disease.
anti-smooth muscle antibody test, the low titer alone is not diagnostic of autoimmune hepatitis.
Autoimmune hepatitis is typically accompanied by higher autoantibody titers and elevated γ-
globulin levels. It requires a liver biopsy to establish the diagnosis. Between 20% and 30% of
patients with NAFLD exhibit low-titer autoantibodies
75-year-old man is evaluated for progressive dysphagia of 8 months' duration for both solid food
and water, and the necessity to induce vomiting several times each month to relieve his
symptoms. He also has experienced chest pain and heartburn symptoms. He has lost 9 kg (20 lb)
since his symptoms began. He has a long history of cigarette and alcohol use
Upper endoscopic findings reveal retained saliva, liquid, and food in the esophagus without
mechanical obstruction. Manometry demonstrates incomplete lower esophageal relaxation and
aperistalsis. - CORRECT ANSWER - Pseudoachalasia is caused by a tumor at the
gastroesophageal junction infiltrating the myenteric plexus causing esophageal motor
abnormalities. Tumors capable of infiltrating the myenteric plexus include those of the distal
esophagus, gastric cardia, pancreatic, breast, lung, and hepatocellular. Patients with
pseudoachalasia are often in their sixth decade of life or older, have a short duration of
symptoms, and experience sudden and profound weight loss. Endoscopic ultrasonography can
exclude an infiltrating tumor, and guidelines recommend its use in patients with a strong
suspicion for malignancy.
Achalasia affects men and women equally, and occur between the ages of 30 and 60 years.
Typical achalasia has an insidious onset and long duration of symptoms, often measured in years,
before patients seek medical attention. This patient's age, short duration of symptoms, and rapid
weight loss argue against the diagnosis of achalasia
In patients requiring NSAIDs, an evidence-based treatment strategy to prevent recurrent NSAID-
induced peptic ulcers is the use of a ___________NSAID plus a proton pump inhibitor -
CORRECT ANSWER - cyclooxygenase-2 selective (COX-2)
The risk for gastroduodenal ulcers and ulcer complications is significantly lower in patients
taking COX-2 inhibitors compared with nonselective NSAIDs such as naproxen; however, in
high-risk patients, such as those with previous peptic ulcer disease, a COX-2 inhibitor alone is no
