FRACP questions

Question 1

Sofosbuvir

Answer 1

NS5B (nonstructural protein 5B) polymerase inhibitor

Question 2

Barrets esophagus follow up

Answer 2

Question 3

Liraglutide in NAFLD

Answer 3

LEAN study

Question 4

Duodenal infusion of donor faeces in C.diff

Answer 4

Question 5

Hep B serology

Answer 5

1. Inactive hepatitis B surface antigen carrier state

• HbsAg and HVcA are positive
• normal live enzymes (AST and ALT)
• HbeAg and HBV DNA are negative
• HbeAB is positive
• asymptomatic

2. Chronic hepatitis B, which is divided into HbeAg positive and HBeAg negative chronic hepatitis B

• HBeAG positive
  
  • ​HBsAg positive
  • HBV DNA positive
  • liver enzymes are persistently or intermittently elevated
• HBeAg negative (precore mutant)
  
  • HbsAg positive
  • HBV DNA positive
  • liver enzymes are persistently or intermittently elevated

3. Resolved chronic hepatitis B (past infection)

• HBsAg negative
• HBsAb positive
• normalization of ALT and AST
• very low levels of HBV DNA (< 10,000 copies/ml)

Key facts to remember

• HBsAg is the first marker to appear and causes the production of anti-HBs
• HBsAg normally implies acute disease (present for 1-6 months)
• if HBsAg is present for > 6 months then this implies chornic disease (i.e infective)
• Anti-HBs implies immunity (either expozure or immunisation). It is negative in chronic disease
• Anti-HBc implies previous (or current) infection. IgM anti-HBc appears during acute or recent hepatitis B infhection and is present for about 6 months
• HbeAg results from breakdown of core angtigen from infected liver cells as is therefore a marker of infectivity

Question 6

H.pylori treatment

Answer 6

Question 7

Multitarget stool DNA testing

Answer 7

Question 8

Leptin and role in obesity

Answer 8

Most obese people are LEPTIN resistant!