Gastroenterology

Question 1

t/f ALT is a more specific marker for liver damage compared to AST

Answer 1

true

Question 2

in addition to measuring AST/ALT for suspected liver dysfunction, what else should you measure?

Answer 2

liver synthetic function ( albumin, coags, etc)

Question 3

if there are mildly elevated liver enzymes on testing, what is the next best step in further evaluation?

Answer 3

repeat the test in 4 weeks

Question 4

if you have concern for MASLD, then what is the next calculation to do in the evaluation for potential progression to fibrosis?

Answer 4

fibrosis 4 index

Question 5

if the Fibrosis 4 index is elevated, what is the next step in evaluation?

Answer 5

liver MRI

Question 6

what 3 medication options should be considered for the MASLD population?

Answer 6

GLP-1, SGLT2, and statins

Question 7

what AST/ALT ratio is suggestive of alcohol liver disease?

Answer 7

> 2

Question 8

t/f acetaminophen, Augmentin, sulfonamides, isoniazid and statin are the most common causes of drug induced liver injury

Answer 8

true

Question 9

if there is suspicion for drug induced liver injury and the offending drug is removed, the AST/ALT should resolve within what period of time?

Answer 9

2-3 months

Question 10

what is the USPSTF recommendation on general adult hep C screening?

Answer 10

screen adults 18-79 yo

Question 11

what condition is characterized by hepcidin deficiency?

Answer 11

hereditary hemachromatosis

Question 12

what are the two tests to perform if concerned about hereditary hemachromotosis?

Answer 12

iron panel and HFE mutation testing

Question 13

where is A1AT produced?

Answer 13

liver

Question 14

what is the acute and maintenance treatment for autoimmune hepatitis?

Answer 14

corticosteroid - acute treatment
azathioprine - maintenance treatment

Question 15

after screening for Wilson’s disease with ceruloplasmin, what is the confirmatory test?

Answer 15

24 hour copper excretion

Question 16

which AST to ALT ratio is indicative of MASLD?

Answer 16

< 0.8

Question 17

what percentage weight loss results in improvement of steatosis in MASLD?

Answer 17

3-5%

Question 18

what percentage weight loss results in improvement of fibrosis in MASLD?

Answer 18

10%

Question 19

what are the two types of drug induced liver injury?

Answer 19

intrinsic - dose dependent
idiosyncratic - may not be dose related

Question 20

how long does it take transaminase levels to normalize after cessation of the offending drug in drug induced liver injury

Answer 20

2-3 months

Question 21

in the initial evaluation of jaundice, you should perform at least what 4 lab studies?

Answer 21

CBC, CMP, GGT, and coags

Question 22

bilirubin is formed by the destruction of what cell type?

Answer 22

erythrocyte

Question 23

which type of bilirubin is water soluble?

Answer 23

conjugated bili

Question 24

where is bilirubin stored before secreation to the GI tract?

Answer 24

gallbladder

Question 25

asterixis, hepatomegaly, splenomegaly, bruising, pallor, spider angioma, palmar erythema, gynecomastia, ascites can be found in chronic cases of disease of what organ?

Answer 25

liver

Question 26

t/f elevated PT, INR and hypoalbuminemia are indicative of decompensated liver disease

Answer 26

true

Question 27

t/f AST, ALT, and AP should be treated as markers of hepatocellular injury rather than functional markers

Answer 27

true

Question 28

if you have suspicion that common bile duct obstruction could be the most likely source of jaundice, what is an appropriate first line imaging test?

Answer 28

MRCP / ERCP

Question 29

anemia, hemoglobinopathy, impaired bilirubin uptake by the liver, and red blood cell enzyme or membrane disorders can cause what type of jaundice/bilirubinemia?

Answer 29

unconjugated hyperbilirubinemia

Question 30

which enzyme activity is deficient in Gilbert syndrome?

Answer 30

bilirubin - UGT

Question 31

t/f evidence of hemolysis and elevated LFTs will be present in most cases of Gilbert disease

Answer 31

false

Question 32

cirrhosis can cause what type of bilirubinemia?

Answer 32

unconjugated (due to impaired bilirubin uptake by the liver)

Question 33

hepatocyte damage or intrahepatic cholestasis is likely to cause what type of bilirubinemia?

Answer 33

conjugated

Question 34

what syndrome is characterized by gallstones lodged in the cystic duct that cause jaundice by mechanically compressing the common hepatic duct ?

Answer 34

Mirizzi syndrome

Question 35

when do GER symptoms peak in children?

Answer 35

4 months

Question 36

infant GER typically resolves by what age?

Answer 36

1 year

Question 37

maternal elimination of what food group can be attempted as a trial treatment for GER in children?

Answer 37

dairy elimination

Question 38

what type of additive should be used in formula fed infants with GERD to reduce regurgitation and vomiting?

Answer 38

thickening agents

Question 39

t/f feeding exclusively with breast milk appears to be protective against GERD symptoms in infants

Answer 39

true

Question 40

an infant with reflux starts to experience vomiting, inconsolable crying, feeding refusal, coughing and choking. what may the diagnosis be at that point?

Answer 40

GERD

Question 41

t/f PPI trial is considered a reasonable way of diagnosing GERd in infants

Answer 41

false - not recommended due to associated comorbidity and concern for overuse of these medications

Question 42

a PPI trial of how many weeks can be used in children and adolescents for diagnosis of GERD

Answer 42

4-8 weeks

Question 43

t/f long term use of H2 blockers and PPIs in children has been linked to obesity, allergies and higher risk of fracture

Answer 43

true

Question 44

what is the treatment failure rate of non operative management with antibiotics for acute uncomplicated appendicitis ?

Answer 44

20%

Question 45

what are the two first line imaging modalities to use for a new patient presenting with jaundice as an outpatient?

Answer 45

ultrasound or CT with contrast

Question 46

what two imaging modalities may be useful for evaluation of CBD obstruction or malignant obstruction causing jaundice?

Answer 46

ERCP or MRCP

Question 47

t/f hepatitis is an INTRAhepatic cause of conjugated hyperbilirubinemia

Answer 47

true

Question 48

t/f exclusively feeding with breastmilk is considered protective for GERD

Answer 48

true

Question 49

which medication class should be used for pain from biliary colic or cholecystitis, due to trials showing equivalent pain control compared to opiates

Answer 49

nsaids

Question 50

What calculation can be useful for staging liver fibrosis in a patient with chronic Hep C infection?

Answer 50

fibrosis - 4 index

Question 51

which intervention is more effective for 1 year in the treatment of knee OA than corticosteroid injection?

Answer 51

physical therapy