Gastroenterology

Question 1

Therapy for PBC with evidence?

Answer 1

Ursodeoxycholic acid, obeticholic acid, fibrates

Question 2

What is the mechanism of obeticholic acid?

Answer 2

farnesoid X receptor - synthetic bile acid, 2nd line therapy for PBC

Question 3

Obeticholic acid causes what weird side effect?

Answer 3

Pruritus in ~60%!

Question 4

Histologic features of PBC?

Answer 4

Periportal fibrosis

Question 5

What is a good prognostic sign for PBC?

Answer 5

Asymptomatic disease

Question 6

Feature of autoimmune hepatitis?

Answer 6

Peri‐portal hepatitis

Question 7

What does PSC affect?

Answer 7

Mainly large ducts, biliary tree

Question 8

Type 2 autoimmune hepatitis?

Answer 8

Anti-LKM antibodies, worse prognosis

Question 9

PSC strictures should be managed how?

Answer 9

With ballooning rather than stenting

Question 10

Most common type of renal stone in Crohn’s disease?

Answer 10

Calcium oxalate stones - ileal resection/ileitis leads to non-absorbed fatty acids/bile salts; fat binds calcium, leaving oxalate unbound; unbound oxalate delivered to colon where it is readily absorbed
Tx: low oxalate diet, calcium supplements

Question 11

HBV drug in HIV coinfection

Answer 11

Tenofovir + emtricitabine or lamivudine

Question 12

HBV treatment in pregnancy or planning

Answer 12

Tenofovir

Question 13

Planning to eradicate virus prior to pregnancy

Answer 13

Peg-IFN - shorter duration of therapy and slightly greater rates of eAg negativity

Question 14

HBeAg+ chronic hepatitis HBV tx

Answer 14

Entecavir/tenofovir 12 months after HBeAg seroconversion, or long term

Or Peg-IGN 48 weeks

Question 15

Decompensated cirrhosis HBV tx

Answer 15

Entecavir/tenofovir

Question 16

HBeAg negative chronic hepatitis HBV tx

Answer 16

entecavir/tenofovir long term unless HBsAg seroconversion (rare) or Peg-IFN for 48 weeks

Question 17

HBV treatment in renal insufficiency

Answer 17

Entecavir with dose reduction