CME/JAAPA

Question 1

1. What is the main reason that patients with hepatitis C do not get diagnosed or treated for their infection?
   a. Most patients become infected from transfused blood that cannot be tested for the presence of hepatitis C.
   b. Patients who abuse IV drugs are too embarrassed to seek healthcare.
   c. Most patients remain asymptomatic or spontaneously clear the virus.
   d. Current therapies are relatively ineffective, so patients do not make an effort to get diagnosed.

Answer 1

C

Question 2

2. Which statement is correct about hepatitis C screening?
   a. Because interferon-based therapies are highly effective, screening patients is more important now.
   b. The 2013 USPSTF scored hepatitis C screening with a grade A recommendation.
   c. More than 60% of primary care providers follow through with the current screening recommendations.
   d. The Affordable Care Act requires insurance companies to cover hepatitis C screening.

Answer 2

D

Question 3

3. Based on the updated criteria, which of the following patients should be screened for hepatitis C?
   a. A man of any age who used IV drugs once.
   b. A young adult who has been tattooed.
   c. A child who received an organ transplant in 2010.
   d. A woman who required blood transfusion during heart surgery in 2005.

Answer 3

A

Question 4

4. Which statement is correct about diagnostic testing for hepatitis C?
   a. Patients with evidence of cirrhosis should undergo quarterly ultrasounds of the liver.
   b. In patients who are actively drinking alcohol, fibrosis scores may be falsely elevated due to higher AST levels.
   c. Genotype testing is of no value because the treatments are non-specific.
   d. Hepatitis C RNA cannot be detected until 9 weeks after exposure to the virus.

Answer 4

B

Question 5

5. Which recommendation should be given to a patient with confirmed hepatitis C?
   a. Reduce alcohol consumption to half of the amount that was being used before diagnosis.
   b. Stop drinking coffee altogether.
   c. Follow a diet that is low in fat and simple carbohydrates.
   d. Never use acetaminophen.

Answer 5

C

Question 6

1. Which source of bleeding should you suspect in a patient
   with symptoms of GI bleeding associated with weight
   loss, anemia, weakness, dysphagia, and early satiety?
   a. malignancy
   b. esophagitis
   c. gastric ulcer
   d. duodenal ulcer

Answer 6

A

Question 7

2. Which of the following is the best intervention for con-
   trolling active upper GI bleeding?

a. NG lavage and aspiration
b. arterial embolization by interventional radiology
c. EGD
d. surgical hemostasis

Answer 7

C

Question 8

3. Which of the following pharmacologic treatments is the
   most effective in high-risk patients for decreasing the
   incidence of rebleeding?
   a. oral PPIs
   b. IV PPI bolus
   c. IV PPI bolus followed by a continuous infusion for 72 hours
   d. histamine2-blockers

Answer 8

C

Question 9

4. Which of the following is the most common cause of
upper GI bleeding?
a. peptic ulcer disease
b. Dieulafoy lesion
c. Mallory-Weiss tears
d. angiodysplasia

Answer 9

A

Question 10

5. Which of the following laboratory tests is most likely to
   be elevated in Zollinger-Ellison syndrome?
   a. gastrin
   b. amylase
   c. bilirubin
   d. gamma-glutamyl transpeptidase

Answer 10

A

Question 11

Which of the following best describes the most common cause of chronic liver disease worldwide?

a. viral hepatitis
b. alcohol overuse
c. nonalcoholic fatty liver
d. steatogenic medications

Answer 11

C

Question 12

What is the most common clinical presentation of patients with NAFLD?

a. right upper quadrant pain
b. jaundice
c. fatigue
d. asymptomatic

Answer 12

D

Question 13

which diagnostic test should be used to screen overweight and obese children age 10 years and older for NAFLD?

a. liver enzymes
b. liver biopsy
c. serum ferritin
d. liver ultrasound with xenon-133 scanning

Answer 13

A

Question 14

which diagnostic test is the standard for definitive diagnosis of NAFLD?

a. liver enzymes
b. liver biopsy
c. serum ferritin
d. liver ultrasound with xenon-133 scanning

Answer 14

B

Question 15

which treatment is recommended for all patients with NAFLD?

a. comorbid condition managment
b. statins
c. metformin
d. vitamin E

Answer 15

A

Question 16

1. What percentage of patients have a personal or family history suggesting a hereditary
colorectal cancer syndrome?
a. 5%
b. 15%
c. 25%
d. 35%

Answer 16

C

Question 17

2. According to the Amsterdam criteria, testing is recommended based on the 3-2-1 rule. What is
   the criterion for the “2” in the rule?
   a. 2 affected family members diagnosed before age 50yrs
   b. 2 generations of the family diagnosed with cancer
   c. 2 episodes of lower gastrointestinal bleeding
   d. 2 or more hyperplastic, inflammatory polyps

Answer 17

B

Question 18

3. A 32yo man is diagnosed on colonoscopy with thousands of adenomatous polyps in the colon.
   He has no family history of colon cancer or multiple polyps. What is his most likely diagnosis?
   a. Hereditary non-polyposis
   b. MUTYH-associated polyposis
   c. FAP
   d. AFAP

Answer 18

C

Question 19

Which is not a role for a genetic counselor working with a pt with hereditary colon cancer?

a. Disclose test results
b. Advise about ethical considerations of a genetic disease
c. Refer pts to psychological counseling
d. Order chemoprevention

Answer 19

D

Question 20

What is the most common tumor location for sporadic colorectal cancer?

a. Ascending colon
b. Descending colon
c. Transverse colon
d. Rectum

Answer 20

B

Question 21

Which of the following is a common extracolonic manifestation of FAP?

a. Biliary disease
b. Breast cancer
c. Osteomas
d. Sarcomas

Answer 21

C