MKSAP 18- GI and Hepatology 100% Correct Review Solution A+

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MKSAP 18- GI and Hepatology 100% Correct Review Solution A+ ___ is a peripherally acting μ-opioid receptor antagonist that is FDA-approved for the treatment of opioid-induced constipation in adults with chronic noncancer pain. - Correct Ans-*Naloxegol* (oral) - if starting naloxegol, stop current maintenance laxative before initiation of naloxegol and can be added to the naloxegol after 3 days of mono therapy as needed methylnatrexone, naloxegol, alvimopan have been approved for opiod-induced constipation Patient has hepatitis B virus infection from birth. + Hep B surface antigen + Hep B e antigen HBV DNA 20,000,000 IU/mL AST and ALT are normal Next step? Treat or Liver US or Repeat liver chemistry in 6 months? - Correct Ans-Patients with hepatitis B infection in the immune-tolerant phase require serial monitoring of aminotransferase levels, *repeat liver chemistry in 6 months* Hepatitis B virus, positive hep B e antigen (HbeAg), high viral load, normal AST/ALT - serial monitoring Antiviral therapy: acute liver failure, cirrhosis, if undergoing treatment with immunosuppressive or chemo regiments, immune-active phase, HBeAg-positive and reactivation Which characteristics are associated with an increased risk for HCC in patients with hepatitis B infection and indication for surveillance with US or cross-sectional imaging every 6 month? - Correct Ans-1. Cirrhosis 2. Asian descent plus male sex plus age older than 40 3. Asian descent plus female sex plus age older than 50 4. Sub-saharan african descent plus age older than 20 5. Persistent inflammatory activity (elevated ALT and HBV DNA level > 10,000 IU/mL for few years 6. Family history of HCC Treatment thresholds for hepatitis B? - Correct Ans-ALT level 2x ULN HBV DNA level 20,000 IU/mL (HBeAg-positive, immune active phase) HBV DNA at least 2000 IU/mL (HBeAg-negative, reactivation phase) first line: entecavir or tenofovir pegylated interferon for 48 weeks in patients with high ALT levels, low HBV DNA levels, without cirrhosis (finite therapy, not pregnant, no psych disease, cardiac dx, sz, cytopenia, or autoimmune disease) Patient is having a colonoscopy with polypectomy when to stop aspirin? - Correct Ans-*Do not discontinue aspirin* Aspirin for secondary pox in patient with CV disease should be continued after colonoscopy with polypectomy d/c aspirin after polypectomy in patients without CV disease 48 year old female with AST 74, ALT 85, + Anti-smooth muscle antibody, DM2, HTN, BMI 31. CONTINUES...

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