Whether you’re preparing for an ABIM exam or updating your knowledge so you can deliver the best patient care, DDSEP Plus can help you achieve your educational goals. Test your knowledge below with practice exam questions! These are a sample of nearly 900 questions you can access with an annual subscription.
Practice question #1
A 60-year-old woman presents with abdominal pain, nausea and weight loss. Endoscopy is performed and shows active gastritis with a duodenal ulcer.
Biopsies show Helicobacter pylori (H. pylori) infection and she is treated with quadruple therapy. She returns to the clinic for follow-up two months later and reports feeling well with no residual symptoms. She has stopped the proton pump inhibitors (PPI) and reports infrequent pyrosis.
What is the best next step?
A. Endoscopy with gastric biopsies
B. H. pylori stool antigen
C. Serum H. pylori IgG
D. Resume PPI therapy
Correct answer:
B. H. pylori stool antigen
Commentary
Guidelines recommend confirmation of eradication of H. pylori, given that it is associated with increased risks of gastric cancer. Numerous tests exist to evaluate for potential H. pylori infection, and these tests have their pros and cons. Urease breath test and H. pylori stool antigen evaluation, when performed off PPI therapy, are both believed to have greater than 95% sensitivity and would be the best options to test for eradication.
Serology is specific for H. pylori exposure but does not differentiate between active and prior infection and would not be appropriate in this case. Biopsies for histopathology of H. pylori are invasive and should only be done if there is another indication for endoscopy. In this situation, in which the patient feels well after treatment and the ulcer was in the duodenum (not the stomach), there is no indication for repeat endoscopy. Given the patient feels well and has a known cause of peptic ulcer disease (H. pylori infection), there is no reason to resume PPI therapy. Her infrequent pyrosis may be treated with as needed therapy (H2RB or antacids).
Practice question #2
A 24-year-old man with newly diagnosed primary sclerosing cholangitis (PSC) presents for initial consultation. His past medical history is unremarkable. He feels well and has no specific complaints.
His aspartate aminotransferase, alanine aminotransferase, total bilirubin, albumin, international normalized ratio, and platelet count are all normal. His alkaline phosphatase is elevated to 347 U/L (reference range, 30-120 U/L).
Magnetic resonance cholangiopancreatography does not show any extrahepatic biliary dilation, but his intrahepatic ducts are dilated in the secondary and tertiary radicles.
Which of the following do you recommend for further management of this patient?
A. Colonoscopy
B. Endoscopic retrograde cholangiopancreatography with sphincterotomy and stenting
C. Liver biopsy
D. Ursodeoxycholic acid at 30 mg daily
Correct answer:
A. Colonoscopy
Commentary
Because PSC is strongly associated with inflammatory bowel disease (IBD), a full colonoscopy with biopsies should be performed in all patients with a new diagnosis of PSC and no previous history of symptoms of IBD.
Moreover, if a diagnosis of IBD is made, surveillance colonoscopy with biopsies should be performed every 1-2 years from the time of PSC diagnosis given the increased risk of colorectal cancer.
Liver biopsy is rarely clinically useful in patients with PSC as the biopsy can be made based on laboratory testing and imaging in most cases. ERCP with sphincterotomy and stenting is unlikely to be of use in small-duct PSC.
Ursodeoxycholic acid does not impact the natural history of PSC.
Moreover, it can be harmful in higher doses (28-30 mg daily) and is not recommended in the treatment of PSC, even for the chemoprevention of colorectal cancer in patients with PSC and IBD.
