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Continuing Medical Examination Exam 3: October 2006
October 2006
CME ACTIVITY
1285
Exam 2: Norfloxacin Versus Ceftriaxone in the Prophylaxis of Infections in Patients With Advanced Cirrhosis and Hemorrhage Fernández et al, Authors Test ID No.: gast0034
Contact hours: 1
Expiration Date: October 31, 2007
Question 1: This study suggests which of the following for management of infectious complication of acute variceal hemorrhage?
a. Norfloxacin is superior to ceftriaxone for prevention of infection. b. Cetriaxone is superior to norfloxacin for prevention of infection. c. Ceftriaxone and norfloxacin are equivalent for prevention of infection. d. Antibiotics improve survival in the setting of acute variceal hemorrhage.
Question 2: This study suggests that the cause of antibiotic failure in acute variceal hemorrhage is:
a. b. c. d.
Poor intra-ascites concentrations of antibiotics. Development of antibiotic-resistant organisms. Poor compliance with use of antibiotics. Nonbacteriocidal activity of the antibiotics used in this study.
a. b. c. d.
Failure to use appropriate antibiotic prophylaxis. Blood transfusion requirements. Mean arterial pressure. All of the above.
Question 3: Factors associated with an increased risk of infectious complications of acute variceal hemorrhage include:
Exam 3: AGA Institute Technical Review: Endoscopic Therapy of Gastroesophageal Reflux Disease Falk et al, Authors Test ID No.: gast0035
Contact hours: 1
Expiration Date: October 31, 2007
Question 1: Trials of endoscopic therapy of gastroesophageal reflux disease (GERD) have studied primarily what type of GERD patients?
a. Uncomplicated GERD refractory to proton pump inhibitor (PPI) therapy. b. Uncomplicated GERD responsive to PPI therapy. c. Barrett’s esophagus. d. Extraesophageal manifestations of GERD. e. GERD patients with failed antireflux therapy.
1286
CME ACTIVITY
GASTROENTEROLOGY Vol. 131, No. 4
Question 2: What is the hypothesized mechanism of action of radiofrequency ablation therapy for GERD?
a. b. c. d. e.
Narrowing of the gastroesophageal junction. An increase in lower esophageal sphincter (LES) pressure. Decrease in number of transient LES relaxations. Decrease in proximal migration of the refluxate. Unknown mechanism.
a. b. c. d. e.
Heartburn score. PPI use. 24-Hour esophageal acid exposure. LES pressure. Esophagitis grade.
Question 3: In the randomized, sham-controlled study by Corley et al that compared radiofrequency ablation to sham therapy, which of the following endpoints of the study were improved by radiofrequency ablation?
Question 4: The mechanism of action of ethylene vinyl alcohol copolymer (Enteryx) as a reflux therapy has been shown to be:
a. Narrowing of the esophagogastric junction forming a mechanical barrier to reflux. b. A decrease in the number of transient LES relaxations resulting in reflux events. c. An increase in LES pressure. d. A decrease sensitivity to esophageal acid exposure. e. Unknown.
Question 5: In controlled clinical trials of ethylene vinyl alcohol copolymer therapy for reflux, the difference in discontinuation of PPI use between actively treated versus sham-treated patients was approximately:
a. b. c. d. e.
10%. 30%. 50%. 70%. 90%.
a. b. c. d. e.
90%–95%. 70%–75%. 60%– 65%. 40%–50%. 30% or less.
Question 6: Data from the various trials of endoscopic gastric plication therapy for GERD using the Bard EndoCinch device have shown an ability to normalize the distal esophageal acid exposure about:
Question 7: A healthy, 25-year-old graduate student with daily uncomplicated heartburn, responsive to PPI medication, comes for consultation about endoscopic treatment of his symptoms. He has been searching on-line and reviewing different endoscopic devices and techniques because he does not want the expense of long-term acid-suppressing medications, and he is not interested in surgical intervention. He wants to know what his response rate will likely be based on the results from the trials of the NDO Plicator. You are able to tell him that:
a. NDO Plicator treatment can be done whatever size his hiatal hernia may be. b. He can expect about a 70% likelihood to be off his PPI medications 1 year out from treatment. c. He can expect that he has a 90% chance to be off his acid-suppressing medications at 1 year following a single full-thickness plication. d. The likelihood that his distal esophageal acid exposure will normalize is about 60%. e. The mechanism of action of the NDO plicator is known to be from reduction of transient LES relaxations.
CME ACTIVITY
1285
Exam 2: Norfloxacin Versus Ceftriaxone in the Prophylaxis of Infections in Patients With Advanced Cirrhosis and Hemorrhage Fernández et al, Authors Test ID No.: gast0034
Contact hours: 1
Expiration Date: October 31, 2007
Question 1: This study suggests which of the following for management of infectious complication of acute variceal hemorrhage?
a. Norfloxacin is superior to ceftriaxone for prevention of infection. b. Cetriaxone is superior to norfloxacin for prevention of infection. c. Ceftriaxone and norfloxacin are equivalent for prevention of infection. d. Antibiotics improve survival in the setting of acute variceal hemorrhage.
Question 2: This study suggests that the cause of antibiotic failure in acute variceal hemorrhage is:
a. b. c. d.
Poor intra-ascites concentrations of antibiotics. Development of antibiotic-resistant organisms. Poor compliance with use of antibiotics. Nonbacteriocidal activity of the antibiotics used in this study.
a. b. c. d.
Failure to use appropriate antibiotic prophylaxis. Blood transfusion requirements. Mean arterial pressure. All of the above.
Question 3: Factors associated with an increased risk of infectious complications of acute variceal hemorrhage include:
Exam 3: AGA Institute Technical Review: Endoscopic Therapy of Gastroesophageal Reflux Disease Falk et al, Authors Test ID No.: gast0035
Contact hours: 1
Expiration Date: October 31, 2007
Question 1: Trials of endoscopic therapy of gastroesophageal reflux disease (GERD) have studied primarily what type of GERD patients?
a. Uncomplicated GERD refractory to proton pump inhibitor (PPI) therapy. b. Uncomplicated GERD responsive to PPI therapy. c. Barrett’s esophagus. d. Extraesophageal manifestations of GERD. e. GERD patients with failed antireflux therapy.
1286
CME ACTIVITY
GASTROENTEROLOGY Vol. 131, No. 4
Question 2: What is the hypothesized mechanism of action of radiofrequency ablation therapy for GERD?
a. b. c. d. e.
Narrowing of the gastroesophageal junction. An increase in lower esophageal sphincter (LES) pressure. Decrease in number of transient LES relaxations. Decrease in proximal migration of the refluxate. Unknown mechanism.
a. b. c. d. e.
Heartburn score. PPI use. 24-Hour esophageal acid exposure. LES pressure. Esophagitis grade.
Question 3: In the randomized, sham-controlled study by Corley et al that compared radiofrequency ablation to sham therapy, which of the following endpoints of the study were improved by radiofrequency ablation?
Question 4: The mechanism of action of ethylene vinyl alcohol copolymer (Enteryx) as a reflux therapy has been shown to be:
a. Narrowing of the esophagogastric junction forming a mechanical barrier to reflux. b. A decrease in the number of transient LES relaxations resulting in reflux events. c. An increase in LES pressure. d. A decrease sensitivity to esophageal acid exposure. e. Unknown.
Question 5: In controlled clinical trials of ethylene vinyl alcohol copolymer therapy for reflux, the difference in discontinuation of PPI use between actively treated versus sham-treated patients was approximately:
a. b. c. d. e.
10%. 30%. 50%. 70%. 90%.
a. b. c. d. e.
90%–95%. 70%–75%. 60%– 65%. 40%–50%. 30% or less.
Question 6: Data from the various trials of endoscopic gastric plication therapy for GERD using the Bard EndoCinch device have shown an ability to normalize the distal esophageal acid exposure about:
Question 7: A healthy, 25-year-old graduate student with daily uncomplicated heartburn, responsive to PPI medication, comes for consultation about endoscopic treatment of his symptoms. He has been searching on-line and reviewing different endoscopic devices and techniques because he does not want the expense of long-term acid-suppressing medications, and he is not interested in surgical intervention. He wants to know what his response rate will likely be based on the results from the trials of the NDO Plicator. You are able to tell him that:
a. NDO Plicator treatment can be done whatever size his hiatal hernia may be. b. He can expect about a 70% likelihood to be off his PPI medications 1 year out from treatment. c. He can expect that he has a 90% chance to be off his acid-suppressing medications at 1 year following a single full-thickness plication. d. The likelihood that his distal esophageal acid exposure will normalize is about 60%. e. The mechanism of action of the NDO plicator is known to be from reduction of transient LES relaxations.