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CME Activities—Exams 1 and 2
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2013;11:e66 – e67
CME Activities–Exams 1 and 2 CME Credits: The AGA Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any relevant financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant articles and taking these CME examinations online at http://www.cghjournal. org/content/cme. Answers can be obtained online after completing the exam(s).
Objectives: See article for specific learning objective.
September 2013
CME ACTIVITIES
e67
Exam 1: Coagulation in Liver Disease: A Guide for the Clinician Test ID No.: 0183
Contact Hours: 1.0
Expiration Date: September 30, 2014
Question 1. Chronic liver disease is associated with pathophysiologic disruptions in hemostasis that are effectively rebalanced by compensatory changes. Which of the following is a typical change in the hemostatic system associated with advanced chronic liver disease?
a. b. c. d. e.
Increased Increased Increased Increased Increased
levels of coagulation proteins II, VII, IX, X levels of von Willebrand factor circulating platelet counts thrombopoietin levels protein C levels
Question 2. Which of the following statements concerning the international normalized ratio (INR) is true?
a. The INR was originally developed in the 1980s for standardization of assessment of coagulation in liver disease b. There is minimal intra-laboratory variability in INR measurements in patients with cirrhosis c. INR values are strongly inversely associated with 90-day survival on the liver transplant waiting list d. INR values between 1.5⫺2.0 are strongly predictive of increased procedural bleeding in patients with cirrhosis
Question 3. Which of the following clinical practices has shown benefit in randomized controlled clinical trials?
a. Transfusion of FFP to obtain an INR less than 1.5 for prophylactic esophageal variceal band ligation in outpatients b. Therapeutic anticoagulation with low molecular weight heparin in cirrhosis patients with thrombosis and cavernous transformation of the portal vein c. Transfusion of platelet concentrates to obtain a blood level greater than 100 ⫻ 109/L in patients with acute variceal bleeding d. The use of intranasal desmopressin prior to dental extractions to prevent procedural bleeding in patients with cirrhosis e. Maintaining hemoglobin levels between 9⫺10 g/dL in acute gastrointestinal bleeding in cirrhosis patients
Question 4. Which of the following laboratory tests gives diagnostic information on all 3 phases of hemostasis (primary hemostasis, coagulation, and fibrinolysis)?
a. b. c. d. e.
Euglobulin lysis time Bleeding time Endogenous thrombin potential Fibrinogen level Thromboelastography
CME Activities–Exams 1 and 2 CME Credits: The AGA Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any relevant financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant articles and taking these CME examinations online at http://www.cghjournal. org/content/cme. Answers can be obtained online after completing the exam(s).
Objectives: See article for specific learning objective.
September 2013
CME ACTIVITIES
e67
Exam 1: Coagulation in Liver Disease: A Guide for the Clinician Test ID No.: 0183
Contact Hours: 1.0
Expiration Date: September 30, 2014
Question 1. Chronic liver disease is associated with pathophysiologic disruptions in hemostasis that are effectively rebalanced by compensatory changes. Which of the following is a typical change in the hemostatic system associated with advanced chronic liver disease?
a. b. c. d. e.
Increased Increased Increased Increased Increased
levels of coagulation proteins II, VII, IX, X levels of von Willebrand factor circulating platelet counts thrombopoietin levels protein C levels
Question 2. Which of the following statements concerning the international normalized ratio (INR) is true?
a. The INR was originally developed in the 1980s for standardization of assessment of coagulation in liver disease b. There is minimal intra-laboratory variability in INR measurements in patients with cirrhosis c. INR values are strongly inversely associated with 90-day survival on the liver transplant waiting list d. INR values between 1.5⫺2.0 are strongly predictive of increased procedural bleeding in patients with cirrhosis
Question 3. Which of the following clinical practices has shown benefit in randomized controlled clinical trials?
a. Transfusion of FFP to obtain an INR less than 1.5 for prophylactic esophageal variceal band ligation in outpatients b. Therapeutic anticoagulation with low molecular weight heparin in cirrhosis patients with thrombosis and cavernous transformation of the portal vein c. Transfusion of platelet concentrates to obtain a blood level greater than 100 ⫻ 109/L in patients with acute variceal bleeding d. The use of intranasal desmopressin prior to dental extractions to prevent procedural bleeding in patients with cirrhosis e. Maintaining hemoglobin levels between 9⫺10 g/dL in acute gastrointestinal bleeding in cirrhosis patients
Question 4. Which of the following laboratory tests gives diagnostic information on all 3 phases of hemostasis (primary hemostasis, coagulation, and fibrinolysis)?
a. b. c. d. e.
Euglobulin lysis time Bleeding time Endogenous thrombin potential Fibrinogen level Thromboelastography