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Exam 1: Comorbidities Affect Risk of Nonvariceal Upper Gastrointestinal Bleeding
GASTROENTEROLOGY 2013;144:e18 – e20
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES Philip S. Schoenfeld, Section Editor
CME Credits: The American Gastroenterological Association Institute (AGA Institute) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this educational 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 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 article and taking these CME examinations online at http://www.gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams.
Objectives: See article for learning objective.
Exam 1: Comorbidities Affect Risk of Nonvariceal Upper Gastrointestinal Bleeding Contact hours: 1.0 Expiration Date: June 30, 2014 Test ID No.: gastro00181
Question 1: Within a population of people who have had an upper gastrointestinal bleeding event, how should the different causes of bleeding be considered?
a. The causes of bleeding are mutually exclusive. b. A single cause of bleeding will always be clearly identifiable for each event. c. A bleeding event may have a number of underlying risk factors that together are causal. d. In the sequence of events leading to a bleed, the final cause is always the most important. e. If everyone in the population is exposed to a risk factor, that risk factor will be identifiable in the analysis.
Question 2: The current paper presents a framework of causal pathways (Figure 1). This framework was based on a search of current literature. Which of the following is therefore correct concerning the causal pathways in Figure 1?
a. Figure 1 includes all causes of upper gastrointestinal bleeding. b. Because Figure 1 is based on a literature search, it does not make a priori assumptions. c. All theoretical models will be incorrect and will therefore be of no use. d. Intermediate factors on the path from cause to effect may be omitted from the statistical model. e. Considering which causal pathways are assumed in a model does not alter the analysis.
June 2013
CME ACTIVITIES
e19
Question 3: Consider the risk factor with the highest odds ratio in an adjusted model. What proportion of cases in the population will be attributed to that risk factor?
a. It depends on the proportion exposed to the risk factor in the population. b. The smallest proportion of cases in the population. c. The greatest proportion of cases in the population. d. It is not possible to estimate the proportion of cases attributable to a risk factor. e. It depends on the biological mechanism.
Question 4: The effect of comorbidity on the risk of upper gastrointestinal bleeding was large in the current study. Which of the following is a plausible explanation for this?
a. The prescribing of medications for comorbidity that are known to increase the risk of bleeding. b. Sicker patients are more likely to have an upper gastrointestinal bleed. c. A particular comorbidity is probably responsible. d. People with more comorbidities are likely to be older. e. The effect was only found with non-peptic ulcer bleeds
Question 5: An elderly lady is admitted to gastroenterology with an upper gastrointestinal bleed. She undergoes successful upper gastrointestinal endoscopy and receives dual therapy to treat a visible vessel in a posterior duodenal ulcer. She does not take any medication that increases the risk of bleeding apart from low-dose aspirin, which she has taken for many years for ischemic heart disease secondary prevention. A rapid urease test was negative. She has no further rebleeding and after finishing her infusion of a high-dose intravenous proton pump inhibitor, she is ready for discharge. What is the most appropriate next step?
a. b. c. d. e.
Stop her aspirin. Reassess her comorbidity. Change her aspirin to clopidogrel. Make no changes. Make an urgent referral to a cardiologist.
Exam 2: Incidence, Presentation, and Outcomes in Patients With Drug-Induced Liver Injury in the General Population of Iceland Test ID No.: gastro00182
Contact hours: 1.0
Expiration Date: June 30, 2014
Question 1: A few large studies on patients with jaundice owing to DILI have shown similar proportion of patients who die from liver disease or require liver transplantation. Which is this proportion approximately?
a. b. c. d. e.
50%. 1%. 10%. 100%. 30%.
a. b. c. d. e.
Nonsteroidal anti-inflammatory drugs. Anti-epileptics. Antibiotics. Herbal drugs and dietary supplements. Cardiovascular drugs.
Question 2: What is the most common type of drugs associated with idiosyncratic DILI?
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES Philip S. Schoenfeld, Section Editor
CME Credits: The American Gastroenterological Association Institute (AGA Institute) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this educational 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 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 article and taking these CME examinations online at http://www.gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams.
Objectives: See article for learning objective.
Exam 1: Comorbidities Affect Risk of Nonvariceal Upper Gastrointestinal Bleeding Contact hours: 1.0 Expiration Date: June 30, 2014 Test ID No.: gastro00181
Question 1: Within a population of people who have had an upper gastrointestinal bleeding event, how should the different causes of bleeding be considered?
a. The causes of bleeding are mutually exclusive. b. A single cause of bleeding will always be clearly identifiable for each event. c. A bleeding event may have a number of underlying risk factors that together are causal. d. In the sequence of events leading to a bleed, the final cause is always the most important. e. If everyone in the population is exposed to a risk factor, that risk factor will be identifiable in the analysis.
Question 2: The current paper presents a framework of causal pathways (Figure 1). This framework was based on a search of current literature. Which of the following is therefore correct concerning the causal pathways in Figure 1?
a. Figure 1 includes all causes of upper gastrointestinal bleeding. b. Because Figure 1 is based on a literature search, it does not make a priori assumptions. c. All theoretical models will be incorrect and will therefore be of no use. d. Intermediate factors on the path from cause to effect may be omitted from the statistical model. e. Considering which causal pathways are assumed in a model does not alter the analysis.
June 2013
CME ACTIVITIES
e19
Question 3: Consider the risk factor with the highest odds ratio in an adjusted model. What proportion of cases in the population will be attributed to that risk factor?
a. It depends on the proportion exposed to the risk factor in the population. b. The smallest proportion of cases in the population. c. The greatest proportion of cases in the population. d. It is not possible to estimate the proportion of cases attributable to a risk factor. e. It depends on the biological mechanism.
Question 4: The effect of comorbidity on the risk of upper gastrointestinal bleeding was large in the current study. Which of the following is a plausible explanation for this?
a. The prescribing of medications for comorbidity that are known to increase the risk of bleeding. b. Sicker patients are more likely to have an upper gastrointestinal bleed. c. A particular comorbidity is probably responsible. d. People with more comorbidities are likely to be older. e. The effect was only found with non-peptic ulcer bleeds
Question 5: An elderly lady is admitted to gastroenterology with an upper gastrointestinal bleed. She undergoes successful upper gastrointestinal endoscopy and receives dual therapy to treat a visible vessel in a posterior duodenal ulcer. She does not take any medication that increases the risk of bleeding apart from low-dose aspirin, which she has taken for many years for ischemic heart disease secondary prevention. A rapid urease test was negative. She has no further rebleeding and after finishing her infusion of a high-dose intravenous proton pump inhibitor, she is ready for discharge. What is the most appropriate next step?
a. b. c. d. e.
Stop her aspirin. Reassess her comorbidity. Change her aspirin to clopidogrel. Make no changes. Make an urgent referral to a cardiologist.
Exam 2: Incidence, Presentation, and Outcomes in Patients With Drug-Induced Liver Injury in the General Population of Iceland Test ID No.: gastro00182
Contact hours: 1.0
Expiration Date: June 30, 2014
Question 1: A few large studies on patients with jaundice owing to DILI have shown similar proportion of patients who die from liver disease or require liver transplantation. Which is this proportion approximately?
a. b. c. d. e.
50%. 1%. 10%. 100%. 30%.
a. b. c. d. e.
Nonsteroidal anti-inflammatory drugs. Anti-epileptics. Antibiotics. Herbal drugs and dietary supplements. Cardiovascular drugs.
Question 2: What is the most common type of drugs associated with idiosyncratic DILI?