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Hepatitis B Screening

Universal one-time screening of all adults in Canada for hepatitis B is recommended.

  • True
  • False
Volume 41.3 - Question 20

Alcohol-Associated Hepatitis

Which one of the following statements regarding alcohol-associated hepatitis is false?

  • About 50% of patients have underlying cirrhosis and may have co-existing decompensation.
  • Corticosteroids improve 1-year mortality.
  • There is benefit from high-protein and high-calorie diets with vitamin B and D supplementation.
  • Transplantation improves survival.
Volume 39.3 - Question 29

Hepatitis C

Which one of the following statements about hepatitis C is false?

  • Most patients with hepatitis C are asymptomatic.
  • Globally, less than 5% of patients with hepatitis C have been diagnosed.
  • Undetectable HCV RNA 12 weeks after treatment is considered a virologic cure.
  • All patients need liver-specific follow-up.
Volume 37.3 - Question 22

Hepatitis B in Children

Which one of the following statements about hepatitis B in children is false? 

  • The World Health Organization recommends hepatitis B vaccination at birth.     
  • Third trimester antivirals are recommended for HBsAg positive women with high viral loads to reduce the risk of vertical transmission.   
  • Neonates are less likely to spontaneously clear hepatitis B infections compared to adults.   
  • Vaccinating at birth is associated with waning of immunity in adulthood compared to vaccinating in adolescence. 
Volume 36.3 - Question 14

Alcohol-Associated Hepatitis

Which one of the following statements about alcohol-associated hepatitis is false?

  • Glucocorticoids can improve long-term survival.
  • Women are more susceptible to alcohol injury.
  • Mortality from moderate disease is up to 20% at one year.
  • The use of alcohol anticraving drugs has not been rigorously tested in the context of alcohol-associated hepatitis.
Volume 38.3 - Question 23

Diagnosis and Management of Celiac Disease

A 7-year-old boy comes in to see you accompanied by his mother. For the last 6 months, he has appeared increasingly tired and complained of headaches. She would like him to be tested for celiac disease. She herself was diagnosed with this around his age as were her siblings
Volume 41.3 - Question 34

Metabolic Dysfunction-Associated Steatotic Liver Disease

Which one of the following statements about metabolic dysfunction-associated steatotic liver disease (MASLD) is false?

  • Weight loss of at least 10% is needed to reduce liver fibrosis.
  • Semaglutide has been shown to exert hepatoprotective effects.
  • SGLT2 inhibitors do not have hepatoprotective effects.
  • No liver-directed pharmacotherapies are available for the treatment of MASLD-related cirrhosis.
Volume 41.1 - Question 32

Steatotic Liver Disease in the Office

Phosphatidylethanol is a biomarker which may identify moderate or heavy alcohol consumption in the past 3 to 4 weeks.

  • True
  • False
Volume 40.5 - Question 29

Statin Use and Risk of Hepatocellular Carcinoma

In patients 40 years or older with chronic liver disease and a baseline Fibrosis-4 (FIB-4) score of 1.3 or higher, statin use is significantly associated with a reduced risk of incident hepatocellular carcinoma.

  • True
  • False
Volume 40.5 - Question 26

Steatotic Liver Disease

Weight loss of more than 10% in people who have metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with an improvement in fibrosis.

  • True
  • False
Volume 40.4 - Question 34

Alcohol Use Disorder

Which one of the following statements about alcohol use disorder (AUD) is false?

  • Less than 50% of people in Canada aged 15 years or older currently drink more than the amount recommended in Canada’s Guidance on Alcohol and Health.
  • A recommended first screening question is ‘How many times in the past year have you had 5 or more drinks on one occasion (for males) or 4 or more drinks on one occasion (for females).
  • Acamprosate is recommended as a first line pharmacotherapy in moderate to severe AUD.
  • Naltrexone is contraindicated when the patient has acute hepatitis.
Volume 40.1 - Question 6

Non-Alcoholic Fatty Liver Disease

In patients with Type 2 Diabetes and Non-Alcoholic Fatty Liver Disease, which one of the following statements regarding treatment with oral antidiabetic drugs is false?

  • Thiazolidinediones restore lowered plasma adiponectin levels in patients with nonalcoholic steatohepatitis.
  • Sodium-glucose cotransporter 2 inhibitors might be preferred over other oral antidiabetic drugs with respect to nonalcoholic fatty liver disease regression.
  • Dipeptidyl peptidase-4 (DPP-4) inhibitors are not significantly associated with weight change.
  • DPP-4 inhibitors are significantly associated with a lower incidence of adverse liver-related outcomes when compared with sulfonylureas.
Volume 39.6 - Question 40

Surgical Care for People Experiencing Homelessness

Of the few people experiencing homelessness who presented with early stage lung cancer, most (80%) received curative surgery and all completed follow up with no recurrences or deaths.     

  • True
  • False
Volume 39.5 - Question 28

HIV Prevention

Post-exposure prophylaxis-in-pocket is an HIV prevention strategy targeted to those who have lower frequencies (i.e., 0 to 4) of higher-risk, and typically unanticipated, HIV exposures per year.

  • True
  • False
Volume 39.5 - Question 1

Pharmacotherapy for Alcohol Use Disorder

Which one of the following statements about pharmacotherapy for alcohol use disorder is false? 

  • Acamprosate is associated with higher incidence of diarrhea compared with placebo.   
  • Evidence regarding the effectiveness of gabapentin is stronger than other pharmacotherapy options.   
  • Oral naltrexone dosing is more convenient than acamprosate dosing.   
  • Acamprosate requires dose adjustment for patients with moderate kidney impairment. 
Volume 39.4 - Question 16

DRESS Syndrome

A 54-year-old female presents to your rural emergency department with a complaint of a new rash. She has a history of gout and has been started on allopurinol over the last few months.  She has a diffuse morbiliform rash, is febrile, and is found to have elevated LFTs and eosinophils. You suspect drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. 
Volume 38.21 - Question 18

Acne

Which one of the following statements about the treatment of acne is false?

  • Concurrent application of dapsone and benzoyl peroxide can cause temporary yellow or orange discoloration of the skin and facial hair.
  • Concurrent application of tretinoin and benzoyl peroxide is recommended.
  • Drug-induced lupus and autoimmune hepatitis can occur with long-term use of minocycline.
  • Spironolactone is used off-label to treat acne in post-pubertal females.
Volume 39.3 - Question 37

Naltrexone

Which one of the following statements about naltrexone is false?

  • It is approved for treatment of alcohol dependence.
  • It is used for treatment of opioid use disorder.
  • Severe hepatotoxicity has occurred with high doses.
  • It can decrease the effects of cannabinoids.
Volume 37.3 - Question 29

SAMP Crohn Disease

20 year old BA presents with intermittent abdominal pain, fever, weight loss and diarrhea. She has been seen several times in the ER and has been tried on “celiac and a FODMAP” diet with no consistent effect. There is no rectal bleeding.  You consider the possibility of Crohn disease and organize further investigations. 
Volume 36.5 - Question 46

Nonalcoholic Fatty Liver Disease

A 35-year-old patient is at your office today because he is experiencing fatigue and right upper abdominal fullness recently. He rarely drinks alcohol and he is wondering if he has nonalcoholic fatty liver disease (NAFLD). 
Volume 36.3 - Question 42

Systemic Acne Therapy

Which one of the following statements about systemic acne therapy is false? 

  • Autoimmune hepatitis can occur with long-term use of minocycline.   
  • Minocycline may have a deleterious effect on spermatogenesis.   
  • Resistance is reported less frequently with erythromycin than tetracyclines.   
  • Trimethoprim/sulfamethoxazole should only be used when other antibiotics are ineffective. 
Volume 36.3 - Question 37

Acute Liver Failure

N-acetylcysteine improves overall survival in the treatment of non-acetaminophen-related acute liver injury. 

  • True
  • False
Volume 36.3 - Question 33

Cytomegalovirus Infection in Pregnancy

Which one of the following statements about Cytomegalovirus (CMV) infection in pregnancy is false?

  • Pregnant patients with a mononucleosis-like illness should be investigated for CMV infection.
  • The most common neurological sequelae of Congenital CMV (cCMV) is sensorineural hearing loss.
  • Risk of long-term sequelae for the infant is directly proportional to the gestational age at which cCMV is acquired.
  • Risk of CMV transmission to the fetus increases proportionally with the gestational age at which the mother is infected.
Volume 37.2 - Question 7

Hashimoto Thyroiditis

Which one of the following statements about Hashimoto thyroiditis is false?

  • It may present with other autoimmune disorders.
  • It often presents with a painless goiter, with or without overt hypothyroidism.
  • Thyroid peroxidase antibodies are found in 95% of patients.
  • Only symptomatic patients require treatment.
Volume 37.4 - Question 30

Type II DM and Fibrosis

In patients with type II diabetes mellitus, ALT/AST levels are adequate screening investigations for liver fibrosis.

  • True
  • False
Volume 37.4 - Question 10

Pre-Exposure Prophylaxis for HIV

A 32-year-old male presents to your office for a “check-up.” At the visit, he mentions that he has just returned from a trip to “P-town” and would like to have some STI testing. As you discuss further with him, he explains that Provincetown, Massachusetts is a popular location for gay men to visit, and while there, he had a couple of new sexual partners. At your visit today, he also mentions that he met a few people using “PrEP,” and is wondering whether he, too, should be on it. 
Volume 38.1 - Question 39

DRESS Syndrome

A 54-year-old female presents to your rural emergency department with a complaint of a new rash. She has a history of gout and has been started on allopurinol over the last few months.  She has a diffuse morbiliform rash, is febrile, and is found to have elevated LFTs and eosinophils. You suspect drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. 
Volume 38.1 - Question 37

Ezetimibe

Which one of the following statements about ezetimibe is false?

  • It reduces low-density lipoprotein (LDL) cholesterol levels by about 20-25%.
  • The incidence of adverse events with ezetimibe plus a statin was similar to that with a statin alone.
  • Patients with moderate liver impairment can take it.
  • It may increase the anticoagulant effect of warfarin.
Volume 38.2 - Question 26

HIV Pre-Exposure Prophylaxis

Your next patient is 28 years old and new to your family practice. He has no known medical problems and considers himself healthy. During your visit, he confirms that he has sex with other men (MSM).   You question the patient’s HIV risk and after careful assessment, you consider that pre-exposure prophylaxis (PrEP) is indicated. The patient has never heard of PrEP and is unsure if it could be useful.
Volume 37.5 - Question 41

Bullous Pemphigoid

Which one of the following statements about bullous pemphigoid due to dipeptidyl-peptidase 4 (DPP4) inhibitors is false?

  • Median onset time from DPP4 inhibitor commencement is 11 months.
  • Skin biopsy is required for diagnosis.
  • Clinically, lesions are more widespread than traditionally described bullous pemphigoid.
  • Most patients with moderate to severe cases are sufficiently treated by potent topical corticosteroids.
Volume 37.5 - Question 29

Drugs for Inflammatory Bowel Disease

Which one of the following statements about drugs for treatment of ulcerative colitis (UC) is false? 

  • Oral aminosalicylates are effective for induction and maintenance of remission in mild UC. 
  • Corticosteroids can be used for maintenance of remission. 
  • In moderate to severe disease, early use of a biologic drug is recommended. 
  • Tumor necrosis factor inhibitors are effective for induction and maintenance of remission. 
Volume 39.1 - Question 36

Liver Disease and Diet

In postmenopausal women, there is a statistically significant association between increased sugar-sweetened beverage intake and chronic liver disease mortality. 

  • True
  • False
Volume 39.1 - Question 35

Infectious Mononucleosis

A 19-year-old female university student athlete is at your office today because she has fever, sore throat, headache, abdominal pain, and fatigue. You discover that she has tonsillar exudate, anterior cervical lymphadenopathy, posterior cervical lymphadenopathy, and splenomegaly during your physical examination. You perform a rapid antigen test to rule out streptococcal tonsillitis, which is negative. You suspect this patient has infectious mononucleosis.
Volume 38.3 - Question 39

Ear-Piercing Complications

Which one of the following statements about ear-piercing complications in children and adolescents is false?

  • In one study, 65% reported local infection after ear-piercing.
  • It has been associated with endocarditis.
  • It is one of the commonest causes of keloids in children 2 to 19 years of age.
  • Trans-cartilaginous piercing infections are most commonly caused by Staphylococcus aureus.
Volume 38.4 - Question 10

Vaccination for Patients Receiving Cancer Therapy

Which one of the following statements about vaccinations in patients receiving cancer therapy is false?

  • Vaccination rates are low.
  • Live vaccines are contraindicated in immunosuppressed patients.
  • Non-live vaccines are contraindicated in patients receiving cancer treatment with immunotherapy.
  • Patients are no longer considered immunosuppressed 3 months after cessation of treatment for cancer.
Volume 38.4 - Question 4

Fibromyalgia

A 45-year-old female patient comes to see you in follow-up. She is known for arthrosis and a long-standing issue with chronic pain. She states today that she feels exhausted and has pain “all over”. Her physical exam doesn’t reveal any sign of inflammation. You are considering a diagnosis of fibromyalgia.
Volume 38.6 - Question 43

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