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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 pro- ton pump inhibitor, she is ready for discharge. What is the most appropriate next step? a. Stop her aspirin. b. Reassess her comorbidity. c. Change her aspirin to clopidogrel. d. Make no changes. e. 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. 50%. b. 1%. c. 10%. d. 100%. e. 30%. Question 2: What is the most common type of drugs associated with idiosyncratic DILI? a. Nonsteroidal anti-inﬂammatory drugs. b. Anti-epileptics. c. Antibiotics. d. Herbal drugs and dietary supplements. e. Cardiovascular drugs. June 2013 CME ACTIVITIES e19

Exam 2: Incidence, Presentation, and Outcomes in Patients With Drug-Induced Liver Injury in the General Population of Iceland

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Page 1: Exam 2: Incidence, Presentation, and Outcomes in Patients With Drug-Induced Liver Injury in the General Population of Iceland

June 2013 CME ACTIVITIES e19

Question 3:

Consider the risk factor with the highest odds ratio inan adjusted model. What proportion of cases in the pop-ulation will be attributed to that risk factor?

Question 4:

Question 5:

most appropriate next step?

Test ID No.: gastro00182 Contact hours: 1.0

Question 1:

Question 2:

a. It depends on the proportion exposed to the risk factorin 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.

The effect of comorbidity on the risk of upper gastro-intestinal bleeding was large in the current study. Whichof the following is a plausible explanation for this?

a. The prescribing of medications for comorbidity thatare known to increase the risk of bleeding.

b. Sicker patients are more likely to have an upper gas-trointestinal 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

An elderly lady is admitted to gastroenterology with anupper gastrointestinal bleed. She undergoes successful uppergastrointestinal endoscopy and receives dual therapy to treata visible vessel in a posterior duodenal ulcer. She does nottake any medication that increases the risk of bleeding apartfrom low-dose aspirin, which she has taken for many yearsfor ischemic heart disease secondary prevention. A rapidurease test was negative. She has no further rebleeding andafter finishing her infusion of a high-dose intravenous pro-ton pump inhibitor, she is ready for discharge. What is the

a. Stop her aspirin.b. Reassess her comorbidity.c. Change her aspirin to clopidogrel.d. Make no changes.e. Make an urgent referral to a cardiologist.

Exam 2: Incidence, Presentation, and Outcomes in Patients With Drug-Induced LiverInjury in the General Population of Iceland

Expiration Date: June 30, 2014

A few large studies on patients with jaundice owing toDILI have shown similar proportion of patients who diefrom liver disease or require liver transplantation. Whichis this proportion approximately?

a. 50%.b. 1%.c. 10%.d. 100%.

e. 30%.

What is the most common type of drugs associatedwith idiosyncratic DILI?

a. Nonsteroidal anti-inflammatory drugs.b. Anti-epileptics.c. Antibiotics.d. Herbal drugs and dietary supplements.

e. Cardiovascular drugs.

Page 2: Exam 2: Incidence, Presentation, and Outcomes in Patients With Drug-Induced Liver Injury in the General Population of Iceland

e20 CME ACTIVITIES GASTROENTEROLOGY Vol. 144, No. 7

Question 3:

The data from the study by Bjornsson et al demon-strated that the greatest risk for DILI was associated withwhich drugs?

Question 4:

a. Amoxicillin-clavulanate and diclofenac.b. Azathioprine and infliximab.c. Nitrofurantoin and isotretinoin.d. Nitrofurantoin and doxycycline.

e. Diclofenac and ibuprofen.

Based on the study by Bjornsson et al, the crude inci-dence of DILI in this population based study was approx-imately

a. 19 per 100,000 inhabitants and year.b. 3 per 100,000 inhabitants and year.c. 14 per 100,000 inhabitants and year.d. 10 per 100,000 inhabitants and year.

e. 50 per 100,000 inhabitants and year.