High -Yield Internal Medicine Board Exam Pearls by Knowmedge - HTML preview

5 Gastroenterology Pearls

By Dr. Sunir Kumar

Gastroenterology and Hepatology comprises about 9% of the ABIM Internal Medicine exam,

making it one of the more critical subjects on the boards. Below, we review 5 High Yield

Gastroenterology / Hepatology Pearls that may help you score a few extra points on your

ABIM or Internal Medicine shelf examination.

Pearl # 1: Remembering Hepatitis B markers can be difficult, but is worth it

Start with these key points:

o Hepatitis B surface Antigen (HBsAg) → active infection

o Hepatitis B surface Antibody (HBsAb) → past infection or vaccination against

hepatitis B

o Hepatitis Be Antigen (HBeAg) → active replication of the virus

o Anti Hepatitis B core IgM Antibody (Anti-HBc IgM) → acute infection

o Anti Hepatitis B core IgG Antibody (Anti-HBc IgG) → chronic infection

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As you see above: Along with the Cleared state, both Chronic and Carrier Hepatitis B patients

will have positive HBsAg and Anti-HBcIgG. How can these two conditions be differentiated?

Easily. Just look at the Liver function tests (LFTs)

o Chronic → Increased LFTs

o Carrier → Normal LFTs

What about that Hepatitis D virus?

o Hepatitis D can’t exist on its own. It requires Hepatitis B infection to be present

o Anti-HBc IgM + Hepatitis D virus → acute co-infection and will not worsen

hepatitis

o Anti-HBc IgG + Hepatitis D virus → acute super-infection and can cause

fulminant hepatitis

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Pearl # 2: Main causes of dysphagia can be broken down into Mechanical & Motility