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CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2011;9:e96–e98

CME Activities–Exams 1 and 2Shyam S. Varadarajulu, MD, Editor, CME Section

CME Credits:The AGA Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medicaleducation for physicians.The AGA Institute designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicianshould 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 Continu-ing 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 priorto 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.cghjour-nal.org/content/cme. Answers can be obtained online after completing the exam(s).

Objectives:See article for specific learning objective.

September 2011 CME ACTIVITIES e97

Exam 1: Biliary Stricture and Negative Cytology: What Next?

Test ID No.: 0137 Contact Hours: 1.0 Expiration Date: September 30, 2012

Question 1

In a patient with distal biliary stricture, which technique isthe most sensitive for diagnosing malignancy?

Question 2

Question 3

duct.

Question 4

tients with malignant obstructive jaundice.

a. Biliary brushings at endoscopic retrograde cholangiopancre-atography (ERCP)

b. Biopsies of the biliary stricture at ERCPc. A combination of ERCP-guided brushings and biopsyd. Endoscopic ultrasound (EUS)-guided fine needle aspiration

(FNA)

In which of the following patients does EUS-guided FNAhave low diagnostic yield?

a. Patient with obstructive jaundice and a pancreatic headmass on computed tomography

b. Patient with obstructive jaundice and several enlarged, hy-poechoic lymph nodes near the pancreatic head region

c. Patient with obstructive jaundice and a stricture at the levelof the liver hilum extending to the proximal common bileduct on magnetic resonance cholangio-pancreatography

d. Patient with a mid-common bile duct stricture on ERCP

Fluorescence in situ hybridization (FISH) is the first linediagnostic modality for evaluation of indeterminate non–pri-mary sclerosing cholangitis associated strictures in the bile

a. Trueb. False

Preoperative biliary decompression is mandatory for all pa-

a. True b. False