42. The natural history of chronic HBV infection is divided into 3 phases: immune tolerance phase, immune clearance phase and viral integration phase. Which of the following description of viral integration phase is correct?
(A) The serum HBV DNA level is still high
(B) The liver inflammation is usually mild or already cirrhotic
(C) HBsAg becomes negative
(D) HBcAg is usually positive

38. A 60 year old man presents with abdominal pain and a CT reveals a mass within the gastrointestinal system, which is resected. Histopathologic examination reveals a submucosal mass composed of spindle cells with lightly eosinophilic cytoplasm arranged in a syncytial pattern. The pathologic diagnosis is a GIST, spindle cell type. Which of the following answer choices correlates with the most favorable prognosis for this patient? (A) KIT mutation present (B) Mass 11 cm in greatest dimension (C) Mass located in the jejunum (D) Mitotic rate ＞10 per 50HPF

39. A biopsy diagnosis of low grade dysplasia was made by a pathologist and confirmed by a subspecialized GI pathologist. What is the preferred appropriate management based on the ACG 2016 guidelines? (A) Endoscopic ablation therapy (B) Endoscopic mucosal resection (C) Endoscopic surveillance at 6 months interval (D) Endoscopic surveillance at 12 months interval

40. Which of the following statements is true about gastric inflammatory fibroid polyp? (A) Associated with activating mutation in the PDGFRA (B) Benign and nonneoplastic (C) Synonymous with inflammatory polyp (D) Typically centered in the muscularis propria

41. Which of the following descriptions of primary biliary cholangitis (PBC) is wrong? (A) Usually a disease of middle-aged women (B) Interlobular bile duct destruction is the typical feature found in the liver biopsy (C) Most patients are positive for anti-mitochondrial antibody (D) Usually present with jaundice in the beginning

43. Which of the following description about exocrine pancreatic carcinoma is Wrong (A) The spindle tumor cells of undifferentiated carcinoma of pancreas are positive for cytokeratin, but always negative for vimentin (B) the average size of tumors at the pancreatic head region is usually smaller than tail region (C) Acinar cell carcinoma of pancreas has better survival in pediatric patients than adult patients (D) The osteoclast-like giant cells in the undifferentiated carcinoma with osteoclast like giant cells (UC-OGC) of pancreas is considered as benign in nature

44. Which of the following description about Wilson’s disease is Correct? (A) Decreased urinary excretion of copper (B) Kayser-Fleischer rings can be seen in the eye with a brown color (C) For children, it usually presented as liver disease. (D) The serum ceruloplasmin is increased

45. Which of the following description about acute hemorrhagic pancreatitis is Wrong? (A) Pseudocyst formation is its sequelae (B) The serum amylase is elevated (C) Alcoholism is one of the major causes (D) If recovered, it will be associated with chronic pancreatitis

46. Which of the following description about angiosarcoma is Wrong? (A) chronic arsenic intoxication is associated with angiosarcoma (B) The preceding lesions of angiosarcoma are different according to the etiology (C) Portal hypertension may be already evident in the preceding lesion (D) CD31 or CD34 are useful diagnostic markers

47. If a person gets hepatitis virus infection in adult, which type of viral hepatitis has the lowest chance of becoming chronic carrier or chronic hepatitis? (A) HAV infection (B) HBV infection (C) HCV infection (D) HDV infection

48. Which of the following description for jaundice is Correct? (A) Kernicterus is belonged to conjugated hyper-bilirubinemia (B) Jaundice due to common bile duct stone is associated with conjugated hyperbilirubinemia (C) Eexcessive hemolysis can cause conjugated hyper-bilirubinemia (D) Dubin-Johnson syndrome is associated with unconjugated hyper-bilirubinemia.