JAAPA CME Post-Test January 2026
Screening and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is an increasingly prevalent condition that poses significant public health challenges. Affecting nearly 30% of the global population, MASLD is intricately linked to metabolic syndrome, insulin resistance, and cardiovascular
disease. Primary care providers, including physician associates (PAs), play a critical role in early detection and management. This article provides an updated overview of MASLD
for primary care PAs, focusing on disease pathophysiology, risk stratification, and screening recommendations. The use of noninvasive testing (e.g., FIB-4, liver stiffness measurement) for diagnosis and monitoring is emphasized, and lifestyle interventions are underscored as first-line therapy. Importantly, the activity highlights the recent FDA approval of resmetirom—the first pharmacologic treatment for noncirrhotic metabolic-associated steatohepatitis (MASH) with moderate to advanced fibrosis—and outlines the AASLD guideline supporting its use without the need for liver biopsy. By equipping primary care physician associates with current knowledge and practical tools, this article aims to improve early identification, guide appropriate referral, and enhance outcomes for patients at risk for MASLD progression. It also provides guidance around use of resmetirom in primary care, reviewing the drug’s indications, dosing, drug-drug interactions, and safety monitoring. Finally, it highlights semaglutide as an emerging treatment option for noncirrhotic MASH.
Learning Objectives
At the conclusion of this activity, participants should be able to:- Recognize the recent shift in terminology to MASLD, along with the implications for discussing this diagnosis with patients
- Describe MASLD risk factors and pathophysiology, including the role of metabolic dysfunction
- Describe the disease’s progression and stages
- Apply the AASLD recommendations for targeted screening and management in the primary care setting
The Evaluation of Leukocytosis
Leukocytosis, defined as an elevated white blood cell count, is a frequently encountered laboratory finding with a broad differential diagnosis ranging from transient reactive processes to life-threatening hematologic malignancies. Distinct patterns of elevation can provide valuable diagnostic clues that narrow the differential diagnosis and guide next steps. This activity outlines a systematic approach to evaluating leukocytosis, emphasizing integration of clinical history, physical examination, and laboratory data. The discussion highlights both nonmalignant and malignant causes, including acute and chronic leukemias, lymphomas, and myeloproliferative disorders, and offers guidance on when to pursue advanced diagnostics. Finally, a practical evaluation algorithm is included to support clinical decision-making. By recognizing key clinical features, laboratory patterns, and risk factors associated with
malignancy, clinicians can appropriately triage patients for specialist referral and ensure timely intervention.
Learning Objectives
At the conclusion of this activity, participants should be able to:- Describe the differential diagnosis of leukocytosis by cell type
- Identify red flag clinical and laboratory findings that signal possible malignancy
- Apply a systematic, evidence-based approach to evaluating and managing leukocytosis
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