34: GERD & peptic ulcer disease

Question 1

1. Gastroesophageal reflux disease may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone:
2. Calcium carbonate
3. Estrogen
4. Furosemide
5. Metoclopramide

Answer 1

2. Estrogen

Question 2

2. Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD). Food or drink that may aggravate GERD include:
3. Eggs
4. Caffeine
5. Chocolate
6. Soda pop

Answer 2

2. Caffeine

Question 3

3. Metoclopramide improves gastroesophageal reflux disease symptoms by:
4. Reducing acid secretion
5. Increasing gastric pH
6. Increasing lower esophageal tone
7. Decreasing lower esophageal tone

Answer 3

3. Increasing lower esophageal tone

Question 4

4. Antacids treat gastroesophageal reflux disease by:
5. Increasing lower esophageal tone
6. Increasing gastric pH
7. Inhibiting gastric acid secretion
8. Increasing serum calcium level

Answer 4

2. Increasing gastric pH

Question 5

5. When treating patients using the “Step-Down” approach the patient with gastroesophageal reflux disease is started on _______ first.
6. Antacids
7. Histamine2 receptor antagonists
8. Prokinetics
9. Proton pump inhibitors

Answer 5

4. Proton pump inhibitors

Question 6

6. If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be:
7. Prokinetic (metoclopramide) for 4 to 8 weeks
8. Proton pump inhibitor (omeprazole) for 12 weeks
9. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks
10. Cytoprotective drug (misoprostol) for 2 weeks

Answer 6

2. Proton pump inhibitor (omeprazole) for 12 weeks

Question 7

7. If a patient with gastroesophageal reflux disease who is taking a proton pump inhibitor daily is not improving, the plan of care would be:
8. Prokinetic (metoclopramide) for 8 to 12 weeks
9. Proton pump inhibitor (omeprazole) twice a day for 4 to 8 weeks
10. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks
11. Cytoprotective drug (misoprostol) for 4 to 8 weeks

Answer 7

2. Proton pump inhibitor (omeprazole) twice a day for 4 to 8 weeks

Question 8

8. The next step in treatment when a patient has been on proton pump inhibitors twice daily for 12 weeks and not improving is:
9. Add a prokinetic (metoclopramide)
10. Referral for endoscopy
11. Switch to another proton pump inhibitor
12. Add a cytoprotective drug

Answer 8

2. Referral for endoscopy

Question 9

9. Infants with reflux are initially treated with:
10. Histamine2 receptor antagonist (ranitidine)
11. Proton pump inhibitor (omeprazole)
12. Anti-reflux maneuvers (elevate head of bed)
13. Prokinetic (metoclopramide)

Answer 9

3. Anti-reflux maneuvers (elevate head of bed)

Question 10

10. Long-term use of proton pump inhibitors may lead to:
11. Hip fractures in at-risk persons
12. Vitamin B6 deficiency
13. Liver cancer
14. All of the above

Answer 10

1. Hip fractures in at-risk persons

Question 11

11. An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is:
12. Histamine2 receptor antagonists for 4 to 8 weeks
13. Proton pump inhibitor bid for 12 weeks until healing is complete
14. Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days
15. Proton pump inhibitor bid and levofloxacin for 14 days

Answer 11

3. Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days

Question 12

12. Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of:
13. Antimicrobial resistance
14. An ineffective antacid
15. Overuse of proton pump inhibitors
16. All of the above

Answer 12

1. Antimicrobial resistance

Question 13

13. If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is:
14. Proton pump inhibitor bid plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days
15. Test H. pylori for resistance to common treatment regimens
16. Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days
17. Proton pump inhibitor and levofloxacin for 14 days

Answer 13

1. Proton pump inhibitor bid plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days

Question 14

14. After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is:
15. Testing for H. pylori eradication with a serum ELISA test
16. Endoscopy by a specialist
17. A proton pump inhibitor for 8 to 12 weeks until healing is complete
18. All of the above

Answer 14

3. A proton pump inhibitor for 8 to 12 weeks until healing is complete