Peptic ulcer as an infectious disease

Question 1

where do peptic ulcers occur (3)

Answer 1

duodenal, antral, gastric body

Question 2

T or F, prepyloric ulcers heal faster and are more likey to occur

Answer 2

false, heal slowly

Question 3

whats the recurrence rate following ulcers that heal spontaneously

Answer 3

50-80%, in 6-12 months

Question 4

state the recurrence rate if H pylori is treated

Answer 4

<10%

Question 5

lifetime prevalence of PUD in pylori positive subjects

Answer 5

10-20%

Question 6

lifetime prevalence of PUD in the general population

Answer 6

5-10%

Question 7

what are the causes PUD (4)

Answer 7

1.H.pylori 2. NSAIDs 3. Smoking 4. extreme physiological stress

Question 8

quantify the amount of ulcers that Hpylori is responsible for each duodenal or gastric ulcer

Answer 8

90% duodenal, 80% gastric

Question 9

T or F, the majority of chldren are infected in developing nations

Answer 9

true usually before the age of 10, and 80% before the age of 50

Question 10

which kind of lymphoma is associated with ulcers

Answer 10

MALT

Question 11

what are the two mechanisms of h plyori attachment

Answer 11

1.formation of membrane attachments with host receptor proteins 2, binding of class II MCH inducing apoptosis

Question 12

List the enzymes secreted by h.pylori

Answer 12

1. urease 2. phopholipases 3. catalase 4. proteolytic

Question 13

which enzymes degrades mucus

Answer 13

proteolytic

Question 14

antioxidant that protects the bacteria from neutrophil toxic Oxygen.

Answer 14

catalase

Question 15

alters the phospholipid content of the gastric mucosal barrier –> alters pH permeability

Answer 15

phospholipases

Question 16

Direct effects or through binding to surface class II MHC inducing apoptosis

Answer 16

urease

Question 17

which cells does the inflammatory response hail

Answer 17

b and t cells

Question 18

list the genes that make a pt more suseptible to GUD

Answer 18

interluekin proteins, TNF alpha

Question 19

state two causes of anemia in pts with ulcers

Answer 19

bleeding, decreased absorption

Question 20

which of the following has both excellent sensitivity and specifificty _+ it is standardized a. culture b. rapid urease testing c. histology d. pcr

Answer 20

histology ©

Question 21

which test has marginal sensititvity

Answer 21

culture

Question 22

when is Culture ± PCR are recommended

Answer 22

Sx did NOT improve after initial Treatment

Question 23

what is the gold standard

Answer 23

rapid urease testing

Question 24

which test indicates active infection

Answer 24

urea breath test

Question 25

which test is useful in monitoring treatment

Answer 25

urea breath test

Question 26

list 4 reasons for false negative on urease test of the antral biopsu

Answer 26

a. Recent antibiotic use
b. GI bleeding
c. Use of Bismuth compound
d. Use of Proton pump inhibitors

Question 27

which two drugs should be stopped 2 weeks before biopsy

Answer 27

bismuth and ppi

Question 28

which drug should be stopped 4 weeks before biopsy

Answer 28

antibiotics

Question 29

regimin 1

Answer 29

clarithromycin, amoxicillin, ppi for two weeks followed by ppi for 2 weeks

Question 30

regimin 2

Answer 30

clarithromycin, metronaidazole, ppi fort wo weeks followed by ppi for 2 weeks

Question 31

regimin 3

Answer 31

metronidazole, tetracycline, bismuth subsalicylate, h2 receptor ntagonist for 2 weeks follow by h2 receptor anatagonist for 2 weeks

Question 32

which regimin can’t be used in children and why

Answer 32

regimin 2, bec of tretracycline/doxyclinicine

Question 33

when is regimin 2 indicated

Answer 33

pts allergic to penicillin

Question 34

Failure of eradication rate

Answer 34

20%

Question 35

state 4 indications for confirming the eradication of ulcers

Answer 35

· Persistent symptoms after treatment for dyspepsia · H. pylori associated ulcer
· Lymphoid tissue (MALT) lymphoma
· Resection for early gastric cancer

Question 36

mention 2 tests that can identify antibiotic susceptibility

Answer 36

culture and pcr but pcr isn’t sensitive thus is used when pt is treated empirically

Question 37

whats the most common cause of refractory ulcers

Answer 37

medication noncomplicancce

Question 38

gastric ulcers most commonoly penetrate into

Answer 38

left lobe of the liver

Question 39

duodenal ulcers most commonly penetrate into the

Answer 39

posteriroly to the adjacent pancreas

Question 40

whats the best endoscopic test done

Answer 40

urease

Question 41

whats the best nonendoscopic test done

Answer 41

urease breath test