PUD Flashcards
Which of the following characteristics differentiates gastric ulcers (GUs) from duodenal ulcers (DUs)?
A. GUs are more commonly benign and do not require biopsy.
B. GUs are associated with NSAID use and often lack H. pylori infection.
C. DUs are more commonly associated with malignancy than GUs.
D. DUs are more likely to show evidence of chemical gastropathy than GUs.
Correct Answer: B
Rationale: Gastric ulcers (GUs) related to NSAIDs are not typically accompanied by H. pylori-associated chronic active gastritis but may instead exhibit chemical gastropathy with features like foveolar hyperplasia and lamina propria edema. GUs require biopsy upon discovery to rule out malignancy (A is incorrect). Malignant transformation is much more common in GUs than in DUs (C is incorrect). DUs are not typically associated with chemical gastropathy (D is incorrect).
In contrast to DUs, GUs can represent a malignancy and should be biopsied upon discovery.
Which of the following best describes the typical location of benign gastric ulcers?
A. Gastric fundus
B. Within 3 cm of the pylorus
C. Distal to the junction between the antrum and acid secretory mucosa
D. Duodenal bulb
Correct Answer: C
Rationale: Benign gastric ulcers are most commonly found distal to the junction between the antrum and the acid secretory mucosa. They are rare in the gastric fundus (A is incorrect). While duodenal ulcers are often located near the pylorus (B is incorrect), the duodenal bulb is the typical location for DUs, not GUs (D is incorrect).
Benign GUs are most often found distal to the junction between the antrum and the acid secretory mucosa. Benign GUs are quite rare in the gastric fundus and are histologically similar to DUs.
Which of the following factors contributes to the pathogenesis of duodenal ulcers (DUs)?
A. Increased bicarbonate secretion in the duodenal bulb
B. Decreased nocturnal gastric acid secretion
C. H. pylori infection and NSAID-induced injuries
D. Increased mucosal defense mechanisms
Correct Answer: C
Rationale: The majority of duodenal ulcers are caused by H. pylori infection and NSAID-induced injuries. Bicarbonate secretion is decreased in the duodenal bulb of patients with active DUs (A is incorrect). Nocturnal gastric acid secretion is increased, not decreased, in DU patients (B is incorrect). Impaired, not enhanced, mucosal defense mechanisms contribute to DU formation (D is incorrect).
Which type of gastric ulcer (GU) is most commonly associated with duodenal ulcers (DUs)?
A. Type I
B. Type II
C. Type III
D. Type IV
Correct Answer: C
Rationale: Type III gastric ulcers are located within 3 cm of the pylorus and are commonly associated with duodenal ulcers and normal or high gastric acid production. Type I ulcers occur in the gastric body and are associated with low gastric acid production (A is incorrect). Type II ulcers occur in the antrum and are associated with variable acid levels (B is incorrect). Type IV ulcers occur in the cardia and are associated with low acid production (D is incorrect).
What distinguishes the pathogenesis of gastric ulcers (GUs) from duodenal ulcers (DUs)?
A. GUs are exclusively caused by H. pylori infection.
B. GUs tend to have normal or decreased gastric acid output.
C. GUs are primarily caused by increased bicarbonate secretion.
D. GUs are less likely to be associated with NSAID use.
Correct Answer: B
Rationale: Gastric ulcers tend to have normal or decreased gastric acid output, whereas duodenal ulcers are associated with increased gastric acid secretion. Both GUs and DUs can be caused by H. pylori infection and NSAID use (A and D are incorrect). Bicarbonate secretion is decreased in DUs, not increased in GUs (C is incorrect).
What is the primary significance of eradicating H. pylori in patients with acid peptic disorders?
A. It prevents all forms of gastric metaplasia.
B. It eliminates the need for NSAID cessation.
C. It reduces the risk of gastric cancer and MALT lymphoma.
D. It increases basal gastric acid production.
Correct Answer: C
Rationale: Eradicating H. pylori reduces the risk of gastric cancer, particularly in high-risk populations, and decreases the risk of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. While it improves ulcer healing, it does not prevent all forms of gastric metaplasia (A is incorrect), eliminate the risks of NSAID use (B is incorrect), or increase gastric acid production (D is incorrect).
Which of the following factors is most strongly associated with higher rates of H. pylori infection?
A. Race
B. Socioeconomic status
C. Age alone
D. Dietary habits
Correct Answer: B
Rationale: Higher colonization rates of H. pylori are associated with poor socioeconomic status and less education, not race. Although age and dietary habits can influence infection risk, they are not as significant as socioeconomic factors (A, C, and D are incorrect).
How is H. pylori most commonly transmitted?
A. Bloodborne transmission
B. Airborne droplets
C. Oral-oral or fecal-oral route
D. Skin-to-skin contact
Correct Answer: C
Rationale: H. pylori is transmitted from person to person via oral-oral or fecal-oral routes. Bloodborne transmission, airborne droplets, and skin-to-skin contact are not mechanisms of transmission for this bacterium (A, B, and D are incorrect).
Which of the following is a major risk factor for H. pylori infection?
A. Daily use of NSAIDs
B. Birth or residence in a developed country
C. Domestic crowding
D. High gastric acid output
Correct Answer: C
Rationale: Domestic crowding increases the likelihood of person-to-person transmission of H. pylori. Birth or residence in a developing country, unsanitary living conditions, and exposure to gastric contents of an infected person are also risk factors. Daily NSAID use and high gastric acid output are not direct risk factors for H. pylori infection (A, B, and D are incorrect).
Which of the following best describes the typical pain pattern of duodenal ulcers (DUs)?
A. Pain occurs immediately after a meal and is worsened by food.
B. Pain occurs 90 minutes to 3 hours after a meal and is relieved by food or antacids.
C. Pain is constant and unrelated to meals or time of day.
D. Pain occurs only in the early morning and is unaffected by food or antacids.
Correct Answer: B
Rationale: The classic pain pattern of duodenal ulcers is pain that occurs 90 minutes to 3 hours after a meal and is often relieved by food or antacids. This pattern differentiates DUs from other types of dyspepsia. Pain that worsens immediately after eating is more characteristic of gastric ulcers (A is incorrect). Constant pain unrelated to meals or time (C) or pain limited to the early morning (D) does not describe typical DU pain.
Which symptom is considered the most discriminating feature of duodenal ulcers?
A. Pain that occurs immediately after eating
B. Pain that is relieved by lying flat
C. Pain that awakens the patient from sleep between midnight and 3 a.m.
D. Pain that radiates to the back and is unaffected by antacids
Correct Answer: C
Rationale: Pain that awakens the patient from sleep between midnight and 3 a.m. is the most discriminating symptom of duodenal ulcers, with two-thirds of patients reporting this complaint. Pain occurring immediately after eating (A) is more typical of gastric ulcers. Pain relieved by lying flat (B) or radiating to the back (D) is not specific to duodenal ulcers and may suggest other conditions.
What symptom is more characteristic of a gastric ulcer than a duodenal ulcer?
A. Pain relieved by food
B. Pain worsened by food
C. Pain awakening the patient at night
D. Pain occurring 2–3 hours after a meal
Correct Answer: B
Rationale: Pain that worsens immediately after eating is characteristic of gastric ulcers due to increased acid secretion in direct contact with the ulcer. Duodenal ulcers are typically associated with pain relief after eating (A) and pain that occurs 2–3 hours after a meal or awakens the patient at night (C and D).
What is the most common complication observed in patients with peptic ulcer disease (PUD)?
A. Perforation
B. Gastric outlet obstruction
C. GI bleeding
D. Fistula formation
Correct Answer: C
Rationale: GI bleeding is the most common complication of peptic ulcer disease, occurring in 19.4–57 per 100,000 individuals in the general population and in approximately 15% of PUD patients. Perforation and gastric outlet obstruction are less common complications (A and B). Fistula formation is rare (D).
What is the second most common complication of peptic ulcer disease (PUD)?
A. GI bleeding
B. Perforation
C. Gastric outlet obstruction
D. Fistula formation
Correct Answer: B
Rationale: Perforation is the second most common complication of PUD, occurring in 6–7% of patients. GI bleeding is the most common complication (A), while gastric outlet obstruction (C) and fistula formation (D) are less common.
Which of the following is the classic clinical triad associated with perforation in PUD?
A. Fever, tachycardia, and abdominal distension
B. Acute abdominal pain, tachycardia, and abdominal rigidity
C. Nausea, vomiting, and diarrhea
D. Abdominal rigidity, melena, and vomiting
Correct Answer: B
Rationale: The classic triad of perforation in PUD includes acute abdominal pain, tachycardia, and abdominal rigidity. These findings indicate peritoneal irritation. Fever and distension (A), nausea and diarrhea (C), or melena (D) are not the hallmark features of perforation.
