PUD

Question 1

1. Which of the following is not a common cause of peptic ulcer disease (PUD)?
   A. Chronic alcohol ingestion
   B. Nonsteroidal anti-inflammatory drugs (NSAIDs)
   C. Stress-related mucosal damage
   D. Helicobacter pylori infection
   E. All of the above are common causes of PUD

Answer 1

A

Question 2

2. Which of the following is a complication of PUD?
   A. GI bleeding
   B. Perforation
   C. Obstruction
   D. All of the above
   E. None of the above

Answer 2

D

Question 3

3. Which of the following is an indication for stress ulcer prophylaxis (SUP) in critically ill patients according to the 1999 American Society of Health-System Pharmacists (ASHP) published guidelines?
   A. Mechanical ventilation for longer than 48 hours
   B. Patients admitted to telemetry for heart failure
   C. Platelet count greater than 50,000/mm3
   (50 × 109/L) but less than 150,000/mm3
   (150 ×109/L)
   D. Thermal injuries to more than 15% of body surface area
   E. Admission to ICU on enteral feedings

Answer 3

A

Question 4

4. Which of the following is an important mechanism of prostaglandin mucosal protection?
   A. Stimulation of both mucus and phospholipid production
   B. Promotion of bicarbonate secretion
   C. Increased mucosal cell turnover
   D. All of the above
   E. None of the above

Answer 4

D

Question 5

5. A 65-year-old woman presents with new onset epigastric pain, recent 10-pound (4.5kg) weight loss, and anemia. What diagnostic test should this patient undergo?
   A. Urea breath test
   B. Stool antigen testing for H. pylori
   C. Esophagogastroduodenoscopy (EGD)
   D. H. pylori serology testing
   E. Manometry

Answer 5

C

Question 6

6. A prophylactic medication regimen to prevent NSAID-induced ulcers would not be recommended in:
   A. A 65-year-old patient on long-term NSAID therapy for osteoarthritis
   B. A 60-year-old patient on aspirin therapy for cardioprotection
   C. A 72-year-old patient with history of GI bleeding on NSAID therapy for osteoarthritis
   D. A 30-year-old patient who takes NSAID for occasional tension headaches
   E. An 80-year-old patient on high-dose corticosteroids for lupus and history of GI bleeding

Answer 6

D

Question 7

7. A preferred first-line option for treating a newly diagnosed patient with H. pylori infection and a penicillin allergy is:
   A. A triple-drug regimen consisting of a proton pump inhibitor (PPI), clarithromycin and tetracycline
   B. A triple-drug regimen consisting of a PPI, levofloxacin, and tetracycline
   C. A quadruple-drug regimen with bismuth subsalicylate, metronidazole, tetracycline, and a PPI
   D. Dual therapy consisting of a PPI and metronidazole
   E. None of the above

Answer 7

C

Question 8

8. Which one of the following should be considered when evaluating a patient who has failed H.
   pylori eradication therapy?
   A. Patient adherence
   B. Preexisting antimicrobial resistance
   C. Potential reinfection
   D. All of the above
   E. None of the above

Answer 8

D

Question 9

9. Which of the following tests can be used to confirm eradication of H. pylori?
   A.Urea breath test
   B. Stool antigen assay
   C. EGD with biopsies
   D.Serologic testing
   E. Both A and D

Answer 9

E

Question 10

10. Which of the following statements is true regarding misoprostol?
    A. Misoprostol is a synthetic prostacyclin analog that exogenously replaces prostacyclin stores
    B. Misoprostol is safe to use in pregnancy
    C. Misoprostol is indicated for reducing the risk of H. pylori-induced gastric ulcer
    D. Misoprostol is limited by a high frequency of GI side effects
    E. Misoprostol is the drug of choice for stress ulcer prophylaxis

Answer 10

D

Question 11

11. Which of the following is an independent risk factor for the development of NSAID-induced
    peptic ulcers?
    A. Concomitant use of corticosteroids
    B. Alcohol consumption
    C. Concomitant use of selective serotonin receptor inhibitors (SSRIs)
    D. Smoking
    E. All of the above

Answer 11

C

Question 12

12. Which one of the following statements is true regarding H. pylori antimicrobial resistance?
    A. Metronidazole resistance is more prevalent in North America than in Asia
    B. Clarithromycin resistance occurs in approximately 10% of H. pylori isolates
    C. Amoxicillin and tetracycline resistance occur in most H. pylori isolates
    D. Antimicrobial resistance with H. pylori is not a concern
    E. None of the above

Answer 12

B

Question 13

13. In which of the following situations is confirmation of H. pylori eradication recommended?
    A. Patients who have undergone resection for early gastric cancer
    B. Patients with gastric MALT lymphoma
    C. Patients with persistent symptoms after H. pylori treatment
    D. None of the above
    E. All of the above

Answer 13

D

Question 14

14. Which of the following is not a goal of PUD therapy?
    A. Resolve symptoms
    B. Increase acid secretion
    C. Promote epithelial healing
    D. Prevent ulcer-related complications
    E. Prevent ulcer recurrence

Answer 14

B

Question 15

15. Refractory peptic ulcers will most likely require which of the following interventions?
    A. An increase in the H2RA dose
    B. An evaluation of serum pepsin to exclude Zollinger-Ellison syndrome
    C. H. pylori testing if not done previously
    D. Combination therapy with an H2RA and PPI
    E. All of the above

Answer 15

C

Question 16

1. Which is a cause of peptic ulcers?
   A. Chronic alcohol ingestion
   B. Psychosocial factors
   C. Dietary factors
   D. Chronic nonsteroidal anti-inflammatory drug (NSAIDs)

Answer 16

D

Question 17

2. Which is a complication of PUD?
   A. GI bleeding
   B. Diarrhea
   C. Constipation
   D. Colon cancer

Answer 17

A

Question 18

3. Which patient is most appropriate to receive stress ulcer prophylaxis?
   A. Admitted to the general medicine ward following a wrist fracture
   B. Admitted to the general medicine ward with a history of PUD
   C. Admitted to the intensive care unit following a spinal cord injury
   D. Admitted to the intensive care unit with continued enteral feeding

Answer 18

C

Question 19

4. Which is an important mechanism of prostaglandin mucosal protection?
   A. Stimulation of phospholipid production
   B. Reduction of bicarbonate secretion
   C. Decreased mucosal cell turnover
   D. Decrease in mucus production

Answer 19

A

Question 20

5. A 65-year-old woman presents with new-onset epigastric pain, recent 10-lb (4.5 kg) weight loss, and anemia. What diagnostic test should this patient undergo?
   A. Urea breath test
   B. Stool antigen testing for H. pylori
   C. Esophagogastroduodenoscopy (EGD)
   D. H. pylori serology testing

Answer 20

C

Question 21

6. A prophylactic medication regimen to prevent NSAID-induced ulcers would be best recommended in which patient?
   A. 65-year-old on as-needed NSAID therapy for osteoarthritis
   B. 60-year-old recently started on aspirin therapy for cardioprotection
   C. 70-year-old who takes an NSAID for occasional tension headaches
   D. 80-year-old with a history of GI bleeding taking high-dose corticosteroids for lupus

Answer 21

D

Question 22

7. Which is a preferred first-line option for treating a newly diagnosed patient with H. pylori infection, penicillin allergy, and previous macrolide exposure?

A. A triple-drug regimen consisting of a proton pump inhibitor (PPI), clarithromycin, and tetracycline
B. A triple-drug regimen consisting of a PPI, levofloxacin, and tetracycline
C. A quadruple-drug regimen with bismuth subsalicylate, metronidazole, tetracycline, and a PPI
D. Dual therapy consisting of a PPI and metronidazole

Answer 22

C

Question 23

8. Which one of the following is a preferred first-line option for treating a newly diagnosed patient with H. pylori infection, no known allergies, and no previous macrolide exposure?

A. A triple-drug regimen consisting of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin
B. A triple-drug regimen consisting of a PPI, clarithromycin, and tetracycline
C. A quadruple-drug regimen with bismuth subsalicylate, metronidazole, tetracycline, and a PPI
D. Either A or C could be recommended

Answer 23

D

Question 24

9. Which of the following statements regarding misoprostol is true?
   A. Misoprostol inhibits acid secretion and promotes mucosal defense
   B. Misoprostol is indicated for reducing the risk of H. pylori-induced gastric ulcer
   C. Misoprostol use is tolerated by most people
   D. Misoprostol is more effective than PPIs in preventing NSAID-induced ulcers

Answer 24

A

Question 25

10. A 68-year-old man was recently treated for an NSAID-induced ulcer. He continues on high-dose NSAIDs for rheumatoid arthritis and rivaroxaban for deep vein thrombosis. What is the best maintenance regimen for his gastric ulcer? A. Maintenance therapy is not needed B. Famotidine 40 mg two times a day C. Misoprostol 200 mcg four times a day D. Omeprazole 40 mg daily

Answer 25

D

Question 26

11. Which medication used in H. pylori eradication requires counseling to avoid alcohol? A. Amoxicillin B. Bismuth subsalicylate C. Levofloxacin D. Metronidazole

Answer 26

D

Question 27

A 52-year-old woman presents to clinic for the results of her recent endoscopy. Previously, she had reported dyspeptic symptoms most days of the week. Her symptoms improved but did not completely resolve with OTC antacids and H 2 RA therapy. She completed a course of azithromycin (500 mg on day 1, followed by 250 mg days 2 through 5) for a COPD exacerbation 2 months ago. PMH: Hypothyroidism × 10 years, COPD × 2 years FH: Parents both living; age 75; PMH noncontributory SH: Smoker, one pack per day; denies alcohol or illicit drugs Allergies: NKDA Meds: Levothyroxine 150 mcg daily, albuterol 1 to 2 puffs every 6 hours as needed for shortness of breath, Advair 250/50 mcg 1 puff twice daily, famotidine 10 mg as needed for dyspeptic symptoms, Tums as needed for dyspeptic symptoms 12. Endoscopy reveals H. pylori infection. Which eradication regimen should you recommend? A. Clarithromycin 500 mg BID + amoxicillin 1 g BID + metronidazole 500 mg BID + PPI BID B. Bismuth subsalicylate 300 mg QID + metronidazole 250 mg QID + tetracycline 500 mg QID + PPI BID C. PREVPAC [clarithromycin 500 mg BID + amoxicillin 1 g BID + lansoprazole 30 mg BID] D. Clarithromycin 500 mg BID + metronidazole 500 mg BID + PPI BID

Answer 27

B

Question 28

A 52-year-old woman presents to clinic for the results of her recent endoscopy. Previously, she had reported dyspeptic symptoms most days of the week. Her symptoms improved but did not completely resolve with OTC antacids and H 2 RA therapy. She completed a course of azithromycin (500 mg on day 1, followed by 250 mg days 2 through 5) for a COPD exacerbation 2 months ago. PMH: Hypothyroidism × 10 years, COPD × 2 years FH: Parents both living; age 75; PMH noncontributory SH: Smoker, one pack per day; denies alcohol or illicit drugs Allergies: NKDA Meds: Levothyroxine 150 mcg daily, albuterol 1 to 2 puffs every 6 hours as needed for shortness of breath, Advair 250/50 mcg 1 puff twice daily, famotidine 10 mg as needed for dyspeptic symptoms, Tums as needed for dyspeptic symptoms 13. The patient returns with persistent symptoms 2 months after completing the course you recommended. Which of the following regimens would be appropriate to recommend for salvage therapy? A. Amoxicillin 1 g BID + PPI BID for 5 to 7 days, followed by clarithromycin 500 mg BID + metronidazole 500 mg BID + PPI BID for 7 days B. Bismuth subsalicylate 300 mg QID + metronidazole 250 to 500 mg QID + tetracycline 500 mg QID + PPI BID C. Levofloxacin 500 mg daily + amoxicillin 1 g BID + PPI BID D. Clarithromycin 500 mg BID + amoxicillin 1 g BID + metronidazole 500 mg BID + PPI BID

Answer 28

C

Question 29

A 74-year-old man presents to clinic for the results of his recent endoscopy. Previously, he had reported dyspepsia and dark, tarry stools. Endoscopy revealed a gastric ulcer, negative for H. pylori. PMH: Hypertension × 10 years, osteoarthritis × 5 years, atrial fibrillation × 2 years FH: Parents both deceased; father with heart disease; died at age 68 after MI SH: Quit smoking 10 years ago, denies alcohol or illicit drug use Allergies: NKDA Meds: Valsartan 80 mg daily, amlodipine 10 mg daily, meloxicam 15 mg daily, warfarin 5 mg daily, famotidine 20 mg as needed for dyspeptic symptoms 14. All of the following are risk factors that this patient has for GI complications related to NSAID use except: A. Age older than 60 years B. Concomitant anticoagulant use C. Duration of NSAID use D. Previous PUD complication

Answer 29

D

Question 30

A 74-year-old man presents to clinic for the results of his recent endoscopy. Previously, he had reported dyspepsia and dark, tarry stools. Endoscopy revealed a gastric ulcer, negative for H. pylori. PMH: Hypertension × 10 years, osteoarthritis × 5 years, atrial fibrillation × 2 years FH: Parents both deceased; father with heart disease; died at age 68 after MI SH: Quit smoking 10 years ago, denies alcohol or illicit drug use Allergies: NKDA Meds: Valsartan 80 mg daily, amlodipine 10 mg daily, meloxicam 15 mg daily, warfarin 5 mg daily, famotidine 20 mg as needed for dyspeptic symptoms 15. Which is the most appropriate course of action for this patient? A. Esomeprazole 40 mg daily for ulcer healing, followed by initiation of cotherapy B. Famotidine 20 mg twice daily for ulcer healing, followed by initiation of cotherapy C. Pantoprazole 40 mg daily for ulcer healing; this patient is not a candidate for cotherapy D. Sucralfate 1 g four times daily for ulcer healing; this patient is not a candidate for cotherapy

Answer 30

A