Question 1

When using the "Step-Up" approach in caring for patients with GERD,the "step up" from once daily proton pump inhibitor use is: A) Prokinetic (metoclopramide)for 8 to 12 weeks B) Proton pump inhibitor (omeprazole)twice a day for 4 to 8 weeks C) Histamine₂receptor antagonist (ranitidine)for 4 to 8 weeks D) Cytoprotective drug (misoprostol)for 4 to 8 weeks

Accepted Answer

The "step-up" from once daily proton pump inhibitor use is to increase the dose to twice daily for 4 to 8 weeks. This is because proton pump inhibitors are the most effective medication for treating GERD and increasing the dose can provide more symptom relief for patients who do not respond adequately to once daily therapy. The other options listed (prokinetic, H2 receptor antagonist, and cytoprotective drugs) are typically used as adjuncts or alternative therapies if proton pump inhibitors are not effective or if patients cannot tolerate them.

Question 2

Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD).Foods that may aggravate GERD include:&#10;A) Eggs&#10;B) White bread&#10;C) Chocolate&#10;D) Chicken

Accepted Answer

White bread

Question 3

When using the "Step-Up" approach in caring for patients with GERD,the "step up" from OTC antacid use is: A) Prokinetic (metoclopramide)for 4 to 8 weeks B) Proton pump inhibitor (omeprazole)for 12 weeks C) Histamine₂receptor antagonist (ranitidine)for 4 to 8 weeks D) Cytoprotective drug (misoprostol)for 2 weeks

Accepted Answer

The "Step-Up" approach for GERD involves starting with lifestyle modifications and OTC antacids, then stepping up to H2 receptor antagonists like ranitidine if symptoms persist.

Question 4

After H.pylori treatment is completed,the next step in peptic ulcer disease therapy is:&#10;A) Testing for H.pylori eradication with a serum ELISA test&#10;B) Endoscopy by a specialist&#10;C) Proton pump inhibitor for 8 to 12 weeks until healing is complete&#10;D) All of the above

Accepted Answer

Proton pump inhibitor (PPI) therapy for 8 to 12 weeks until healing is complete is recommended after H.pylori treatment to further reduce acid secretion and promote mucosal healing. Testing for eradication with a serum ELISA test may be considered, but it is not always necessary. Endoscopy by a specialist may be indicated in certain cases, such as if there is suspicion for a malignancy or if symptoms persist despite treatment. However, routine endoscopy is not required after H.pylori treatment in most patients unless there are specific concerns or complications.

Question 5

Long-term use of proton pump inhibitors may lead to: A) Hip fractures in at-risk persons B) Vitamin B₆deficiency C) Liver cancer D) All of the above

Accepted Answer

The answer of Long-term use of proton pump inhibitors may...

Question 6

Metoclopramide improves GERD symptoms by:&#10;A) Reducing acid secretion&#10;B) Increasing gastric pH&#10;C) Increasing lower esophageal tone&#10;D) Decreasing lower esophageal tone

Accepted Answer

Metoclopramide works by increasing the tone of the lower esophageal sphincter, which helps prevent stomach acid from flowing back into the esophagus and causing reflux symptoms.

Question 7

Infants with reflux are initially treated with: A) Histamine₂receptor antagonist (ranitidine) B) Proton pump inhibitor (omeprazole) C) Anti-reflux maneuvers (elevate head of bed) D) Prokinetic (metoclopramide)

Accepted Answer

Infants with reflux are initially treated with anti-reflux maneuvers such as elevating the head of the bed. Drug therapy is generally considered if non-pharmacologic measures fail. Medications such as histamine receptor antagonists, proton pump inhibitors, and prokinetics may be considered for infants with persisting symptoms. However, they should only be prescribed in consultation with a healthcare professional.

Question 8

When using &#34;Step-Up&#34; therapy for GERD,the next &#34;step up&#34; in treatment when a patient has been on proton pump inhibitors for 12 weeks is:&#10;A) Add a prokinetic (metoclopramide)&#10;B) Referral for endoscopy&#10;C) Switch to another proton pump inhibitor&#10;D) Add a cytoprotective drug

Accepted Answer

If symptoms persist after 12 weeks of PPI therapy, referral for endoscopy is recommended to evaluate for complications or other causes of symptoms.

Question 9

Treatment failure in patients with peptic ulcer disease associated with H.pylori may be due to:&#10;A) Antimicrobial resistance&#10;B) Ineffective antacid&#10;C) Overuse of proton pump inhibitors&#10;D) All of the above

Accepted Answer

Antimicrobial resistance is a common reason for treatment failure in H.pylori-associated peptic ulcer disease, as it can render antibiotics ineffective.

Question 10

Gastroesophageal reflux disease (GERD)may be aggravated by the following medication that effects lower esophageal sphincter (LES)tone:&#10;A) Calcium carbonate&#10;B) Estrogen&#10;C) Furosemide&#10;D) Metoclopramide

Accepted Answer

Estrogen can decrease the tone of the lower esophageal sphincter, potentially aggravating GERD symptoms.

Question 11

Antacids treat GERD by:&#10;A) Increasing lower esophageal tone&#10;B) Increasing gastric pH&#10;C) Inhibiting gastric acid secretion&#10;D) Increasing serum calcium level

Accepted Answer

The answer of Antacids treat GERD by:&#10;A) Increasing lower esophageal...

Question 12

When treating patients using the "Step-Down" approach the patient with GERD is started on first. A) Antacids B) Histamine₂receptor antagonists C) Prokinetics D) Proton pump inhibitors

Accepted Answer

The answer of When treating patients using the &#34;Step-Down&#34; approach...

Question 13

An acceptable first-line treatment for peptic ulcer disease with positive H.pylori test is: A) Histamine₂receptor antagonists for 4 to 8 weeks B) Proton pump inhibitor BID for 12 weeks until healing is complete C) Proton pump inhibitor BID plus clarithromycin plus amoxicillin for 14 days D) Proton pump inhibitor BID and levofloxacin for 14 days

Accepted Answer

The answer of An acceptable first-line treatment for peptic ulcer...

Question 14

If a patient with H.pylori positive peptic ulcer disease fails first-line therapy the second-line treatment is:&#10;A) Proton pump inhibitor BID plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days&#10;B) Test H.pylori for resistance to common treatment regimens&#10;C) Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days&#10;D) Proton pump inhibitor and levofloxacin for 14 days

Accepted Answer

The answer of If a patient with H.pylori positive peptic...

Deck 34: Gastroesophageal Reflux and Peptic Ulcer Disease