Question 1

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

Hip fractures in at-risk persons

Question 2

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) A proton pump inhibitor for 8 to 12 weeks until healing is complete&#10;D) All of the above&#10;

Accepted Answer

After H. pylori treatment is completed, it is recommended to continue therapy with a proton pump inhibitor for 8 to 12 weeks until the ulcers have healed. Testing for H. pylori eradication and endoscopy may also be indicated, but the primary next step is continued acid suppression with a PPI.

Question 3

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

Accepted Answer

Antacids work by neutralizing stomach acid, thereby increasing gastric pH. This can provide relief from symptoms of gastroesophageal reflux disease.

Question 4

Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD). Food or drink that may aggravate GERD include:&#10;A) Eggs&#10;B) Caffeine&#10;C) Chocolate&#10;D) Soda pop&#10;

Accepted Answer

The answer of Lifestyle changes are the first step in...

Question 5

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: 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

OTC ranitidine may provide some relief for gastroesophageal reflux disease symptoms, but it is not as effective as a proton pump inhibitor. The appropriate treatment would be a proton pump inhibitor (such as omeprazole) for at least 12 weeks. Prokinetic agents (metoclopramide) may be used in addition to a proton pump inhibitor if further symptom relief is needed. Histamine receptor antagonists (such as ranitidine) are another option, but they are not as effective as proton pump inhibitors and are typically used as second-line therapy. Cytoprotective drugs (such as misoprostol) are not commonly used for gastroesophageal reflux disease.

Question 6

The next step in treatment when a patient has been on proton pump inhibitors twice daily for 12 weeks and not improving 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&#10;

Accepted Answer

If a patient has been on proton pump inhibitors twice daily for 12 weeks and there has been no improvement, it is important to refer them for endoscopy to assess the underlying cause of their symptoms. This is especially important in patients who are older, have symptoms such as dysphagia or weight loss, or have a family history of gastrointestinal cancer. Adding a prokinetic or switching to another proton pump inhibitor may be considered after endoscopy, but it is important to identify the underlying cause of the symptoms first. Adding a cytoprotective drug may be considered if the endoscopy identifies erosive esophagitis, but not as the first step after 12 weeks of proton pump inhibitor treatment without improvement.

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

Anti-reflux maneuvers such as elevating the head of the bed are the initial treatment for infants with reflux. Drug therapies such as histamine receptor antagonists and proton pump inhibitors are reserved for cases where non-pharmacological measures fail. Prokinetics like metoclopramide are not recommended for use in infants.

Question 8

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&#10;

Accepted Answer

Second-line treatment for H. pylori-positive peptic ulcer disease often involves a combination therapy that includes a proton pump inhibitor (PPI) twice daily, metronidazole, tetracycline, and bismuth subsalicylate for 14 days. This regimen is recommended when first-line therapy fails, providing a different combination of antibiotics to overcome potential antibiotic resistance.

Question 9

If a patient with gastroesophageal reflux disease who is taking a proton pump inhibitor daily is not improving, the plan of care would be: 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

If a patient with gastroesophageal reflux disease who is taking a proton pump inhibitor daily is not improving, increasing the dose or frequency of the proton pump inhibitor is the first step. Adding a prokinetic (metoclopramide) or histamine₂receptor antagonist (ranitidine) may also be considered, but increasing the proton pump inhibitor dose is the best initial approach. Cytoprotective drugs like misoprostol are not typically used for GERD.

Question 10

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 most effective first-line treatment for peptic ulcer disease with positive H. pylori test is a combination therapy of a proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days. This regimen has a higher eradication rate compared to treatment with a proton pump inhibitor alone or histamine receptor antagonists. The use of levofloxacin as an alternative to clarithromycin should be reserved for cases with resistance or intolerance to clarithromycin.

Question 11

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

Accepted Answer

The answer of Gastroesophageal reflux disease may be aggravated by...

Question 12

When treating patients using the "Step-Down" approach the patient with gastroesophageal reflux disease 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

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

Accepted Answer

The answer of Treatment failure in patients with peptic ulcer...

Question 14

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

Accepted Answer

The answer of Metoclopramide improves gastroesophageal reflux disease symptoms by:&#10;A)...

Deck 34: Gastroesophageal Reflux and Peptic Ulcer Disease