Deck 36: Gastroesophageal Reflux and Peptic Ulcer Disease

Question 1

After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is:

A)Testing for H. pylori eradication with a serum enzyme-linked immunosorbent assay (ELISA) test
B)Endoscopy by a specialist
C)A PPI for 8 to 12 weeks until healing is complete
D)All of the above

Answer 1

A PPI for 8 to 12 weeks until healing is complete

Question 2

Metoclopramide improves GERD symptoms by:

A)Reducing acid secretion
B)Increasing gastric pH
C)Increasing lower esophageal tone
D)Decreasing lower esophageal tone

Answer 2

Increasing lower esophageal tone

Question 3

Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone:

A)Calcium carbonate
B)Estrogen
C)Furosemide
D)Metoclopramide

Answer 3

Estrogen

Question 4

What would be the appropriate treatment for H. pylori in a patient who recently took azithromycin for "bronchitis"?

A)PPI b.i.d. plus clarithromycin plus amoxicillin for 14 days
B)Quadruple therapy with a PPI, bismuth, tetracycline, and metronidazole for 10 to 14 days
C)PPI and levofloxacin for 14 days
D)Triple therapy with PPI, bismuth, and levofloxacin

Question 5

If a patient with GERD who is taking a PPI daily is not improving, the plan of care would be:

A)Prokinetic (metoclopramide) for 8 to 12 weeks
B)PPI (omeprazole) twice a day for 4 to 8 weeks
C)Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks
D)Cytoprotective drug (misoprostol) for 4 to 8 weeks

Question 6

The next step in treatment when a patient has been on PPIs twice daily for 12 weeks and not improving is:

A)Add a prokinetic (metoclopramide).
B)Refer the patient for endoscopy.
C)Switch to another PPI.
D)Add a cytoprotective drug.

Question 7

Lifestyle changes are the first step in treatment of GERD. Food or drink that may aggravate GERD include:

A)Eggs
B)Caffeine
C)Chocolate
D)Soda pop

Question 8

Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of:

A)Antimicrobial resistance
B)An ineffective antacid
C)Overuse of PPIs
D)All of the above

Question 9

Long-term use of PPIs may lead to:

A)Hip fractures in at-risk persons
B)Vitamin B₆ deficiency
C)Liver cancer
D)All of the above

Question 10

Antacids treat GERD by:

A)Increasing lower esophageal tone
B)Increasing gastric pH
C)Inhibiting gastric acid secretion
D)Increasing serum calcium level

Question 11

Infants with reflux are initially treated with:

A)Histamine-2 receptor antagonist (ranitidine)
B)PPI (omeprazole)
C)Antireflux maneuvers (such as elevating the head of the bed)
D)Prokinetic (metoclopramide)

Question 12

If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the next step would be:

A)A PPI b.i.d. plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days
B)To test H. pylori for resistance to common treatment regimens
C)A PPI plus clarithromycin plus amoxicillin for 14 days
D)A PPI and levofloxacin for 14 days

Question 13

If a patient with symptoms of GERD states that he has been self-treating at home with over-the-counter (OTC) ranitidine daily, the appropriate treatment would be:

A)Prokinetic (metoclopramide) for 4 to 8 weeks
B)PPI (omeprazole) for 12 weeks
C)Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks
D)Cytoprotective drug (misoprostol) for two weeks

Question 14

An acceptable first-line treatment for peptic ulcer disease with positive Helicobacter pylori (H. pylori) test is:

A)Histamine-2 receptor antagonists for 4 to 8 weeks
B)PPI bid for 12 weeks until healing is complete
C)PPI bid plus clarithromycin plus amoxicillin for 14 days
D)PPI bid and levofloxacin for 14 days

Question 15

A patient with mild GERD is started on _______ first.

A)Antacids
B)Histamine-2 receptor antagonists
C)Prokinetics
D)Proton pump inhibitors (PPIs)