Question 1

Which of the following organisms is the causative agent in 90% to 99% of cases of pseudomembranous colitis?&#10;A) H. pylori&#10;B) C. difficile&#10;C) S. aureus&#10;D) C. albicans

Accepted Answer

Pseudomembranous colitis is a severe and sometimes fatal form of colitis that results from the overgrowth of Clostridium difficile in the large colon.C.difficile is a gram-positive,spore-forming anaerobic rod that has been found in sand,soil,and feces.C.difficile produces and releases potent enterotoxins that induce colitis and diarrhea.

Question 2

Which of the following is the most common oral complication associated with inflammatory bowel disease (IBD)?&#10;A) petechiae&#10;B) vascular pools&#10;C) sialadenitis&#10;D) aphthous ulcer-like lesions

Accepted Answer

Aphthous ulcer-like lesions occur in up to 20% of patients with ulcerative colitis.They typically are located on the alveolar,labial,and buccal mucosa,as well as the soft palate,uvula,and retromolar trigone,and they may be difficult to distinguish from aphthous lesions.Pyostomatitis vegetAnswer also can affect patients with ulcerative colitis and may aid in the diagnosis.Unique oral manifestations of Crohn's disease occur in approximately 20% of patients and may precede the diagnosis of gastrointestinal disease by several years.Features include atypical mucosal ulcerations and diffuse swelling of the lips and cheeks.

Question 3

Which of the following is/are components of currently recommended therapy when a peptic ulcer is confirmed and H.pylori is present?&#10;A) inhibitors of gastric acid secretion&#10;B) dissection of the vagus nerves from the gastric fundus&#10;C) antimicrobial agents&#10;D) a, b, and c&#10;E) a and c

Accepted Answer

Combination therapy is recommended because antisecretory drugs,such as histamine H₂ receptor antagonists and PPIs,provide rapid relief of pain and accelerate healing,and antibiotics are effective in eradicating H.pylori.Combination treatment accelerates healing and produces an ulcer-free state in 92% to 99% of treated patients.Elective surgical intervention largely has been abandoned in the management of peptic ulcer disease.Today,surgery is reserved primarily for complications of peptic ulcer disease,such as significant bleeding,perforation,and gastric outlet obstruction.

Question 4

Patients with IBD who have fewer than __ bowel movements per day with little or no blood,no fever,few symptoms,and a sedimentation rate below 20 mm/hour are considered to have mild disease and can receive dental care in the dentist's office.

A) 2
B) 4
C) 6
D) 8

Accepted Answer

Patients with fewer than 4 bowel movements per day can receive dental care in the dentist's office.Patients with moderate disease or severe disease-the latter defined as having 6 or more bowel movements per day with blood,fever,anemia,and a sedimentation rate higher than 30 mm/hour-are poor candidates for dental care and should be referred to their physician.

Question 5

Which of the following is characteristic of gastric peptic ulcers rather than duodenal peptic ulcers?&#10;A) epigastric pain that is long-standing&#10;B) diffuse rather than localized epigastric pain&#10;C) symptoms rapidly relieved in most cases by ingestion of food, milk, or antacids&#10;D) pain that most commonly manifests 90 minutes to 3 hours after eating

Accepted Answer

Many patients with an active peptic ulcer report no ulcer symptoms; however,most experience epigastric pain that is long-standing and sharply localized.The pain is described as burning or gnawing,but may be ill-defined or aching.The discomfort of a duodenal ulcer manifests most commonly on an empty stomach,usually 90 minutes to 3 hours after eating,and frequently awakens the patient in the middle of the night.Ingestion of food,milk,or antacids provides rapid relief in most cases.By contrast,patients with gastric ulcers are unpredictable in their response to food; in fact,eating may precipitate abdominal pain.

Question 6

Which of the following is the most common cause of peptic ulcer disease?&#10;A) cytomegalovirus infection&#10;B) acid hypersecretion&#10;C) H. pylori infection&#10;D) use of nonsteroidal anti-inflammatory medication

Accepted Answer

The primary etiologic factor is H.pylori.This organism is present in 60% to 90% of duodenal ulcers and in 50% to 70% of gastric ulcers.Use of NSAIDs is the second most common cause of peptic ulcer disease.Other aggressive factors include acid hypersecretion,cigarette smoking,and psychological and physical stress.Cytomegalovirus infection is a rare cause noted in human immunodeficiency virus (HIV)-positive patients.Non-NSAID non-H.pylori peptic ulcers are infrequent and occur more often in elderly persons.

Question 7

Which of the following is the most common presenting manifestation of pseudomembranous colitis?&#10;A) &#34;red man&#34; syndrome&#10;B) diarrhea&#10;C) peptic ulcer&#10;D) acute hypertension

Accepted Answer

Diarrhea is the most common presenting manifestation of pseudomembranous colitis.In mild cases,the stool is watery and loose.In severe cases,bloody diarrhea is accompanied by abdominal cramps,tenderness,and fever.Severe dehydration,metabolic acidosis,hypotension,peritonitis,and toxic megacolon are serious complications of untreated disease.

Question 8

Which of the following is true of Crohn's disease?&#10;A) Crohn's disease is limited to the large intestine and the rectum.&#10;B) Crohn's disease affects men and women equally.&#10;C) Crohn's disease occurs more often in smokers.&#10;D) Most patients who have Crohn's disease require at least one operation for their condition.

Accepted Answer

Most patients with Crohn's disease require at least one operation.Crohn's disease is a trAnswermural process that may produce "patchy" ulcerations at any point along the alimentary canal,from the mouth to the anus,but most commonly involves the terminal ileum.Ulcerative colitis affects men and women equally,whereas Crohn's disease is slightly more common among women.Crohn's disease occurs more often in nonsmokers,whereas smoking protects against ulcerative colitis.

Question 9

Which is the most common location for peptic ulcers in Western populations?&#10;A) stomach&#10;B) duodenum&#10;C) jejunum&#10;D) ileum

Accepted Answer

The first portion of the duodenum is the location of most ulcers in Western populations,whereas gastric ulcers are more frequent in Asia.The upper jejunum rarely is involved.Peptic ulcers develop principally in regions of the gastrointestinal tract that are proximal to acid and pepsin secretions.

Deck 11: Gastrointestinal Disease