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

Long-term use of proton pump inhibitors (PPIs) can lead to decreased calcium absorption, increasing the risk of hip fractures, especially in at-risk individuals. There is no strong evidence linking PPIs to vitamin B6 deficiency or liver cancer.

Question 2

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

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

Question 3

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

Referral for endoscopy is the next step when a patient has been on proton pump inhibitors twice daily for 12 weeks and not improving. This is because endoscopy allows for visualization of the esophagus and stomach to identify any structural abnormalities or underlying conditions that may be causing the symptoms. Adding a prokinetic or switching to another proton pump inhibitor may be considered if the endoscopy is negative, but endoscopy is the first step to rule out any serious conditions. Adding a cytoprotective drug is not recommended as it is not a first-line treatment for GERD.

Question 4

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 5

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

Proton pump inhibitors are the first-line treatment for gastroesophageal reflux disease in the step-down approach, as they provide more efficient and sustained acid suppression compared to antacids or histamine receptor antagonists. Prokinetics may also be added to enhance esophageal clearance, but they are typically added after proton pump inhibitors have been initiated.

Question 6

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 (GERD) is not improving despite taking a proton pump inhibitor (PPI) daily, the next step would be to increase the dose of the PPI rather than switch to a different class of medication. Therefore, the best choice would be option B, which suggests doubling the dose of the PPI for a period of 4 to 8 weeks. Option A (prokinetic) may be considered if symptoms persist despite the increased PPI dose, but it is not the first-line treatment in this situation. Option C (histamine receptor antagonist) is generally not recommended for patients with GERD as it is less effective than PPIs. Option D (cytoprotective drug) is not typically used for GERD and is reserved for other conditions such as NSAID-induced gastric ulcers.

Question 7

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 8

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

While ranitidine is a histamine receptor antagonist that can be effective in treating GERD symptoms, the patient has been self-treating with it and is still experiencing symptoms. This suggests that a stronger medication may be necessary. The most effective first-line treatment for GERD is a proton pump inhibitor like omeprazole, which decreases acid production and allows the esophagus to heal. A prokinetic like metoclopramide may be used in addition to a PPI if the patient has delayed gastric emptying, but it is not the initial recommended treatment. Misoprostol is a cytoprotective medication that may be used in certain cases to prevent ulcers, but it is not typically used as a first-line treatment for GERD.

Question 9

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

Metoclopramide increases lower esophageal tone, which helps to prevent the reflux of stomach acid into the esophagus. It does not reduce acid secretion or increase gastric pH, and it does not decrease lower esophageal tone (which would worsen reflux symptoms).

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 best first-line treatment for positive H. pylori test is triple therapy with proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days. This regimen has been shown to achieve high eradication rates and is recommended by most guidelines. Histamine receptor antagonists may be used as an alternative treatment but are less effective than triple therapy. Proton pump inhibitors alone are not recommended as the first-line treatment unless the patient has previously failed H. pylori eradication therapy. Levofloxacin-based triple therapy can be used as an alternative treatment if the patient has allergies to penicillin or clarithromycin.

Question 11

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

The answer of Infants with reflux are initially treated with:&#10;A)...

Question 12

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 13

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 14

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

The answer of After H. pylori treatment is completed, the...

Deck 34: Gastroesophageal Reflux and Peptic Ulcer Disease