PUD/GERD PANCE-Style Questions PDF

**PUD/GERD PANCE-Style Questions** **1.**\ **Question**: What is the primary mechanism underlying gastroesophageal reflux disease (GERD)?\ **Choices**:\ A. Increased gastric acid production\ B. Relaxation of the lower esophageal sphincter\ C. Delayed gastric emptying\ D. Impaired esophageal perista...

**PUD/GERD PANCE-Style Questions** **1.**\ **Question**: What is the primary mechanism underlying gastroesophageal reflux disease (GERD)?\ **Choices**:\ A. Increased gastric acid production\ B. Relaxation of the lower esophageal sphincter\ C. Delayed gastric emptying\ D. Impaired esophageal peristalsis\ **Correct Answer**: B\ **Explanation**: GERD is primarily caused by transient relaxation of the lower esophageal sphincter, allowing reflux of gastric contents into the esophagus. **2.**\ **Question**: Which of the following medications is most likely to worsen GERD symptoms?\ **Choices**:\ A. Antacids\ B. Calcium channel blockers\ C. Proton pump inhibitors (PPIs)\ D. H2 receptor antagonists\ **Correct Answer**: B\ **Explanation**: Calcium channel blockers relax the lower esophageal sphincter, increasing the risk of reflux and worsening GERD symptoms. **3.**\ **Question**: A patient with a BMI of 35 has frequent GERD symptoms. What is the first-line nonpharmacologic recommendation?\ **Choices**:\ A. Eliminate all dairy products\ B. Weight loss and dietary modifications\ C. Start a bland diet\ D. Take herbal supplements\ **Correct Answer**: B\ **Explanation**: Weight loss and dietary changes, such as avoiding trigger foods, are first-line nonpharmacologic recommendations for GERD management. **4.**\ **Question**: What is the first-line pharmacologic therapy for moderate to severe GERD?\ **Choices**:\ A. H2 receptor antagonists\ B. Proton pump inhibitors (PPIs)\ C. Antacids\ D. Prokinetic agents\ **Correct Answer**: B\ **Explanation**: Proton pump inhibitors are the most effective pharmacologic therapy for moderate to severe GERD, reducing gastric acid secretion and promoting mucosal healing. **5.**\ **Question**: Which of the following is a complication of untreated GERD?\ **Choices**:\ A. Esophageal stricture\ B. Colonic polyps\ C. Barrett\'s esophagus\ D. Both A and C\ **Correct Answer**: D\ **Explanation**: Untreated GERD can lead to complications such as esophageal strictures and Barrett's esophagus, a precursor to esophageal cancer. **6.**\ **Question**: What is the most common cause of peptic ulcer disease (PUD)?\ **Choices**:\ A. NSAID use\ B. Alcohol consumption\ C. H. pylori infection\ D. Stress\ **Correct Answer**: C\ **Explanation**: Helicobacter pylori infection is the most common cause of PUD, followed by NSAID use. **7.**\ **Question**: Which medication is indicated for NSAID-induced PUD prevention?\ **Choices**:\ A. Sucralfate\ B. Misoprostol\ C. Omeprazole\ D. Metronidazole\ **Correct Answer**: B\ **Explanation**: Misoprostol, a prostaglandin analog, is effective in preventing NSAID-induced ulcers by enhancing mucosal protection. **8.**\ **Question**: What is the primary mechanism of action of proton pump inhibitors (PPIs) in GERD and PUD management?\ **Choices**:\ A. Inhibition of H+/K+ ATPase\ B. Blockage of histamine H2 receptors\ C. Neutralization of stomach acid\ D. Enhancement of gastric motility\ **Correct Answer**: A\ **Explanation**: PPIs inhibit the H+/K+ ATPase in gastric parietal cells, reducing gastric acid secretion. **9.**\ **Question**: Which of the following medications can be used to protect the gastric mucosa without altering gastric acid production?\ **Choices**:\ A. Sucralfate\ B. Omeprazole\ C. Famotidine\ D. Misoprostol\ **Correct Answer**: A\ **Explanation**: Sucralfate forms a protective barrier over ulcers without affecting gastric acid production. **10.**\ **Question**: A patient presents with duodenal ulcer symptoms. Which of the following findings suggests H. pylori infection?\ **Choices**:\ A. Positive urea breath test\ B. Negative stool antigen test\ C. Positive anti-parietal cell antibodies\ D. Positive stool occult blood test\ **Correct Answer**: A\ **Explanation**: A positive urea breath test is a reliable indicator of H. pylori infection, a common cause of duodenal ulcers. **11.**\ **Question**: What is the recommended first-line therapy for H. pylori eradication?\ **Choices**:\ A. Triple therapy: PPI + clarithromycin + amoxicillin\ B. Bismuth-based quadruple therapy\ C. Ciprofloxacin and metronidazole\ D. High-dose antacids and sucralfate\ **Correct Answer**: A\ **Explanation**: Triple therapy with a PPI, clarithromycin, and amoxicillin is the first-line treatment for H. pylori eradication in areas with low macrolide resistance. **12.**\ **Question**: Which of the following is a contraindication to long-term PPI use?\ **Choices**:\ A. Chronic kidney disease\ B. Osteoporosis\ C. H. pylori infection\ D. Barrett\'s esophagus\ **Correct Answer**: A\ **Explanation**: Long-term PPI use is associated with an increased risk of chronic kidney disease, necessitating caution in these patients. **13.**\ **Question**: Which feature differentiates gastric ulcers from duodenal ulcers?\ **Choices**:\ A. Gastric ulcers are relieved by eating.\ B. Duodenal ulcers are exacerbated by eating.\ C. Gastric ulcers often present with weight loss.\ D. Duodenal ulcers rarely occur with H. pylori infection.\ **Correct Answer**: C\ **Explanation**: Gastric ulcers are often associated with weight loss, as eating exacerbates pain, whereas duodenal ulcers are relieved by eating. **14.**\ **Question**: Which medication should be avoided in a patient with known GERD?\ **Choices**:\ A. Proton pump inhibitors\ B. Calcium channel blockers\ C. Antacids\ D. H2 receptor antagonists\ **Correct Answer**: B\ **Explanation**: Calcium channel blockers can worsen GERD by relaxing the lower esophageal sphincter. **15.**\ **Question**: A patient with GERD has been on PPIs for six months. What is a potential adverse effect of prolonged therapy?\ **Choices**:\ A. Vitamin B12 deficiency\ B. Hyperkalemia\ C. Polycythemia\ D. Hypercalcemia\ **Correct Answer**: A\ **Explanation**: Prolonged PPI use can reduce gastric acid, impairing the absorption of vitamin B12 and potentially leading to deficiency. **16.**\ **Question**: Which of the following is a risk factor for NSAID-induced peptic ulcers?\ **Choices**:\ A. Advanced age\ B. Use of selective COX-2 inhibitors\ C. High-dose PPI use\ D. Absence of H. pylori infection\ **Correct Answer**: A\ **Explanation**: Advanced age is a significant risk factor for NSAID-induced peptic ulcers due to increased vulnerability of the gastric mucosa. **17.**\ **Question**: What is the mechanism of action of misoprostol in ulcer prevention?\ **Choices**:\ A. Enhances gastric emptying\ B. Inhibits gastric acid secretion\ C. Increases mucus and bicarbonate secretion\ D. Forms a protective mucosal barrier\ **Correct Answer**: C\ **Explanation**: Misoprostol is a prostaglandin analog that enhances mucosal protection by increasing mucus and bicarbonate secretion. **18.**\ **Question**: A patient is prescribed sucralfate for PUD. What is the most important counseling point?\ **Choices**:\ A. Take with meals for maximum effect.\ B. Avoid taking other medications within 2 hours.\ C. Limit fluid intake during therapy.\ D. Combine with antacids for enhanced relief.\ **Correct Answer**: B\ **Explanation**: Sucralfate can interfere with the absorption of other medications, so patients should avoid taking other drugs within 2 hours of sucralfate. **19.**\ **Question**: Which of the following medications is most appropriate for preventing stress-related mucosal disease in ICU patients?\ **Choices**:\ A. H2 receptor antagonists\ B. Proton pump inhibitors\ C. Antacids\ D. Both A and B\ **Correct Answer**: D\ **Explanation**: Both H2 receptor antagonists and PPIs are effective in preventing stress ulcers in critically ill patients. **20.**\ **Question**: A patient presents with GERD symptoms despite optimal PPI therapy. What is the next step in management?\ **Choices**:\ A. Increase PPI dosage\ B. Add an H2 receptor antagonist at bedtime\ C. Perform esophageal pH monitoring\ D. Switch to antacids\ **Correct Answer**: C\ **Explanation**: Esophageal pH monitoring is indicated to confirm the diagnosis and evaluate the effectiveness of therapy in refractory GERD. **21.**\ **Question**: Which of the following is the most common side effect of bismuth subsalicylate therapy in H. pylori eradication?\ **Choices**:\ A. Diarrhea\ B. Black stools\ C. Headache\ D. Constipation\ **Correct Answer**: B\ **Explanation**: Bismuth subsalicylate can cause harmless black discoloration of stools and the tongue. **22.**\ **Question**: A patient with chronic GERD symptoms is diagnosed with Barrett\'s esophagus. What is the primary goal of treatment in this condition?\ **Choices**:\ A. Promote ulcer healing\ B. Prevent progression to esophageal adenocarcinoma\ C. Treat current esophageal stricture\ D. Eliminate acid reflux symptoms completely\ **Correct Answer**: B\ **Explanation**: Barrett's esophagus is a premalignant condition, and treatment focuses on preventing progression to esophageal adenocarcinoma. **23.**\ **Question**: Which of the following increases the risk of NSAID-induced gastric ulcers?\ **Choices**:\ A. Use of low-dose aspirin\ B. Concomitant PPI therapy\ C. Use of acetaminophen\ D. Vegetarian diet\ **Correct Answer**: A\ **Explanation**: Low-dose aspirin, often used for cardiovascular protection, increases the risk of gastric ulcers, especially when combined with NSAIDs. **24.**\ **Question**: What is the recommended duration of therapy for H. pylori eradication?\ **Choices**:\ A. 3-5 days\ B. 7-10 days\ C. 10-14 days\ D. 14-21 days\ **Correct Answer**: C\ **Explanation**: Standard H. pylori eradication regimens typically last 10-14 days to ensure efficacy. **25.**\ **Question**: Which diagnostic test is most accurate for confirming H. pylori eradication after treatment?\ **Choices**:\ A. Stool antigen test\ B. Urea breath test\ C. Serum IgG antibodies\ D. Endoscopic biopsy\ **Correct Answer**: B\ **Explanation**: The urea breath test is a noninvasive, accurate method for confirming H. pylori eradication after therapy. **26.**\ **Question**: Which lifestyle modification is least likely to improve GERD symptoms?\ **Choices**:\ A. Avoiding trigger foods\ B. Elevating the head of the bed\ C. Increasing fluid intake before bedtime\ D. Weight loss\ **Correct Answer**: C\ **Explanation**: Increasing fluid intake before bedtime may exacerbate GERD symptoms by increasing gastric volume and the risk of reflux. **27.**\ **Question**: A patient on long-term PPI therapy develops fatigue and glossitis. What is the most likely diagnosis?\ **Choices**:\ A. Iron deficiency anemia\ B. Vitamin B12 deficiency\ C. Folate deficiency\ D. Vitamin D deficiency\ **Correct Answer**: B\ **Explanation**: Long-term PPI use can reduce gastric acid secretion, impairing vitamin B12 absorption and leading to deficiency. **28.**\ **Question**: Which of the following PPIs is considered safe and effective for pregnant patients with GERD?\ **Choices**:\ A. Omeprazole\ B. Pantoprazole\ C. Esomeprazole\ D. Lansoprazole\ **Correct Answer**: D\ **Explanation**: Lansoprazole is commonly used in pregnancy and is considered safe and effective for managing GERD symptoms. **29.**\ **Question**: Which of the following therapies is most appropriate for a patient with Zollinger-Ellison syndrome?\ **Choices**:\ A. High-dose H2 receptor antagonists\ B. High-dose proton pump inhibitors\ C. Triple therapy for H. pylori\ D. Prokinetic agents\ **Correct Answer**: B\ **Explanation**: Zollinger-Ellison syndrome causes excessive gastric acid secretion, requiring high-dose PPI therapy for control. **30.**\ **Question**: A patient with PUD caused by NSAID use is started on a PPI. What is the expected duration of therapy?\ **Choices**:\ A. 2-4 weeks\ B. 4-8 weeks\ C. 8-12 weeks\ D. Lifelong therapy\ **Correct Answer**: B\ **Explanation**: PPI therapy is typically prescribed for 4-8 weeks to heal NSAID-induced ulcers and prevent recurrence. **31.**\ **Question**: What is a potential complication of chronic H. pylori infection if left untreated?\ **Choices**:\ A. Gastric adenocarcinoma\ B. Esophageal varices\ C. Pancreatitis\ D. Achalasia\ **Correct Answer**: A\ **Explanation**: Chronic H. pylori infection can lead to gastritis, gastric ulcers, and an increased risk of gastric adenocarcinoma. **32.**\ **Question**: Which of the following tests should be avoided in patients who have recently completed H. pylori treatment?\ **Choices**:\ A. Stool antigen test\ B. Serum IgG antibodies\ C. Urea breath test\ D. Endoscopic biopsy\ **Correct Answer**: B\ **Explanation**: Serum IgG antibodies can remain positive after H. pylori eradication and are not reliable for confirming treatment success. **33.**\ **Question**: What is the mechanism of action of H2 receptor antagonists in GERD management?\ **Choices**:\ A. Block histamine receptors on parietal cells\ B. Neutralize gastric acid\ C. Inhibit the H+/K+ ATPase pump\ D. Stimulate prostaglandin synthesis\ **Correct Answer**: A\ **Explanation**: H2 receptor antagonists block histamine receptors on parietal cells, reducing gastric acid secretion. **34.**\ **Question**: A patient with GERD is nonresponsive to standard PPI therapy. What is the next best step?\ **Choices**:\ A. Add a prokinetic agent\ B. Double the PPI dose\ C. Switch to an H2 receptor antagonist\ D. Perform upper endoscopy\ **Correct Answer**: D\ **Explanation**: Upper endoscopy is recommended for GERD patients who fail PPI therapy to evaluate for alternative diagnoses or complications. **35.**\ **Question**: Which of the following is the most appropriate initial treatment for stress-related mucosal disease in critically ill patients?\ **Choices**:\ A. PPIs\ B. Sucralfate\ C. Antacids\ D. Misoprostol\ **Correct Answer**: A\ **Explanation**: PPIs are commonly used for prophylaxis against stress-related mucosal disease in critically ill patients due to their effectiveness in reducing gastric acid production. **36.**\ **Question**: Which of the following is a hallmark feature of Zollinger-Ellison syndrome?\ **Choices**:\ A. Gastric acid hyposecretion\ B. Multiple, refractory peptic ulcers\ C. Esophageal stricture\ D. Weight gain\ **Correct Answer**: B\ **Explanation**: Zollinger-Ellison syndrome is characterized by excessive gastric acid secretion, leading to multiple, refractory peptic ulcers. **37.**\ **Question**: A patient with GERD is recommended to take antacids. What is the primary mechanism of action of antacids?\ **Choices**:\ A. Neutralize stomach acid\ B. Inhibit gastric acid production\ C. Enhance gastric emptying\ D. Block histamine H2 receptors\ **Correct Answer**: A\ **Explanation**: Antacids work by neutralizing existing stomach acid, providing quick symptom relief for GERD. **38.**\ **Question**: Which test is used to evaluate the severity of acid reflux in patients with GERD symptoms?\ **Choices**:\ A. Esophageal manometry\ B. Esophageal pH monitoring\ C. Endoscopy\ D. Barium swallow\ **Correct Answer**: B\ **Explanation**: Esophageal pH monitoring measures acid reflux and is used to assess the severity of GERD symptoms. **39.**\ **Question**: Which PPI is most appropriate for treating a patient with GERD and chronic kidney disease?\ **Choices**:\ A. Omeprazole\ B. Esomeprazole\ C. Lansoprazole\ D. Pantoprazole\ **Correct Answer**: D\ **Explanation**: Pantoprazole has minimal interactions with the renal system, making it a safer option for patients with chronic kidney disease. **40.**\ **Question**: Which of the following is an adverse effect of long-term H2 receptor antagonist use?\ **Choices**:\ A. Hypercalcemia\ B. Gynecomastia\ C. Constipation\ D. Pancreatitis\ **Correct Answer**: B\ **Explanation**: H2 receptor antagonists, particularly cimetidine, can cause gynecomastia due to antiandrogenic effects.