[MCQ] Peptic Ulcer Disease- Part 4

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Peptic Ulcer Disease- Part 4

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Question 1

Proton Pump Inhibitors may interfere with absorption of ?

A	Ketoconazole
B	Iron
C	Digoxin
D	All of the above

Question 1 Explanation:

PPIs may interfere with absorption of ketoconazole, ampicillin, iron & digoxin.

Question 2

Hepatic cytochrome P450 can be inhibited by ?

A	Lansoprazole
B	Rabeprazole
C	Rabeprazole
D	Esomeprazole

Question 2 Explanation:

Hepatic cytochrome P450 can be inhibited by omeprazole & lansoprazole and not by Rabeprazole, pantoprazole and esomeprazole

Question 3

Long-term acid suppression with PPIs has been associated with a higher incidence of ?

A	Bacterial meningitis
B	Community-acquired pneumonia
C	Urinary tract infection
D	Gall stones

Question 3 Explanation:

Long-term acid suppression with PPIs is associated with higher incidence of community-acquired pneumonia

Question 4

PPI containing an imidazopyridine ring instead of a benzimidazole ring is ?

A	Rabeprazole
B	Pantoprazole
C	Tenatoprazole
D	Esomeprazole

Question 4 Explanation:

Tenatoprazole is a PPI containing an imidazopyridine ring instead of a benzimidazole ring.

Question 5

Which of the following is false about Sucralfate ?

A	Complex sucrose salt
B	Insoluble in water
C	To be avoided in chronic renal insufficiency
D	To be avoided in chronic renal insufficiency

Question 6

Black stools & darkening of tongue are adverse effects of ?

A	Misoprostol
B	Sucralfate
C	Colloidal bismuth subcitrate (CBS)
D	Colloidal bismuth subcitrate (CBS)

Question 6 Explanation:

Adverse effects with short-term usage of Colloidal bismuth subcitrate (CBS) and bismuth subsalicylate (BSS) include black stools, constipation and darkening of tongue

Question 7

Combination therapy for H. pylori infection should be given for a period of ?

A	7 days
B	14 days
C	21 days
D	28 days

Question 7 Explanation:

Combination therapy for H. pylori infection for 14 days provides the greatest efficacy

Question 8

First triple regimen therapy against H. pylori was ?

A	Amoxicillin + omeprazole + metronidazole
B	Bismuth + metronidazole + tetracycline
C	Clarithromycin + omeprazole + metronidazole
D	Lansoprazole + clarithromycin + amoxicillin

Question 8 Explanation:

First triple regimen therapy against H. pylori was bismuth, metronidazole & tetracy

Question 9

Which of the following is a treatment regimen for eradication of H. pylori infection ?

A	Triple therapy
B	Quadruple Therapy
C	Sequential therapy
D	All of the above

Question 10

Which of the following can heal GUs or DUs, independent of whether NSAIDs are discontinued ?

A	H2 receptor antagonist
B	PPIs
C	Misoprostol
D	Sucralfate

Question 10 Explanation:

Only PPIs can heal GUs or DUs, independent of whether NSAIDs are discontinued

Question 11

Test of choice for documenting eradication of H. pylori is ?

A	Biopsy urease test
B	Fecal H. pylori antigen test
C	13C- or 14C-urea breath test
D	Urinary Hp antigen test

Question 11 Explanation:

The test of choice for documenting eradication is the urea breath test (UBT)

Question 12

A GU is considered refractory if it fails to heal after how many weeks of therapy ?

A	4 weeks
B	8 weeks
C	12 weeks
D	16 weeks

Question 13

A DU is considered refractory if it fails to heal after how many weeks of therapy ?

A	4 weeks
B	8 weeks
C	12 weeks
D	16 weeks

Question 13 Explanation:

GU that fails to heal >12 weeks & a DU that does not heal >8 weeks of therapy is considered refractory

Question 14

Etiologies of refractory ulcers (GU / DU) include all except ?

A	Ischemia
B	Crohn’s disease
C	Ulcerative colitis
D	Amyloidosis

Question 15

Etiologies of refractory ulcers (GU / DU) include all except ?

A	Sarcoidosis
B	Lymphoma
C	Eosinophilic gastroenteritis
D	HIV

Question 16

Etiologies of refractory ulcers (GU / DU) include all except ?

A	Leprosy
B	Cytomegalovirus (CMV)
C	Tuberculosis
D	Syphilis

Question 16 Explanation:

Rare etiologies of refractory GU/DU’s include ischemia, Crohn’s disease, amyloidosis, sarcoidosis, lymphoma, eosinophilic gastroenteritis, cytomegalovirus (CMV), tuberculosis or syphilis

Question 17

Posterior DU can penetrate into ?

A	Pancreas
B	Colon
C	Liver
D	All of the above

Question 17 Explanation:

Posterior DU can penetrate into pancreas, colon, liver or biliary tree

Question 18

Which of the following is not a typical feature of Zollinger– Ellison Syndrome (ZES) ?

A	Gastrin release from beta cell endocrine tumor
B	Hypergastrinemia
C	Erosive esophagitis
D	Diarrhea

Question 18 Explanation:

Diarrhea

Question 19

In ZES, majority of patients are diagnosed between the ages of ?

A	01 and 10 years
B	10 and 30 years
C	30 and 50 years
D	50 and 70 years

Question 19 Explanation:

In ZES, males are more commonly affected than females, and majority of patients are diagnosed between the ages of 30 and 50 years

Question 20

Which of the following is the action of gastrin ?

A	Stimulates acid secretion through gastrin receptors on parietal cells
B	Stimulates acid secretion by inducing histamine release from ECL cells
C	Has a trophic action on gastric epithelial cells
D	All of the above

Question 21

‘Gastrinoma triangle’ is formed by all except ?

A	Cystic and common bile ducts
B	Junction of II and III portions of duodenum
C	Inferior surface of liver
D	Junction of neck & body of pancreas

Question 21 Explanation:

Hypothetical gastrinoma triangle is formed by confluence of cystic & common bile ducts superiorly, junction of second & third portions of duodenum inferiorly, and junction of neck & body of pancreas medially

Question 22

What proportion of gastrinoma are found within the hypothetical gastrinoma triangle ?

A	20 %
B	40 %
C	60 %
D	80 %

Question 22 Explanation:

Over 80% of gastrinoma are found within the hypothetical gastrinoma triangle.

Question 23

Which of the following is the most common extrapancreatic site of gastrinoma ?

A	Stomach
B	Duodenum
C	Liver
D	Lymph nodes

Question 23 Explanation:

Duodenal gastrinoma tumors constitute the most common nonpancreatic lesion (50 to75%). Lesscommon extrapancreatic sites include stomach, bones, ovaries, heart, liver, and lymph nodes.

Question 24

What proportion of gastrinoma are malignant ?

A	20 %
B	40 %
C	60 %
D	80 %

Question 24 Explanation:

More than 60% of gastrinoma tumors are considered malignant, with up to 30–50% of patients having multiple lesions or metastatic disease at presentation.

Question 25

Which of the following suggest the diagnosis of ZES ?

A	Ulcer in II part of duodenum & beyond
B	Ulcers refractory to standard medical therapy
C	Ulcer presenting with frank complication
D	All of the above

Question 25 Explanation:

Gastrinoma should be suspected when ulcers occur unusual locations like II part of duodenum & beyond, ulcers refractory to standard medical therapy, ulcer recurrence after acid-reducing surgery, ulcers presenting with frank complications (bleeding, obstruction, and perforation), or ulcers in the absence of H. pylori or NSAID ingestion

Question 26

What proportion of ZES patients have diarrhoea ?

A	25 %
B	50 %
C	75 %
D	100 %

Question 26 Explanation:

Diarrhea is the next most common clinical manifestation after peptic ulcer and is found in up to 50% of patients of ZES.

Question 27

Etiology of the diarrhea in ZES is ?

A	Volume overload to the small bowel
B	Pancreatic enzyme inactivation by acid
C	Damage of the intestinal epithelial surface by acid
D	All of the above

Question 27 Explanation:

In ZES, etiology of diarrhea is multifactorial, resulting from marked volume overload to small bowel, pancreatic enzyme inactivation by acid & damage of intestinal epithelial surface by acid.

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Peptic Ulcer Disease- Part 5

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Question 1

Organs involved in MEN I syndrome are all except ?

A	Parathyroid
B	Thyroid
C	Pancreas
D	Pituitary

Question 1 Explanation:

MEN I syndrome (autosomal dominant) involves parathyroid glands (80-90%), pancreas (40-80%), and pituitary gland (30-60%).

Question 2

Genetic defect in MEN I is in ?

A	Short arm of chromosome 11
B	Long arm of chromosome 11
C	Short arm of chromosome 12
D	Long arm of chromosome 12

Question 2 Explanation:

The genetic defect in MEN I is in the long arm of chromosome 11 (11q11-q13)

Question 3

Distinguishing feature between MEN I & sprodic ZES is ?

A	Incidence of gastric carcinoid tumor
B	Size, number & location of gastrinoma
C	Disease free period after surgery
D	All of the above

Question 3 Explanation:

Gastrinomas tend to be smaller, multiple, and located in the duodenal wall more often than is seen in patients with sporadic ZES. An additional distinguishing feature in ZES patients with MEN I is the higher incidence of gastric carcinoid tumor development (as compared to patients with sporadic gastrinomas). Gastrinomas tend to be smaller, multiple, and located in the duodenal wall more often than is seen in patients with sporadic ZES.

Question 4

Patients with gastrinoma have gastrin level more than ?

A	25 pg/mL
B	50 pg/mL
C	100 pg/mL
D	150 pg/mL

Question 4 Explanation:

Fasting gastrin levels are <150 pg/mL. All gastrinoma patients have a gastrin level >150 - 200 pg/mL

Question 5

Elevated fasting gastrin level are due to all except ?

A	Hypochlorhydria
B	Renal insufficiency
C	Diabetes mellitus
D	Hypertension

Question 6

Elevated fasting gastrin level are due to all except ?

A	Rheumotoid arthritis
B	Ankylosing arthritis
C	Pheochromocytoma
D	Vitiligo

Question 6 Explanation:

Elevated fasting gastrin level are due to gastric hypochlorhydria or achlorhydria, renal insufficiency, massive small-bowel obstruction, rheumatoid arthritis, vitiligo, diabetes mellitus & pheochromocytoma

Question 7

Patients with gastrinoma have a BAO level more than ?

A	4 meq/hour
B	8 meq/hour
C	12 meq/hour
D	15 meq/hour

Question 8

What value of BAO / MAO is highly suggestive of ZES ?

A	< 0.3
B	< 0.6
C	> 0.3
D	> 0.6

Question 8 Explanation:

BAO/MAO ratio >0.6 is highly suggestive of ZES, but a ratio <0.6 does not exclude the diagnosis

Question 9

What level of basal gastric pH excludes gastrinoma ?

A	>= 1
B	>= 1.5
C	>= 2
D	>= 3

Question 9 Explanation:

A basal gastric pH >=3 virtually excludes a gastrinoma.

Question 10

Which of the following is the most sensitive & specific gastrin provocative test ?

A	Secretin stimulation test
B	Calcium infusion study
C	Standard meal test
D	None of the above

Question 10 Explanation:

Most sensitive & specific gastrin provocative test for diagnosis of gastrinoma is secretin study. Increase in gastrin of >=120 pg within 15 minutes of secretin injection has a sensitivity & specificity of >90% for ZES. Calcium infusion study is less sensitive & specific with greater potential for adverse effects.

Question 11

Which of the following tests has maximum sensitivity in detecting primary gastrinoma ?

A	Selective arterial secretin injection (SASI)
B	Octreoscan imaging with 111In-pentreotide
C	Endoscopic ultrasonography (EUS)
D	Magnetic resonance imaging

Question 11 Explanation:

Sensitivity of EUS in Zollinger-Ellison Syndrome is 80 - 100%.

Question 12

Which of the following is a favorable prognostic indicator in ZES ?

A	Primary duodenal wall tumor
B	Isolated lymph node tumor
C	Undetectable tumor upon surgical exploration
D	All of the above

Question 12 Explanation:

In ZES, favorable prognostic indicators include primary duodenal wall tumors, isolated lymph node tumor, and undetectable tumor upon surgical exploration. Poor outcome indicators are shorter disease duration; higher gastrin levels (>10,000 pg/mL); large pancreatic primary tumors (>3 cm); metastatic disease to lymph nodes, liver, and bone and Cushing’s syndrome. Rapid growth of hepatic metastases is also predictive of poor outcome

Question 13

Procedure that provides the lowest rates of peptic ulcer recurrence but has highest complication rate is ?

A	Vagotomy
B	Billroth I
C	Vagotomy in combination with antrectomy
D	Billroth II

Question 14

Cushing’s ulcer refers to ?

A	Stress ulceration after head trauma
B	Stress ulceration after severe burns
C	Stress ulceration after mechanical ventilation
D	Stress ulceration after sepsis

Question 14 Explanation:

Elevated gastric acid secretion may be noted in patients with stress ulceration after head trauma (Cushing’s ulcer).

Question 15

Curling’s ulcer refers to ?

A	Stress ulceration after head trauma
B	Stress ulceration after severe burns
C	Stress ulceration after mechanical ventilation
D	Stress ulceration after sepsis

Question 15 Explanation:

Elevated gastric acid secretion may be noted in patients with stress ulceration after severe burns (Curling’s ulcer).

Question 16

To avoid stress ulceration, gastric pH should be maintained at ?

A	> 1.5
B	> 2.0
C	> 2.5
D	> 3.5

Question 16 Explanation:

Maintenance of gastric pH >3.5 with continuous infusion of H2 blockers or liquid antacids administered every 2–3 hours are viable options to avoid stress ulceration.

Question 17

Treatment of choice for stress ulcer prophylaxis is ?

A	H2 blocker
B	PPI
C	Sucralfate
D	All of the above

Question 17 Explanation:

PPIs are the treatment of choice for stress ulcer prophylaxis

Question 18

‘Phlegmonous gastritis’ refers to ?

A	Viral infection of stomach
B	Bacterial infection of stomach
C	Vascular congestion of stomach
D	All of the above

Question 18 Explanation:

Bacterial infection of the stomach or phlegmonous gastritis although rare is a potentially lifethreatening disorder characterized by marked & diffuse acute inflammatory infiltrates of entire gastric wall, at times accompanied by necrosis.

Question 19

Which of the following are affected by Phlegmonous gastritis ?

A	Elderly individuals
B	Alcoholics
C	AIDS patients
D	All of the above

Question 19 Explanation:

Elderly individuals, alcoholics, and AIDS patients may be affected by Phlegmonous gastritis

Question 20

Organism associated with Phlegmonous gastritis is ?

A	Staphylococci
B	Escherichia coli
C	Haemophilus
D	All of the above

Question 20 Explanation:

Organisms associated with Phlegmonous gastritis include streptococci, staphylococci, Escherichia coli, Proteus, and Haemophilus species.

Question 21

The final stage of chronic gastritis is ?

A	Superficial gastritis
B	Atrophic gastritis
C	Gastric atrophy
D	Intestinal metaplasia

Question 21 Explanation:

Early phase of chronic gastritis is superficial gastritis in which inflammatory changes are limited to lamina propria and intact gastric glands. Next stage is atrophic gastritis in which inflammatory infiltrate extends deeper into mucosa, with destruction of gastric glands. Final stage of chronic gastritis is gastric atrophy in which glandular structures are lost, and there is a paucity of inflammatory infiltrates. Endoscopically, mucosa is thin and underlying blood vessels can be visualized. Intestinal metaplasia refers to the conversion of gastric glands to small-bowel mucosal glands containing goblet cells. Intestinal metaplasia is an important predisposing factor for gastric cancer.

Question 22

Antral-predominant form of chronic gastritis is called ?

A	Type A gastritis
B	Type B gastritis
C	Type AB gastritis
D	Type O gastritis

Question 22 Explanation:

Chronic gastritis is also classified according to the predominant site of involvement. Type A refers to fundus and body predominant form , with antral sparing (autoimmune) and type B is the antralpredominant form (H. pylori–related). AB gastritis refers to a mixed antral/body picture

Question 23

Which of the following types of chronic gastritis is associated with pernicious anemia ?

A	Type A gastritis
B	Type B gastritis
C	Type AB gastritis
D	Type O gastritis

Question 23 Explanation:

Type A gastritis, also called autoimmune gastritis is associated with pernicious anemia with circulating antibodies against parietal cells and IF.

Question 24

Parietal cell antibodies are directed against which of the following ?

A	Gastrin receptors
B	Acetylcholine receptors
C	Histamine receptors
D	H+,K+-ATPase

Question 24 Explanation:

Antibodies to parietal cells are detected in >90% of patients with pernicious anemia and in up to 50% of patients with type A gastritis. The parietal cell antibody is directed against H+,K+-ATPase.

Question 25

Varioliform gastritis best relates to ?

A	Lymphocytic gastritis
B	Eosinophilic gastritis
C	Granulomatous gastritis
D	Sarcoidosis

Question 25 Explanation:

A subgroup of patients with lymphocytic gastritis have thickened folds noted on endoscopy. These folds are often capped by small nodules that contain a central depression or erosion; this form of the disease is called varioliform gastritis.

Question 26

Which of the following is false about Ménétrier’s disease ?

A	Protein-losing gastropathy
B	Large gastric mucosal folds in body and fundus
C	Hyperplasia of surface & glandular mucous cells
D	None of the above

Question 26 Explanation:

Ménétrier’s disease is not considered a form of gastritis. It is characterized by large, tortuous gastric mucosal folds.

Question 27

Large gastric folds can be seen in ?

A	ZES
B	Gastric malignancy
C	Sarcoidosis
D	All of the above

Question 28

Which of the following decreases protein loss in Ménétrier’s disease ?

A	Anticholinergic agents
B	Prednisone
C	H2 receptor antagonists
D	PPIs

Question 28 Explanation:

Medical therapy with anticholinergic agents, prostaglandins, PPIs, prednisone, and H2 receptor antagonists yields varying results. Anticholinergics decrease protein loss.

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Peptic Ulcer Disease- Part 1| Peptic Ulcer Disease- Part 2 | Peptic Ulcer Disease- Part 3 | Peptic Ulcer Disease- Part 4| Peptic Ulcer Disease- Part 5

1.Inhibitors may interfere with absorption of ?
A. Ketoconazole
B. Iron
C. Digoxin

D. All of the above

2. Hepatic cytochrome P450 can be inhibited by ?
A. Lansoprazole
B. Rabeprazole
C. Pantoprazole
D. Esomeprazole

2. Long-term acid suppression with PPIs has been associated
with a higher incidence of ?
A. Bacterial meningitis
B. Community-acquired pneumonia
C. Urinary tract infection
D. Gall stones

3. PPI containing an imidazopyridine ring instead of a
benzimidazole ring is ?
A. Rabeprazole
B. Pantoprazole
C. Tenatoprazole
D. Esomeprazole

4. Which of the following is false about Sucralfate ?
A. Complex sucrose salt
B. Insoluble in water
C. To be avoided in chronic renal insufficiency
D. None of the above
5. Black stools & darkening of tongue are adverse effects of ?
A. Misoprostol
B. Sucralfate
C. Colloidal bismuth subcitrate (CBS)
D. Proton Pump Inhibitors (PPI)

6. Combination therapy for H. pylori infection should be given
for a period of ?
A. 7 days
B. 14 days
C. 21 days
D. 28 days

7. First triple regimen therapy against H. pylori was ?
A. Amoxicillin + omeprazole + metronidazole
B. Bismuth + metronidazole + tetracycline
C. Clarithromycin + omeprazole + metronidazole
D. Lansoprazole + clarithromycin + amoxicillin

8. Which of the following is a treatment regimen for eradication
of H. pylori infection ?
A. Triple therapy
B. Quadruple Therapy
C. Sequential therapy
D. All of the above
9. Which of the following can heal GUs or DUs, independent of
whether NSAIDs are discontinued ?
A. H2 receptor antagonist
B. PPIs
C. Misoprostol
D. Sucralfate

10. Test of choice for documenting eradication of H. pylori is ?
A. Biopsy urease test
B. Fecal H. pylori antigen test
C. 13C- or 14C-urea breath test
D. Urinary Hp antigen test

11. A GU is considered refractory if it fails to heal after how many
weeks of therapy ?
A. 4 weeks
B. 8 weeks
C. 12 weeks
D. 16 weeks
12. A DU is considered refractory if it fails to heal after how many
weeks of therapy ?
A. 4 weeks
B. 8 weeks
C. 12 weeks
D. 16 weeks

13. Etiologies of refractory ulcers (GU / DU) include all except ?
A. Ischemia
B. Crohn’s disease

C. Ulcerative colitis
D. Amyloidosis
14. Etiologies of refractory ulcers (GU / DU) include all except ?
A. Sarcoidosis
B. Lymphoma
C. Eosinophilic gastroenteritis
D. HIV
15. Etiologies of refractory ulcers (GU / DU) include all except ?
A. Leprosy
B. Cytomegalovirus (CMV)
C. Tuberculosis
D. Syphilis

16. Posterior DU can penetrate into ?
A. Pancreas
B. Colon
C. Liver
D. All of the above

17. Which of the following is not a typical feature of Zollinger–
Ellison Syndrome (ZES) ?
A. Gastrin release from beta cell endocrine tumor
B. Hypergastrinemia
C. Erosive esophagitis
D. Diarrhea

18. In ZES, majority of patients are diagnosed between the ages of ?
A. 01 and 10 years
B. 10 and 30 years
C. 30 and 50 years
D. 50 and 70 years

19 Which of the following is the action of gastrin ?
A. Stimulates acid secretion through gastrin receptors on parietal cells
B. Stimulates acid secretion by inducing histamine release from ECL cells
C. Has a trophic action on gastric epithelial cells
D. All of the above

20. ‘Gastrinoma triangle’ is formed by all except ?
A. Cystic and common bile ducts
B. Junction of II and III portions of duodenum
C. Inferior surface of liver
D. Junction of neck & body of pancreas

21. What proportion of gastrinoma are found within the hypothetical gastrinoma triangle ?
A. 20 %
B. 40 %
C. 60 %
D. 80 %

22. Which of the following is the most common extrapancreatic
site of gastrinoma ?
A. Stomach
B. Duodenum
C. Liver
D. Lymph nodes

23 What proportion of gastrinoma are malignant ?
A. 20 %
B. 40 %
C. 60 %
D. 80 %

24 Which of the following suggest the diagnosis of ZES ?
A. Ulcer in II part of duodenum & beyond
B. Ulcers refractory to standard medical therapy
C. Ulcer presenting with frank complication
D. All of the above

25 What proportion of ZES patients have diarrhoea ?
A. 25 %
B. 50 %
C. 75 %

D. 100 %

26. Etiology of the diarrhea in ZES is ?
A. Volume overload to the small bowel
B. Pancreatic enzyme inactivation by acid
C. Damage of the intestinal epithelial surface by acid
D. All of the above

Peptic Ulcer Disease

[MCQ] Peptic Ulcer Disease- Part 4

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Peptic Ulcer Disease- Part 4

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Peptic Ulcer Disease- Part 5

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