Gastroenterology Medical Quizzes

[MCQ] Peptic Ulcer Disease- Part 3

by MedQuizzes October 28, 2021

written by MedQuizzes October 28, 2021

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Peptic Ulcer Disease- Part 3

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Question 1

Which of the following statements about H. pylori is false ?

A	Its genome contains 1.65 million base pairs
B	May transform into coccoid dormant form
C	Produces urease to convert urea to NH 3 and water
D	Single strain of H. pylori exist

Question 1 Explanation:

Multiple strains of H. pylori exist. Different diseases related to H. pylori infection can be attributed to different strains with distinct pathogenic features.

Question 2

Which of the following statements about H. pylori is false ?

A	80% population by age 20 years is infected in developing countries
B	Transmission occurs through faeco-oral route
C	Infection is associated with chronic active gastritis
D	BabA is vital for entry into gastric epithelial cell

Question 3

Which of the following statements about H. pylori is false ?

A	Express vacuolating cytotoxin VacA
B	Cag A and pic B are virulence factors
C	Its LPS has high immunologic activity
D	Neutrophil response is strong in acute & chronic H. pylori infection

Question 4

Which out of the following factors has a central role in H. pylori infection ?

A	Interleukin-1β
B	Interleukin-2
C	Interleukin-6
D	Interleukin-8

Question 5

Which of the following statements about H. pylori is false ?

A	Most pathogenic strains contain VacA pathogenicity island
B	5 of its genes are similar to Agrobacterium tumefaciens
C	Pathogenicity island proteins are involved in interleukin-8 production by gastric epithelial cells
D	Pathogenicity island proteins are involved in translocation of CagA from bacterium into host cell

Question 6

Adhesins for H. pylori include all except ?

A	BabA
B	AlpA
C	AlpB
D	HopY

Question 7

Which of the following statements about H. pylori is false ?

A	H. pylori is usually acquired in childhood
B	Acute infection causes transient hypochlorhydria
C	80-90% with chronic gastritis will never have symptoms
D	After eradication, reinfection rates are high

Question 7 Explanation:

Reinfection after successful eradication of H. pylori is rare in US. If recurrent infection occurs within first 6 months after completing therapy, most likely explanation is recrudescence and not reinfection

Question 8

Which of the following enzymes is not related to H. pylori– induced gastrointestinal disease ?

A	Urease
B	Vac A
C	GAD
D	Cag A

Question 8 Explanation:

Bacterial enzymes that cause H. pylori - induced gastrointestinal disease are Urease, Vac A & Cag A

Question 9

Chronic H. pylori infection may lead to ?

A	Antral predominant gastritis
B	Nonatrophic pangastritis
C	Corpus predominant atrophic gastritis
D	All of the above

Question 10

Asymptomatic H. pylori infection may be a consequence of ?

A	Antral predominant gastritis
B	Nonatrophic pangastritis
C	Corpus predominant atrophic gastritis
D	All of the above

Question 11

Which of the following consequences of chronic H. pylori infection leads to gastric cancer ?

A	Antral predominant gastritis
B	Nonatrophic pangastritis
C	Corpus predominant atrophic gastritis
D	All of the above

Question 11 Explanation:

Chronic H. pylori infection leading to corpus predominant atrophic gastritis going on to intestinal metaplasia is an important predisposing factor for gastric cancer.

Question 12

Which of the following consequences of chronic H. pylori infection leads to DU ?

A	Antral predominant gastritis
B	Nonatrophic pangastritis
C	Corpus predominant atrophic gastritis
D	All of the above

Question 12 Explanation:

Presence of antral-predominant gastritis is associated with DU formation.

Question 13

Which of the following consequences of chronic H. pylori infection leads to MALT lymphoma ?

A	Antral predominant gastritis
B	Nonatrophic pangastritis
C	Corpus predominant atrophic gastritis
D	All of the above

Question 13 Explanation:

Chronic infection with H. pylori is associated with development of a low-grade B cell lymphoma, gastric MALT lymphoma. (MALT refers to mucosal-associated lymphoid tissue)

Question 14

Which of the following about NSAIDs induced disease is false ?

A	NSAID-related GUs not accompanied by chronic active gastritis
B	No dose of NSAID is completely safe
C	Misoprostol is useful for active treatment
D	Misoprostol is useful for active treatment

Question 14 Explanation:

Primary prevention of NSAID-induced ulceration can be accomplished by misoprostol or a PPI.

Question 15

Risk factors that increase morbidity and mortality related to NSAID usage are all except ?

A	Advanced age
B	History of PUD
C	Concomitant use of iron

Question 16

Risk factors that increase morbidity and mortality related to NSAID usage are all except ?

A	High dose NSAIDs
B	Multiple NSAIDs
C	Concomitant use of anticoagulants
D	Spicy food

Question 16 Explanation:

Established risk factors for serious gastrointestinal complications from NSAIDs include advanced age, history of ulcer, concomitant use of glucocorticoids, high-dose NSAIDs, multiple NSAIDs,concomitant use of anticoagulants, and serious or multisystem disease. Possible risk factors include concomitant infection with H. pylori, cigarette smoking, and alcohol consumption

Question 17

Disorders that are associated with PUD include all except ?

A	Systemic mastocytosis
B	Chronic pulmonary disease
C	Chronic renal failure
D	Acute pancreatitis

Question 18

Disorders that are associated with PUD include all except ?

A	Cirrhosis
B	Nephrolithiasis
C	Hyperthyroidism
D	α1 antitrypsin deficiency

Question 18 Explanation:

Chronic disorders that have a strong association with PUD are systemic mastocytosis, chronic pulmonary disease, chronic renal failure, cirrhosis, nephrolithiasis, and alpha1-antitrypsin deficiency. Those with a possible association are hyperparathyroidism, coronary artery disease, polycythemia vera, and chronic pancreatitis

Question 19

The typical pain pattern in DU occurs ?

A	15 minutes to 1 hour after a meal
B	30 minutes to 2 hour after a meal
C	60 minutes to 3 hour after a meal
D	90 minutes to 3 hour after a meal

Question 19 Explanation:

Typical pain pattern in DU occurs 90 minutes to 3 hours after a meal and is frequently relieved by antacids or food. Pain that awakes the patient from sleep (between midnight and 3 AM) is the most discriminating symptom. In GU, nausea & weight loss occur more commonly & discomfort may be precipitated by food.

Question 20

Most common complication observed in PUD is ?

A	Gastrointestinal bleeding
B	Perforation
C	Gastric Outlet Obstruction
D	Malignancy

Question 20 Explanation:

Gastrointestinal bleeding is the most common complication observed in PUD followed by perforation and gastric outlet obstruction

Question 21

Out of the following, which is the least common ulcer-related complication ?

A	Gastric outlet obstruction
B	Gastrointestinal bleeding
C	Perforation
D	Malignancy

Question 21 Explanation:

Gastric outlet obstruction is the least common ulcer-related complication.

Question 22

GUs tend to perforate into the ?

A	Spleen
B	Pancreas
C	Left hepatic lobe
D	Left kidney

Question 22 Explanation:

GUs tend to penetrate into the left hepatic lobe while DUs tend to penetrate posteriorly into pancreas

Question 23

Non ulcer dyspepsia is typified by ?

A	Heartburn
B	Upper abdominal pain
C	Abdominal distension
D	Loss of appetite

Question 23 Explanation:

NUD (functional dyspepsia / essential dyspepsia) is typified by upper abdominal pain without presence of ulcer

Question 24

Tests for diagnosing H. pylori include ?

A	Biopsy urease test
B	Fecal H. pylori antigen test
C	13C- or 14C-urea breath test
D	All of the above

Question 24 Explanation:

Tests for diagnosing H. pylori include serologic testing, 13C- or 14C-urea breath test& fecal H. pylori (Hp) antigen test. urinary Hp antigen test & monoclonal antibody stool antigen test appear promising.

Question 25

Milk-alkali syndrome includes all except ?

A	Hypercalcemia
B	Hypophosphatemia
C	Renal calcinosis
D	Progression to renal insufficiency

Question 25 Explanation:

Milk-alkali syndrome comprises of hypercalcemia, hyperphosphatemia, possible renal calcinosis & progression to renal insufficiency.

Question 26

Structure of H2 receptor antagonists share homology with ?

A	Pepsin
B	Secretin
C	Gastrin
D	Histamine

Question 26 Explanation:

H2 receptor antagonists (cimetidine, ranitidine, famotidine & nizatidine) have structural homology with histamine

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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.Which of the following statements about H. pylori is false ?
A. Its genome contains 1.65 million base pairs
B. May transform into coccoid dormant form
C. Produces urease to convert urea to NH3 and water
D. Single strain of H. pylori exist

2. Which of the following statements about H. pylori is false ?
A. 80% population by age 20 years is infected in developing countries

B. Transmission occurs through faeco-oral route
C. Infection is associated with chronic active gastritis
D. BabA is vital for entry into gastric epithelial cell
3. Which of the following statements about H. pylori is false ?
A. Express vacuolating cytotoxin VacA
B. Cag A and pic B are virulence factors
C. Its LPS has high immunologic activity
D. Neutrophil response is strong in acute & chronic H. pylori infection
3. Which out of the following factors has a central role in H. pylori
infection ?
A. Interleukin-1
B. Interleukin-2
C. Interleukin-6
D. Interleukin-8
4. Which of the following statements about H. pylori is false ?
A. Most pathogenic strains contain VacA pathogenicity island
B. 5 of its genes are similar to Agrobacterium tumefaciens
C. Pathogenicity island proteins are involved in interleukin-8
production by gastric epithelial cells
D. Pathogenicity island proteins are involved in translocation of
CagA from bacterium into host cell
5. Adhesins for H. pylori include all except ?
A. BabA
B. AlpA
C. AlpB
D. HopY
6. Which of the following statements about H. pylori is false ?
A. H. pylori is usually acquired in childhood
B. Acute infection causes transient hypochlorhydria
C. 80-90% with chronic gastritis will never have symptoms
D. After eradication, reinfection rates are high

7. Which of the following enzymes is not related to H. pylori– induced gastrointestinal disease ?
A. Urease
B. Vac A
C. GAD
D. Cag A

8. Chronic H. pylori infection may lead to ?
A. Antral predominant gastritis
B. Nonatrophic pangastritis
C. Corpus predominant atrophic gastritis
D. All of the above
9. Asymptomatic H. pylori infection may be a consequence of ?
A. Antral predominant gastritis
B. Nonatrophic pangastritis
C. Corpus predominant atrophic gastritis
D. All of the above
10. Which of the following consequences of chronic H. pylori
infection leads to gastric cancer ?
A. Antral predominant gastritis
B. Nonatrophic pangastritis
C. Corpus predominant atrophic gastritis
D. All of the above

11. Which of the following consequences of chronic H. pylori
infection leads to DU ?
A. Antral predominant gastritis
B. Nonatrophic pangastritis
C. Corpus predominant atrophic gastritis
D. All of the above

12. Which of the following consequences of chronic H. pylori
infection leads to MALT lymphoma ?
A. Antral predominant gastritis
B. Nonatrophic pangastritis
C. Corpus predominant atrophic gastritis
D. All of the above

13. Which of the following about NSAIDs induced disease is false ?
A. NSAID-related GUs not accompanied by chronic active gastritis
B. No dose of NSAID is completely safe
C. Misoprostol is useful for active treatment
D. Selective COX-2 inhibitor useful in prophylactic therapy

14. Risk factors that increase morbidity and mortality related to NSAID usage are all except ?
A. Advanced age

B. History of PUD
C. Concomitant use of iron
D. Multisystem disease
15. Risk factors that increase morbidity and mortality related to
NSAID usage are all except ?
A. High dose NSAIDs
B. Multiple NSAIDs
C. Concomitant use of anticoagulants
D. Spicy food

16. Disorders that are associated with PUD include all except ?
A. Systemic mastocytosis
B. Chronic pulmonary disease
C. Chronic renal failure
D. Acute pancreatitis
17. Disorders that are associated with PUD include all except ?
A. Cirrhosis
B. Nephrolithiasis
C. Hyperthyroidism
D. 1 antitrypsin deficiency

18. The typical pain pattern in DU occurs ?
A. 15 minutes to 1 hour after a meal
B. 30 minutes to 2 hour after a meal
C. 60 minutes to 3 hour after a meal
D. 90 minutes to 3 hour after a meal

19. Most common complication observed in PUD is ?
A. Gastrointestinal bleeding
B. Perforation
C. Gastric Outlet Obstruction
D. Malignancy

20. Out of the following, which is the least common ulcer-related
complication ?
A. Gastric outlet obstruction

B. Gastrointestinal bleeding
C. Perforation
D. Malignancy

21. GUs tend to perforate into the ?
A. Spleen
B. Pancreas
C. Left hepatic lobe
D. Left kidney

22. Non ulcer dyspepsia is typified by ?
A. Heartburn
B. Upper abdominal pain
C. Abdominal distension
D. Loss of appetite

23. Tests for diagnosing H. pylori include ?
A. Biopsy urease test
B. Fecal H. pylori antigen test
C. 13C- or 14C-urea breath test
D. All of the above

24. Milk-alkali syndrome includes all except ?
A. Hypercalcemia
B. Hypophosphatemia
C. Renal calcinosis
D. Progression to renal insufficiency

25. Structure of H2 receptor antagonists share homology with ?
A. Pepsin
B. Secretin
C. Gastrin
D. Histamine

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