[MCQ] Peptic Ulcer Disease- Part 5

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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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See all quizzes of Peptic Ulcer Disease at here:

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.Organs involved in MEN I syndrome are all except ?
A. Parathyroid
B. Thyroid
C. Pancreas
D. Pituitary

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

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

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

5. Elevated fasting gastrin level are due to all except ?
A. Hypochlorhydria
B. Renal insufficiency
C. Diabetes mellitus
D. Hypertension

6. Elevated fasting gastrin level are due to all except ?
A. Rheumotoid arthritis
B. Ankylosing arthritis
C. Pheochromocytoma
D. Vitiligo

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
8. What value of BAO / MAO is highly suggestive of ZES ?
A. < 0.3
B. < 0.6
C. > 0.3
D. > 0.6

9.What level of basal gastric pH excludes gastrinoma ?
A. >= 1
B. >= 1.5
C. >= 2
D. >= 3

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

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

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

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
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

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

16.To avoid stress ulceration, gastric pH should be maintained at?
A. > 1.5
B. > 2.0
C. > 2.5
D. > 3.5

17.Treatment of choice for stress ulcer prophylaxis is ?
A. H2 blocker
B. PPI
C. Sucralfate
D. All of the above

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

19. Which of the following are affected by Phlegmonous gastritis ?
A. Elderly individuals
B. Alcoholics
C. AIDS patients
D. All of the above

20. Organism associated with Phlegmonous gastritis is ?
A. Staphylococci
B. Escherichia coli
C. Haemophilus
D. All of the above

21. The final stage of chronic gastritis is ?
A. Superficial gastritis
B. Atrophic gastritis
C. Gastric atrophy
D. Intestinal metaplasia

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

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

24. Parietal cell antibodies are directed against which of the following ?
A. Gastrin receptors
B. Acetylcholine receptors
C. Histamine receptors
D. H+,K+-ATPase

25. Varioliform gastritis best relates to ?
A. Lymphocytic gastritis
B. Eosinophilic gastritis
C. Granulomatous gastritis
D. Sarcoidosis

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

27. Large gastric folds can be seen in ?
A. ZES
B. Gastric malignancy
C. Sarcoidosis
D. All of the above
28. Which of the following decreases protein loss in Ménétrier’s disease ?
A. Anticholinergic agents
B. Prednisone
C. H
2 receptor antagonists
D. PPIs

Peptic Ulcer Disease

[MCQ] Peptic Ulcer Disease- Part 5

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Peptic Ulcer Disease- Part 5

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