Peptic ulcer disease - Quiz
Peptic ulcer disease
  • 1. What is the recommended target INR for patients already on anticoagulants according to expert opinion?
A) 1.0
B) 2.0
C) 2.5
D) 1.5
  • 2. What is the increased risk of rebleeding for aspirin users after endoscopic treatment for bleeding peptic ulcers?
A) Ten times
B) Three times
C) Two times
D) Five times
  • 3. How much does the risk of death decrease at eight weeks after resuming aspirin in patients treated for bleeding peptic ulcers?
A) Two times
B) Ten times
C) Eight times
D) Five times
  • 4. Why should double antiplatelet agents not be stopped in patients with an indwelling blood vessel stent?
A) Risk of internal hemorrhage
B) Risk of vitamin K deficiency
C) High risk of stent thrombosis
D) Risk of INR fluctuation
  • 5. Which agent is preferred for treating severe bleeding in patients on warfarin?
A) Fresh frozen plasma
B) Recombinant factor VIIa
C) Prothrombin complex concentrates
D) Vitamin K
  • 6. Why is recombinant factor VIIa reserved only for life-threatening bleeding?
A) High risk of infection
B) Slow onset of action
C) High cost of treatment
D) High risk of thromboembolism
  • 7. Why should high doses of vitamin K be avoided in warfarin patients with stomach bleeding?
A) To reduce the time for rewarfarinisation
B) To avoid liver damage
C) To prevent allergic reactions
D) To improve INR stability
  • 8. What is the recommended antidote for bleeding caused by DOACs if administered within four hours?
A) Vitamin K
B) Fresh frozen plasma
C) Prothrombin complex concentrates
D) Activated charcoal
  • 9. What is the lifetime risk of developing a peptic ulcer?
A) 5% to 10%
B) 20% to 30%
C) 1% to 3%
D) 10% to 20%
  • 10. How many deaths were attributed to peptic ulcers in 2013?
A) 327,000
B) 301,000
C) 400,000
D) 200,000
  • 11. What is the approximate prevalence of H. pylori infection in a 30-year-old in Western countries?
A) 40%
B) 30%
C) 20%
D) 80%
  • 12. What is the estimated prevalence of H. pylori infection in third-world countries?
A) 40%
B) 70%
C) 20%
D) 50%
  • 13. What is the maximum prevalence ratio of H. pylori infection in developed countries?
A) 80%
B) 40%
C) 70%
D) 20%
  • 14. Which of these is a known method of H. pylori transmission?
A) Airborne droplets
B) Sharing food utensils
C) Direct skin contact
D) Mosquito bites
  • 15. What is a primary reason for the decreased incidence of peptic ulcer disease in recent decades?
A) Elimination of sugar from diets
B) Increased smoking cessation
C) New effective acid suppressants
D) Widespread vaccination
  • 16. Which factor is mentioned as contributing to the decreased rate of peptic ulcer disease?
A) Rational use of NSAIDs
B) Increased intake of vitamin K
C) Increased use of anticoagulants
D) Higher reliance on warfarin
  • 17. Compared to warfarin, why are DOACs recommended?
A) Cheaper in cost
B) More effective at preventing thromboembolism
C) Easier to reverse with vitamin K
D) Fewer interactions with food
  • 18. Which type of ulcer is specifically noted to be very tender upon palpation?
A) Esophageal ulcer
B) Meckel's diverticulum ulcer
C) Gastric ulcer
D) Duodenal ulcer
  • 19. Which Modified Johnson classification type is associated with the chronic use of NSAIDs?
A) Type II
B) Type III
C) Type V
D) Type I
  • 20. In the chronic form of a peptic ulcer, what do the borders look like?
A) Perpendicular with no surrounding inflammation
B) Smooth with no elevation
C) Irregular with elevated borders
D) Regular with elevated borders
  • 21. What four zones are present at the base of a gastric ulcer during the active phase?
A) Epithelial tissue, muscle tissue, blood vessels, and nerves
B) Fibrin, collagen, epithelial cells, and inflammatory exudate
C) Granuloma, fibrous tissue, necrotic debris, and mucus
D) Fibrinoid necrosis, inflammatory exudate, granulation tissue, and fibrous tissue
  • 22. Which medication is noted as the most popular agent for peptic ulcer prevention?
A) Proton pump inhibitor (PPI)
B) Aspirin
C) H2 antagonist
D) Misoprostol
  • 23. What is the primary drawback of using misoprostol for ulcer prevention?
A) It promotes abortion and causes gastrointestinal distress
B) It has high cardiovascular risks
C) It interacts negatively with proton pump inhibitors
D) It is ineffective against gastric ulcers
  • 24. What is the recommended treatment if clarithromycin resistance exceeds 15%?
A) Increased dosage of amoxicillin
B) Immediate surgery
C) Bismuth-containing quadruple therapy
D) Triple regimen therapy
  • 25. What is the eradication rate of the quadruple therapy mentioned in the text?
A) 60%
B) 70%
C) 90%
D) 80%
  • 26. In Modified Johnson classification, which type involves the pyloric channel within 3 cm of the pylorus?
A) Type I
B) Type II
C) Type III
D) Type IV
  • 27. A gastric peptic ulcer is defined as a perforation that penetrates which layers?
A) Muscularis mucosae and lamina propria
B) Serosa and muscularis propria
C) Submucosa and adventitia
D) Epithelium and basement membrane
  • 28. Which combination is recommended for patients with high cardiovascular risk?
A) Naproxen with PPI
B) Ibuprofen with PPI
C) Aspirin with H2 antagonist
D) Celecoxib with misoprostol
  • 29. What happens to the rate of H. pylori eradication if the duration of triple therapy is increased to 14 days?
A) It increases
B) It drops below 50%
C) It decreases
D) It stays the same
  • 30. What is the macroscopic appearance of the borders in the ulcerative form of gastric cancer?
A) Elevated and regular
B) Perpendicular
C) Irregular
D) Smooth
  • 31. What does a perforation lead to if left untreated?
A) Increased appetite
B) Catastrophic consequences
C) Immediate healing
D) Chronic constipation
  • 32. What is the result of contents spilling into the abdominal cavity during a perforation?
A) Acute chemical peritonitis
B) Pulmonary embolism
C) Systemic hypoglycemia
D) Viral gastroenteritis
  • 33. What is the first sign of a perforation?
A) Sudden intense abdominal pain
B) Severe diarrhea
C) High fever
D) Blurred vision
  • 34. Which syndrome is associated with sudden intense abdominal pain from a perforation?
A) Valentino's syndrome
B) Cushing's syndrome
C) Conn's syndrome
D) Zollinger-Ellison syndrome
  • 35. What is the death rate for a posterior gastric wall perforation involving the gastroduodenal artery?
A) 10%
B) 5%
C) 20%
D) 50%
  • 36. What is penetration in the context of peptic ulcers?
A) A narrowing of the pyloric canal
B) The spread of bacteria to the lungs
C) The thickening of the stomach wall
D) A hole leading into adjacent organs
  • 37. What is gastric outlet obstruction also known as?
A) Stenosis
B) Hyperchlorhydria
C) Metaplasia
D) Peritonitis
  • 38. What symptom is typically presented in cases of gastric outlet obstruction?
A) Severe vomiting
B) High fever
C) Internal bleeding
D) Severe constipation
  • 39. What is used to determine if an ulcer is cancerous?
A) Stool culture
B) Biopsies
C) Blood tests
D) Physical examination
  • 40. What enzyme does H. pylori secrete to create an alkaline environment?
A) Lipase
B) Amylase
C) Pepsin
D) Urease
  • 41. Which adhesin enables H. pylori to attach to the gastric epithelium?
A) Glucagon
B) Cortisol
C) BabA
D) Insulin
  • 42. Which gene encodes for the vacuolating cytotoxin in H. pylori?
A) VacA
B) CagA
C) OipA
D) PicB
  • 43. What causes duodenal cell metaplasia in the antrum?
A) Lack of stomach acid
B) Viral infection
C) An acidic environment
D) An alkaline environment
  • 44. What human gene encodes for Interleukin 1 beta?
A) BabA
B) IL1B
C) TNF
D) CagA
  • 45. What is the primary location of a gastric ulcer?
A) The gallbladder
B) The stomach
C) The esophagus
D) The small intestine
  • 46. Which of the following is a common cause of peptic ulcer disease?
A) Lack of physical exercise
B) Chronic dehydration
C) Excessive intake of spicy foods
D) Helicobacter pylori infection
  • 47. Which diagnostic test can be used to identify H. pylori?
A) Urine analysis
B) Liver function test
C) MRI scan
D) Urea breath test
  • 48. When is open surgery typically used for bleeding ulcers?
A) For all gastric ulcer cases
B) When endoscopic treatment is unsuccessful
C) Only in elderly patients
D) As the first line of treatment
  • 49. What is the primary effect of NSAIDs regarding ulcers?
A) They neutralize stomach acid
B) They can cause or worsen ulcers
C) They help heal the stomach lining
D) They kill H. pylori bacteria
  • 50. Which age group is mentioned as being more sensitive to the effects of NSAIDs?
A) Teenagers
B) Young adults
C) Older people
D) Children
  • 51. What symptom is described as a 'rush of saliva' following regurgitation?
A) Nausea
B) Waterbrash
C) Heartburn
D) Belching
  • 52. Which enzyme function do NSAIDs block, hindering prostaglandin production?
A) COX-1
B) COX-2
C) Lipoxygenase
D) Pepsinogen
  • 53. What is the primary cause of stress ulcers?
A) Physiological stress from serious health problems
B) Excessive spice consumption
C) High caffeine intake
D) Chronic psychological stress
  • 54. Which of the following is considered the gold standard for diagnosing peptic ulcer disease?
A) Blood antibody test
B) Esophagogastroduodenoscopy (EGD)
C) Barium contrast x-ray
D) Stool antigen test
  • 55. What is the hallmark of a perforated peptic ulcer on an erect chest X-ray?
A) Enlargement of the stomach lining
B) Presence of H. pylori colonies
C) Free gas underneath the diaphragm
D) Increased blood flow to the stomach
  • 56. Which medication category, if combined with NSAIDs, increases the risk of bleeding?
A) Anticoagulants
B) Antibiotics
C) Proton-pump inhibitors
D) Antacids
  • 57. Which substance is used in the urea breath test to detect H. pylori?
A) Nitrogen gas
B) Radioactive carbon
C) Barium sulfate
D) Hydrochloric acid
  • 58. What is the recommended age threshold for ordering diagnostic tests when ulcer symptoms first appear?
A) Over age 45
B) Over age 30
C) Over age 60
D) Over age 18
  • 59. Which of the following is identified as a rare gastrin-secreting tumor causing multiple ulcers?
A) Carcinoid
B) Lymphoma
C) Adenocarcinoma
D) Gastrinoma
  • 60. What is a potential side effect of taking antibiotics or proton-pump inhibitors before a blood test?
A) Severe allergic reaction
B) A false negative result
C) A false positive result
D) A highly accurate result
  • 61. What is the recommended hemoglobin threshold for restrictive blood transfusion in bleeding peptic ulcers?
A) Less than 5 g/dL
B) Greater than 12 g/dL
C) Greater than 7 g/dL
D) Exactly 10 g/dL
  • 62. Which scoring system helps determine if a patient with a bleeding ulcer should be treated as an inpatient or outpatient?
A) Glasgow-Blatchford score
B) MELD score
C) Child-Pugh score
D) APACHE II score
  • 63. Which agents are given before endoscopy to improve the visual field?
A) Antifibrinolytics
B) Crystalloids
C) Antacids
D) Prokinetic agents
  • 64. What is the defined dosage for high-dose intravenous PPI therapy?
A) 20 mg bolus followed by 2 mg per hour
B) 80 mg bolus followed by 8 mg per hour
C) 40 mg bolus followed by 4 mg per hour
D) 100 mg bolus followed by 10 mg per hour
  • 65. At what duration is the high-dose intravenous PPI infusion maintained?
A) 96 hours
B) 48 hours
C) 24 hours
D) 72 hours
  • 66. Which treatment is considered effective for stopping bleeding during early endoscopy?
A) Antifibrinolytic agents
B) Tranexamic acid
C) Cautery
D) Oral PPIs
  • 67. In what year did John Lykoudis begin treating peptic ulcer disease with antibiotics?
A) 1958
B) 1997
C) 1984
D) 1982
  • 68. What specific symptom prompted Marshall's wife to urge him to take antibiotics?
A) Nausea
B) Halitosis
C) Vomiting
D) Severe abdominal pain
  • 69. In which journal was Marshall’s self-experiment published in 1984?
A) Journal of Molecular Biology
B) Karolinska Medical Review
C) Australian Medical Journal
D) New England Medical Journal
  • 70. In what year was the Nobel Prize in Physiology or Medicine awarded to Warren and Marshall?
A) 1997
B) 1984
C) 2005
D) 1998
  • 71. Where is Barry J. Marshall's molecular biology lab located?
A) Athens, Greece
B) UWA in Perth, Western Australia
C) Atlanta, Georgia
D) Stockholm, Sweden
  • 72. What substance was found to eliminate H. pylori in a 1998 New England Medical Journal study?
A) Mastic gum
B) A petri dish culture
C) Spicy food extracts
D) Antibiotics
  • 73. What were the results of subsequent studies regarding the efficacy of mastic gum on H. pylori?
A) Moderate improvement
B) No effect
C) Immediate elimination
D) High effectiveness
  • 74. What profession did John Lykoudis practice in Greece?
A) Microbiologist
B) General practitioner
C) Nobel Laureate
D) Gastroenterologist
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