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