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