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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) 2.0
B) 1.5
C) 2.5
D) 1.0
  • 2. What is the increased risk of rebleeding for aspirin users after endoscopic treatment for bleeding peptic ulcers?
A) Three times
B) Five times
C) Two 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) Risk of vitamin K deficiency
B) Risk of INR fluctuation
C) High risk of stent thrombosis
D) Risk of internal hemorrhage
  • 5. Which agent is preferred for treating severe bleeding in patients on warfarin?
A) Vitamin K
B) Fresh frozen plasma
C) Prothrombin complex concentrates
D) Recombinant factor VIIa
  • 6. Why is recombinant factor VIIa reserved only for life-threatening bleeding?
A) Slow onset of action
B) High cost of treatment
C) High risk of infection
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 improve INR stability
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) Fresh frozen plasma
C) Vitamin K
D) Activated charcoal
  • 9. What is the lifetime risk of developing a peptic ulcer?
A) 10% to 20%
B) 20% to 30%
C) 5% to 10%
D) 1% to 3%
  • 10. How many deaths were attributed to peptic ulcers in 2013?
A) 200,000
B) 327,000
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) 20%
B) 30%
C) 80%
D) 40%
  • 12. What is the estimated prevalence of H. pylori infection in third-world countries?
A) 70%
B) 50%
C) 20%
D) 40%
  • 13. What is the maximum prevalence ratio of H. pylori infection in developed countries?
A) 80%
B) 70%
C) 20%
D) 40%
  • 14. Which of these is a known method of H. pylori transmission?
A) Sharing food utensils
B) Airborne droplets
C) Mosquito bites
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) 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) Increased intake of vitamin K
B) Increased use of anticoagulants
C) Higher reliance on warfarin
D) Rational use of NSAIDs
  • 17. Compared to warfarin, why are DOACs recommended?
A) More effective at preventing thromboembolism
B) Easier to reverse with vitamin K
C) Cheaper in cost
D) Fewer interactions with food
  • 18. Which type of ulcer is specifically noted to be very tender upon palpation?
A) Duodenal ulcer
B) Gastric ulcer
C) Esophageal ulcer
D) Meckel's diverticulum ulcer
  • 19. Which Modified Johnson classification type is associated with the chronic use of NSAIDs?
A) Type I
B) Type II
C) Type III
D) Type V
  • 20. In the chronic form of a peptic ulcer, what do the borders look like?
A) Perpendicular with no surrounding inflammation
B) Irregular with elevated borders
C) Smooth with no elevation
D) Regular 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) Fibrinoid necrosis, inflammatory exudate, granulation tissue, and fibrous tissue
C) Epithelial tissue, muscle tissue, blood vessels, and nerves
D) Fibrin, collagen, epithelial cells, and inflammatory exudate
  • 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 is ineffective against gastric ulcers
C) It has high cardiovascular risks
D) It interacts negatively with proton pump inhibitors
  • 24. What is the recommended treatment if clarithromycin resistance exceeds 15%?
A) Immediate surgery
B) Bismuth-containing quadruple therapy
C) Increased dosage of amoxicillin
D) Triple regimen therapy
  • 25. What is the eradication rate of the quadruple therapy mentioned in the text?
A) 70%
B) 60%
C) 80%
D) 90%
  • 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) 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) Ibuprofen with PPI
B) Naproxen with PPI
C) Celecoxib with misoprostol
D) Aspirin with H2 antagonist
  • 29. What happens to the rate of H. pylori eradication if the duration of triple therapy is increased to 14 days?
A) It decreases
B) It increases
C) It stays the same
D) It drops below 50%
  • 30. What is the macroscopic appearance of the borders in the ulcerative form of gastric cancer?
A) Irregular
B) Smooth
C) Perpendicular
D) Elevated and regular
  • 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) Systemic hypoglycemia
B) Acute chemical peritonitis
C) Viral gastroenteritis
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) Zollinger-Ellison syndrome
B) Cushing's syndrome
C) Conn's syndrome
D) Valentino's syndrome
  • 35. What is the death rate for a posterior gastric wall perforation involving the gastroduodenal artery?
A) 50%
B) 10%
C) 5%
D) 20%
  • 36. What is penetration in the context of peptic ulcers?
A) The spread of bacteria to the lungs
B) A narrowing of the pyloric canal
C) The thickening of the stomach wall
D) A hole leading into adjacent organs
  • 37. What is gastric outlet obstruction also known as?
A) Peritonitis
B) Stenosis
C) Hyperchlorhydria
D) Metaplasia
  • 38. What symptom is typically presented in cases of gastric outlet obstruction?
A) High fever
B) Severe vomiting
C) Severe constipation
D) Internal bleeding
  • 39. What is used to determine if an ulcer is cancerous?
A) Biopsies
B) Physical examination
C) Blood tests
D) Stool culture
  • 40. What enzyme does H. pylori secrete to create an alkaline environment?
A) Amylase
B) Lipase
C) Pepsin
D) Urease
  • 41. Which adhesin enables H. pylori to attach to the gastric epithelium?
A) BabA
B) Insulin
C) Glucagon
D) Cortisol
  • 42. Which gene encodes for the vacuolating cytotoxin in H. pylori?
A) PicB
B) VacA
C) CagA
D) OipA
  • 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) CagA
B) TNF
C) BabA
D) IL1B
  • 45. What is the primary location of a gastric ulcer?
A) The stomach
B) The esophagus
C) The small intestine
D) The gallbladder
  • 46. Which of the following is a common cause of peptic ulcer disease?
A) Helicobacter pylori infection
B) Chronic dehydration
C) Lack of physical exercise
D) Excessive intake of spicy foods
  • 47. Which diagnostic test can be used to identify H. pylori?
A) Liver function test
B) MRI scan
C) Urine analysis
D) Urea breath test
  • 48. When is open surgery typically used for bleeding ulcers?
A) For all gastric ulcer cases
B) As the first line of treatment
C) Only in elderly patients
D) When endoscopic treatment is unsuccessful
  • 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) Children
B) Older people
C) Teenagers
D) Young adults
  • 51. What symptom is described as a 'rush of saliva' following regurgitation?
A) Heartburn
B) Nausea
C) Waterbrash
D) Belching
  • 52. Which enzyme function do NSAIDs block, hindering prostaglandin production?
A) Lipoxygenase
B) COX-2
C) COX-1
D) Pepsinogen
  • 53. What is the primary cause of stress ulcers?
A) Physiological stress from serious health problems
B) High caffeine intake
C) Excessive spice consumption
D) Chronic psychological stress
  • 54. Which of the following is considered the gold standard for diagnosing peptic ulcer disease?
A) Barium contrast x-ray
B) Stool antigen test
C) Blood antibody test
D) Esophagogastroduodenoscopy (EGD)
  • 55. What is the hallmark of a perforated peptic ulcer on an erect chest X-ray?
A) Free gas underneath the diaphragm
B) Presence of H. pylori colonies
C) Enlargement of the stomach lining
D) Increased blood flow to the stomach
  • 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) Hydrochloric acid
B) Barium sulfate
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 45
B) Over age 18
C) Over age 60
D) Over age 30
  • 59. Which of the following is identified as a rare gastrin-secreting tumor causing multiple ulcers?
A) Adenocarcinoma
B) Gastrinoma
C) Carcinoid
D) Lymphoma
  • 60. What is a potential side effect of taking antibiotics or proton-pump inhibitors before a blood test?
A) A highly accurate result
B) A false positive result
C) Severe allergic reaction
D) A false negative result
  • 61. What is the recommended hemoglobin threshold for restrictive blood transfusion in bleeding peptic ulcers?
A) Exactly 10 g/dL
B) Less than 5 g/dL
C) Greater than 12 g/dL
D) Greater than 7 g/dL
  • 62. Which scoring system helps determine if a patient with a bleeding ulcer should be treated as an inpatient or outpatient?
A) Child-Pugh score
B) Glasgow-Blatchford score
C) MELD score
D) APACHE II score
  • 63. Which agents are given before endoscopy to improve the visual field?
A) Crystalloids
B) Prokinetic agents
C) Antacids
D) Antifibrinolytics
  • 64. What is the defined dosage for high-dose intravenous PPI therapy?
A) 40 mg bolus followed by 4 mg per hour
B) 80 mg bolus followed by 8 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) 48 hours
B) 24 hours
C) 72 hours
D) 96 hours
  • 66. Which treatment is considered effective for stopping bleeding during early endoscopy?
A) Oral PPIs
B) Antifibrinolytic agents
C) Tranexamic acid
D) Cautery
  • 67. In what year did John Lykoudis begin treating peptic ulcer disease with antibiotics?
A) 1984
B) 1982
C) 1997
D) 1958
  • 68. What specific symptom prompted Marshall's wife to urge him to take antibiotics?
A) Halitosis
B) Nausea
C) Severe abdominal pain
D) Vomiting
  • 69. In which journal was Marshall’s self-experiment published in 1984?
A) Journal of Molecular Biology
B) New England Medical Journal
C) Australian Medical Journal
D) Karolinska Medical Review
  • 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) Stockholm, Sweden
B) Atlanta, Georgia
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) Mastic gum
B) A petri dish culture
C) Antibiotics
D) Spicy food extracts
  • 73. What were the results of subsequent studies regarding the efficacy of mastic gum on H. pylori?
A) Immediate elimination
B) High effectiveness
C) Moderate improvement
D) No effect
  • 74. What profession did John Lykoudis practice in Greece?
A) Gastroenterologist
B) Nobel Laureate
C) General practitioner
D) Microbiologist
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