Slide 4 GI

H. pylori–associated ulcers most commonly present with what symptom compared to NSAID-induced ulcers? A. Asymptomatic B. Epigastric pain C. Severe vomiting only D. No acid-related symptoms

B. Epigastric pain

How do H. pylori ulcers compare to NSAID-induced ulcers in depth? A. H. pylori ulcers are deeper B. NSAID ulcers are superficial C. H. pylori ulcers are superficial and NSAID ulcers are deeper D. Both are equally deep

C. H. pylori ulcers are superficial and NSAID ulcers are deeper

Which statement best describes bleeding severity in ulcer types? A. H. pylori ulcers cause more severe bleeding B. NSAID ulcers cause more severe bleeding C. Neither causes bleeding D. Both have identical bleeding risk

B. NSAID ulcers cause more severe bleeding

What is the primary mechanism behind ulcer development in PUD? A. Increased mucus production B. Decreased bile secretion C. Imbalance between gastric acid and pepsin secretion D. Increased pancreatic enzymes

C. Imbalance between gastric acid and pepsin secretion

Which of the following are common symptoms of PUD? A. Burning epigastric pain, early satiety, heartburn B. Rash and fever C. Joint pain only D. Vision changes

A. Burning epigastric pain, early satiety, heartburn

What laboratory finding is associated with bleeding ulcers? A. Elevated hemoglobin/hematocrit B. Low hemoglobin/hematocrit C. Elevated platelets only D. Normal CBC always

B. Low hemoglobin/hematocrit

Which strategy is recommended for patients at risk of NSAID-induced ulcers? A. High-dose NSAID only B. COX-2 selective NSAID with PPI C. NSAID with antibiotics D. NSAID with antihistamine

B. COX-2 selective NSAID with PPI

H. pylori infection is associated with which conditions? A. Asthma and COPD B. Chronic gastritis, PUD, and MALT lymphoma C. Diabetes and hypertension D. Kidney disease

B. Chronic gastritis, PUD, and MALT lymphoma

Which medications should be avoided before H. pylori urea breath or fecal antigen testing? A. Only antibiotics B. PPIs, H2RAs, antibiotics, and bismuth C. Only PPIs D. Only antacids

B. PPIs, H2RAs, antibiotics, and bismuth

What is the first-line treatment for H. pylori in most patients? A. Monotherapy with amoxicillin B. Concomitant quadruple therapy C. PPI alone D. Antacid therapy

B. Concomitant quadruple therapy

What is the composition of concomitant quadruple therapy? A. Clarithromycin + amoxicillin + metronidazole + PPI B. Bismuth + tetracycline only C. Amoxicillin + levofloxacin D. Metronidazole alone

A. Clarithromycin + amoxicillin + metronidazole + PPI

What is the first-line therapy for H. pylori in penicillin-allergic patients? A. Concomitant therapy B. Bismuth quadruple therapy C. Levofloxacin triple therapy D. PPI monotherapy

B. Bismuth quadruple therapy

What are the components of bismuth quadruple therapy? A. Bismuth subsalicylate, tetracycline, metronidazole B. Amoxicillin, clarithromycin, PPI C. Levofloxacin, amoxicillin D. Metronidazole only

A. Bismuth subsalicylate, tetracycline, metronidazole

What is the purpose of sequential therapy in H. pylori treatment? A. Increase antibiotic resistance B. Reduce pill burden C. Treat fungal infections D. Replace PPIs

B. Reduce pill burden

When is levofloxacin triple therapy used? A. First-line treatment B. Pediatric patients only C. When first-line options fail or safety concerns exist D. Pregnancy

C. When first-line options fail or safety concerns exist

What should be done if initial H. pylori treatment fails? A. Repeat the same regimen B. Use a regimen without clarithromycin and consider bismuth C. Stop all therapy D. Use PPI only

B. Use a regimen without clarithromycin and consider bismuth

How long should H. pylori treatment be extended if initial therapy fails? A. 3 days B. 7 days C. 10 days D. 14 days

D. 14 days

After successful H. pylori eradication, what is true regarding PPI use? A. Must be continued lifelong B. Not required for ulcer healing C. Must be doubled in dose D. Must be combined with antibiotics

B. Not required for ulcer healing

How is NSAID-induced PUD primarily managed? A. Increase NSAID dose B. Discontinue NSAID and treat with PPI C. Add antibiotics D. Add anticoagulants

B. Discontinue NSAID and treat with PPI

What is another strategy for managing NSAID-induced PUD if NSAID must be resumed? A. Avoid all therapy B. Restart at higher dose C. Switch to COX-2 inhibitor or lower dose after healing D. Add insulin

C. Switch to COX-2 inhibitor or lower dose after healing

If NSAIDs must be continued, what should be co-administered? A. Antihistamine B. Long-term PPI or misoprostol C. Antibiotics D. Statins

B. Long-term PPI or misoprostol

How long should PPI therapy last for NSAID-induced PUD (NSAID discontinued)? A. 2 weeks B. 4 weeks C. 8 weeks D. 16 weeks

C. 8 weeks

How long should PPI therapy last if NSAID is continued? A. 4 weeks B. 8 weeks C. 12 weeks D. 24 weeks

C. 12 weeks

What is the role of H2 receptor antagonists (H2RAs) in PUD? A. First-line eradication therapy B. Maintenance after PPI therapy C. Antibiotic replacement D. Pain relievers

B. Maintenance after PPI therapy

What are sucralfate and misoprostol used for in PUD? A. Acid suppression B. Antibiotic therapy C. Mucosal protection D. Pain control

C. Mucosal protection

Which drugs can cause ulcers? A. Bisphosphonates, clindamycin, ferrous sulfate, KCl, SSRIs B. Only antibiotics C. Only NSAIDs D. Only antihypertensives

A. Bisphosphonates, clindamycin, ferrous sulfate, KCl, SSRIs

What should be avoided with potassium chloride (KCl) formulations? A. Immediate release only B. Slow-release formulations C. Liquid formulations D. IV use

B. Slow-release formulations

What is the correct general approach to drug-induced PUD? A. Start antibiotics immediately B. Confirm ulcer, reduce/stop offending agent, then treat with PPI C. Ignore offending drug D. Use only antacids

B. Confirm ulcer, reduce/stop offending agent, then treat with PPI

How should PPIs be dosed for H. pylori vs NSAID-induced PUD? A. Once daily for H. pylori, BID for NSAID B. BID for H. pylori, once daily for NSAID C. Same dosing for both D. No PPI needed

B. BID for H. pylori, once daily for NSAID

How should antibiotics be taken during H. pylori treatment? A. On empty stomach B. With meals C. Only at night D. Only with water and no food

B. With meals

What adverse effect is associated with clarithromycin? A. Nephrotoxicity B. Metallic taste and QT prolongation C. Ototoxicity D. Hypoglycemia

B. Metallic taste and QT prolongation

What are common adverse effects of metronidazole? A. Hearing loss B. Alcohol intolerance, neuropathy, taste changes C. Liver failure only D. Constipation

B. Alcohol intolerance, neuropathy, taste changes

What are adverse effects of tetracycline? A. Kidney stones B. Teeth discoloration (children <8) and photosensitivity C. Hair loss D. Hypertension

B. Teeth discoloration (children <8) and photosensitivity

What are adverse effects of levofloxacin? A. Bleeding B. Tendon rupture, photosensitivity, QT prolongation C. Hearing loss D. Rash only

B. Tendon rupture, photosensitivity, QT prolongation