Question 1
Question
From this list, select the four defensive factors that protect the GI tract.
Answer
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Mucous
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Bicarbonate
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Blood flow
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Prostaglandins
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Enzymes
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Fats
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Pepsin
Question 2
Question
Select the two main mechanisms by which chronic use of NSAIDs can cause ulcers.
Answer
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inhibit prostaglandin synthesis
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Directly irritate GI mucosa
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Increase mucosal blood flow
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Decrease gastric acid secretion
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Increase mucous secretion
Question 3
Question
Which of the following is best described as a proteolytic enzyme in gastric juice that injures unprotected cells of the GI mucosa?
Answer
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Pepsin
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Pepsinogen
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Prostaglandin
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Bicarbonate
Question 4
Question
Which cells are responsible for pumping acid into the lumen of the stomach?
Answer
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Mucosal
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Pepsin
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Parietal
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Gastric
Question 5
Question
You are caring for a patient who has peptic ulcer disease. The patient tells you, "My brother has reflux disease and he stopped drinking coffee and alcohol. He got so much better. Should I stop drinking coffee and alcohol too?" What is the best response?
Answer
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"Yes, it would be a good idea for you to stop drinking coffee and alcohol. There are other dietary modifications that you can make. Would you like me to give you pamphlet about that?"
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"Dietary modifications are more helpful for people with reflux disease. In people with peptic ulcer disease, changes to your diet may help relieve some of your symptoms but it won't actually affect the healing of your ulcers."
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"Dietary modifications are really important. If you eliminate certain foods from your diet, it will allow your body to heal."
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"Changes to your diet make no real difference. You can keep drinking alcohol and coffee, if you want."
Question 6
Question
Which of the following drugs work to decrease acid secretion?
Question 7
Question
What is the main contraindication of taking misoprostol to prevent NSAID-induced PUD and duodenal ulcers?
Question 8
Question
Why are patients advised against taking clopidogrel (antiplatelet agent) and a PPI concurrently?
Answer
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PPIs reduce the efficacy of clopidogrel
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PPIs result in a toxic build up of clopidogrel
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Clopidogrel inactivates PPIs
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PPIs increase the availability of clopidogrel
Question 9
Question
PPIs are more potent than histamine-2 receptor antagonists because they irreversibly inhibit H+K+ATPase.
Question 10
Question
Which patient population should be advised against using magnesium hydroxide (milk of magnesia) for symptomatic relief of PUD/GERD?
Answer
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Patients with renal failure
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Patients with congestive heart failure
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Patients with hypertension
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Patients who are pregnant
Question 11
Question
All of the following are classes of laxatives EXCEPT:
Answer
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bulk-forming
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stimulant
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osmotic
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surfactants
Question 12
Question
Which of the following laxatives (miscellaneous class) is given as a large amount of solution (usually 4 litres) to cleanse the bowel prior to diagnostic or surgical procedures?
Question 13
Question
You are caring for a patient who reports that they have chronic constipation. They tell you that unless they take Milk of Magnesia, they become constipated. What is the best response?
Answer
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"You can continue to take Milk of Magnesia. It is a gentle laxative and will help you to have regular bowel movements."
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"Milk of Magnesia is an older product. Would you like me to recommend something that might be more helpful?"
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"If this is a serious problem that is really bothering you, I suggest you take it up with your family doctor."
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"It is common for patients to become dependent on laxatives, which can have some adverse effects, including dehydration, electrolyte imbalances, and colitis. Would it be OK if we talked more about some alternatives?"
Question 14
Question
A mother of a 4-year-old child tells you that her child is recovering from a viral infection. She says that her child is continuing to have some diarrhea and asks you what she should do. What is the best response?
Answer
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"You can give your child some PeptoBismol, which is an over-the-counter product and will help your child to have less watery stools."
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"You should not give your child PeptoBismol. You can offer your child an oral rehydration solution and I can give you a simple recipe. If your child has diarrhea for more than 24 hours or has symptoms of dehydration, you can bring him/her to the hospital or your pediatrician."
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"Your child needs to be taken to the ER right away."