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GPM Exam 2 Review (part 2)

Total questions: 100

Worksheet time: 4hrs 53mins

Name
Class
Date
1.

Osmotic agents create an osmotic gradient pulling water into the intestines/stool. There is no kind of dependence; they just work their way through the body and are not absorbed systemically. They work similarly to which of the following?

a)

saline cathartics

b)

bulk forming laxatives

c)

electrolyte lavages

d)

evacuation drug therapies

e)

overnight agents

2.

Which of the following is/are not effective in treating constipation?

a)

corn syrup

b)

fiber

c)

extra fluid intake

d)

mineral oil lubricant

e)

probiotics

3.

Which of the following is preferred for bowel evacuation/disimpaction in children?

a)

PediaLyte

b)

Miralax (PEG)

c)

lactulose

d)

mineral oil

e)

milk of magnesia

4.

Which of the following is the first line maintenance therapy for children with constipation?

a)

PediaLyte

b)

Miralax (PEG)

c)

lactulose

d)

mineral oil

e)

milk of magnesia

5.

Which of the following are selective chloride channel activators that are indicated for chronic idiopathic constipation in adults, opioid induced constipation in adults with chronic non-cancer pain, and IBS-C in women 18 and older where other treatments aren't working?

a)

lubiprostone

b)

linaclotide

c)

linzess

d)

relistor

e)

amitiza

6.

Which of the following is/are peripherally acting mu-opioid antagonist(s) used for the treatment of constipation in patients receiving palliative care that are non-responsive to traditional laxatives?

a)

lubiprostone

b)

relistor

c)

linzess

d)

trulance

e)

methylnaltrexone

7.

Which of the following is/are part of the subjective history of a patient with diarrhea?

a)

stool characterization

b)

electrolytes

c)

capillary refill time

d)

stool evaluation

e)

disease states

8.

Which of the following is/are part of the objective history of a patient with diarrhea?

a)

stool characterization

b)

electrolytes

c)

capillary refill time

d)

stool evaluation

e)

disease states

9.

When triaging a patient with diarrhea, when should you refer them to their MD?

a)

patient is less than 3 years old

b)

patient has traveler's diarrhea

c)

severe abdominal pain

d)

diarrhea more than 48 hours

e)

vomiting more than 24 hours

10.

What is the definition of diarrhea?

4 lines
11.

Acute diarrhea is classified as which of the following?

a)

less than 14 days

b)

15-29 days

c)

1-2 months

d)

3-6 months

e)

none of the above

12.

Chronic diarrhea is classified as which of the following?

a)

less than 14 days

b)

15-29 days

c)

more than 30 days

d)

2-4 weeks

e)

none of the above

13.

Persistent diarrhea is classified as which of the following?

a)

less than 14 days

b)

15-29 days

c)

more than 30 days

d)

2-4 months

e)

none of the above

14.

Which of the following is the most common reason for acute GI illness?

a)

food allergies

b)

medications

c)

parasites

d)

bacteria

e)

viruses

15.

What are the goals of therapy for a patient with diarrhea?

a)

control symptoms

b)

produce 1-2 soft stools a day

c)

prevent and manage fluid/electrolyte loss

d)

prevent complications such as fecal impaction

e)

treat underlying cause(s)

16.

Which of the following are anti-motility agent(s)?

a)

loperamide

b)

lomotil

c)

polycarbophil

d)

diphenoxylate/atropine

e)

bismuth subsalicylate

17.

When taking an anti-motility agent, there should be caution with use in patients with which of the following?

a)

IBS due to toxic mega colon

b)

IBD due to toxic mega colon

c)

diarrhea due to toxic mega colon

d)

constipation due to toxic mega colon

e)

abdominal pain due to toxic mega colon

18.

Polycarbophil is classified as a/an (a)   .

19.

Bismuth subsalicylate (Pepto-Bismol) is an anti-secretory agent indicated for symptomatic relief of mild, non-specific diarrhea, and is also used for traveler's diarrhea. What is the MOA of this agent?

a)

anti-cholinergic

b)

anti-microbial

c)

anti-motility

d)

anti-inflammatory

e)

anti-secretory

20.

Bismuth subsalicylate is associated with which of the following side effects?

a)

nausea and vomiting

b)

orange, leaky stools

c)

lactose intolerance

d)

toxic mega colon

e)

black furry tongue

21.

Lactase enzymes and probiotics are also anti-secretory agents. Lactase enzymes (Lactaid) are for those with lactose intolerance. Probiotics include culturelle (Lactobacillus GG) and florastor (Saccharomyces boulardii). When is the use of probiotics helpful? *BASED ON WHAT WAS LEARNED IN CLASS*

a)

if a patient has traveler's diarrhea

b)

if a patient has constipation due to antibiotics

c)

if a patient has diarrhea due to antibiotics

d)

if a patient has IBS due to antibiotics

e)

if a patient has a food allergy

22.

If dehydration is the main concern in a patient with diarrhea, what is going to be the main treatment?

a)

adsorbents

b)

probiotics

c)

bulk-forming laxative

d)

oral replacement solution (ORS)

e)

increasing apple juice intake

23.

When calculating fluid deficits, 1 kilogram of weight loss is equal to how much deficit of fluid?

a)

10 mL

b)

100 mL

c)

500 mL

d)

1000 mL

e)

10000 mL

24.

Which of the following non-drug therapies is/are useful for treating diarrhea?

a)

simple sugars

b)

BRAT diet

c)

complex carbohydrates

d)

FODMAP diet

e)

increased physical activity

25.

Which of the following is/are part of the subjective history of a patient with irritable bowel syndrome (IBS)?

a)

sense of urgency

b)

bloating

c)

altered bowel function

d)

CBC labs

e)

abdominal pain

26.

Which of the following is/are part of the objective history of a patient with irritable bowel syndrome (IBS)?

a)

sense of urgency

b)

celiac testing

c)

altered bowel function

d)

CBC labs

e)

abdominal pain

27.

The Rome IV Criteria definition for IBS is recurrent abdominal pain at least once a week for at least how long?

a)

1 month

b)

3 months

c)

6 months

d)

1 week

e)

6 weeks

28.

IBS subtypes include which of the following?

a)

IBS with diarrhea

b)

IBS with constipation

c)

IBS mixed

d)

IBS unsubtyped

e)

IBS with IBD

29.

Which of the following is/are useful in patients with IBS?

a)

weak fiber

b)

soluble fiber

c)

FODMAP diet

d)

BRAT diet

e)

primrose oil

30.

Which of the following medications can be used for IBS-Constipation?

a)

lubiprostone

b)

linaclotide

c)

alosetron

d)

ondansetron

e)

eluxadoline

31.

Which of the following medications can be used for IBS-Diarrhea?

a)

lubiprostone

b)

linaclotide

c)

alosetron

d)

ondansetron

e)

eluxadoline

32.

What condition is lifelong, where the goal of therapy is to manage and control symptoms and find ways to improve these symptoms?

(a)  

33.

Which of the following are possible drug therapies for a patient with diarrhea?

a)

anti-motility agents

b)

saline cathartics

c)

anti-secretory agents

d)

osmotic agents

e)

adsorbents

34.

Which of the following are mu-opioid agonists that work by peripheral restriction, meaning they do not get into the CNS?

a)

methylnaltrexone

b)

loperamide

c)

alvimopan

d)

diphenoxylate/atropine

e)

naloxegol

35.

Bismuth subsalicylate (Pepto-Bismol) has which of the following properties?

a)

anti-motility agent

b)

bactericidal

c)

weak antacid

d)

benzoic acid and phenol in a para relationship

e)

anti-inflammatory

36.

Polycarbophil (Equalactin, Konsyl Fiber) is an adsorbent that has which of the following properties?

a)

polymers that do not get absorbed by GI tract

b)

very hydrophobic

c)

very hydrophilic

d)

lots of polar hydroxyl groups

e)

polymers that get absorbed by GI tract

37.

Antibiotics such as ciprofloxacin (Cipro) are used to treat traveler's diarrhea. This antibiotic falls under what therapeutic class?

a)

tetracyclines

b)

anthraquinones

c)

fluoroquinolones

d)

tricyclic antibiotics

e)

5-HT3 receptor agonists

38.

Docusate Sodium (Colace) is an example of an emollient laxative/stool softener. It helps with movement of fecal matter through the GI tract. It wants to make stool wetter and fattier so the result is the stool becomes greasier and passes more readily through the GI tract. Docusate Sodium has which of the following characteristic(s)?

a)

gets activated in the colon by bacteria

b)

are hydrophilic

c)

are hydrophobic

d)

anionic surfactant

e)

cationic surfactant

39.

Which of these medications is a laxative that activates cell surface guanylate cyclase 2C (GC-C) receptor?

a)

lubiprostone

b)

linaclotide

c)

alvimopan

d)

methylnaltrexone

e)

lotronex

40.

Which of these medications is a zwitterionic laxative used for treating opioid-induced constipation (OIC)?

a)

alvimopan

b)

methylnaltrexone

c)

naloxegol

d)

lubiprostone

e)

sorbitol

41.

Which of these medications is a quaternary ammonium laxative used for treating opioid-induced constipation (OIC)?

a)

alvimopan

b)

methylnaltrexone

c)

naloxegol

d)

lubiprostone

e)

sorbitol

42.

Which of these medications is a laxative that contains several PEG groups and is used for treating opioid-induced constipation (OIC)?

a)

alvimopan

b)

methylnaltrexone

c)

naloxegol

d)

Miralax

e)

sorbitol

43.

Define gastroesophageal reflux disease (GERD).

4 lines
44.

True or False: GERD and heartburn are interchangeable.

a)

true

b)

false

45.

Possible etiology factors of GERD include which of the following?

a)

delayed gastric emptying

b)

H. Pylori infection

c)

transient LES relaxation

d)

taking too many NSAIDs

e)

impaired tissue resistance

46.

The presence of a hiatus hernia is a strong predictor of which of the following condition(s)?

a)

non-erosive reflux disease (NERD)

b)

gastroesophageal reflux disease (GERD)

c)

peptic ulcer disease (PUD)

d)

irritable bowel syndrome (IBS)

e)

transient lower esophageal sphincter relaxations (TLESRs)

47.

What is the intermediate stage before developing esophageal cancer known as?

(a)  

48.

Define peptic ulcer disease (PUD).

4 lines
49.

Which of the following are major types of secretory epithelial cells?

a)

mucus cells

b)

parental cells

c)

kuppfer cells

d)

chief cells

e)

G cells

50.

Zollinger-Ellison syndrome is a rare form of PUD resulting from which of the following?

a)

hyper secretion of gastrin

b)

hyper secretion of bile

c)

hyper secretion of H. Pylori

d)

hyper secretion of prostanglandins

e)

hyper secretion of pepsin

51.

What is the function of parietal (oxyntic) cells?

a)

aid in the production of gastric acid via the release of histamine

b)

secrete the hormone gastrin, which is responsible for the stimulation of gastric acid in the presence of certain foodstuff

c)

secrete hydrochloric acid and intrinsic factor which is required for vitamin B12 absorption

d)

secrete an alkaline mucus and bicarbonate that protects the epithelium against shear stress and acid

e)

secrete pepsinogen, a proteolytic proenzyme that will form pepsin under acidic conditions of a pH less than 3

52.

What is the function of chief cells?

a)

aid in the production of gastric acid via the release of histamine

b)

secrete the hormone gastrin, which is responsible for the stimulation of gastric acid in the presence of certain foodstuff

c)

secrete hydrochloric acid and intrinsic factor which is required for vitamin B12 absorption

d)

secrete an alkaline mucus and bicarbonate that protects the epithelium against shear stress and acid

e)

secrete pepsinogen, a proteolytic proenzyme that will form pepsin under acidic conditions of a pH less than 3

53.

Major causes of duodenal ulcers include:

a)

H. Pylori infection

b)

too many prostaglandins

c)

NSAID use

d)

cigarette smoking

e)

impaired tissue resistance

54.

What are the stages of ulcer formation, as shown by the arrows in the picture?

a)

erosion → indentation → chronic ulcer

b)

indentation → ulcer → chronic ulcer

c)

indentation → erosion → chronic ulcer

d)

erosion → ulcer → chronic ulcer

e)

ulcer → erosion → chronic ulcer

55.

What is the gold standard in diagnosing a gastric/duodenal ulcer?

a)

endoscopy

b)

biopsy

c)

endoscopy with biopsy

d)

GI radiologic series

e)

H. Pylori test

56.

Acute stress-related mucosal lesions (SRML) or stress ulcers are superficial lesions located predominately in the fundus of the stomach. They are different from PUD. It occurs mainly in critically ill patients, usually victims of severe trauma and sepsis and those who have an unrelated history of ulcer disease. The stress that causes SRML is:

a)

psychological stress

b)

physiological stress

c)

pathological stress

d)

acute stress

e)

critical stress

57.

Which of the following is the current main optimal approach for neutralizing acidity in acid-peptic diseases such as PUD and GERD?

a)

antacids

b)

proton pump inhibitors

c)

histaminic H2-agonists

d)

histaminic H2-antagonists

e)

mimics of the actual mucosa

58.

Gastrin interacts with which of the following epithelial cell(s) to secrete acid in the stomach?

a)

mucus cells

b)

parietal cells

c)

ECL cells

d)

chief cells

e)

ulcer cells

59.

The proton pump is also called:

a)

sodium-potassium ATPase

b)

sodium-chloride ATPase

c)

hydrogen-chloride ATPase

d)

hydrogen-potassium ATPase

e)

potassium-chloride ATPase

60.

When giving either Sodium Bicarbonate or Calcium Carbonate, which of the following should a patient expect?

a)

long duration of action

b)

short duration of action

c)

side effect of belching

d)

healing of peptic ulcer(s)

e)

no healing of any peptic ulcer(s)

61.

When giving either Magnesium Hydroxide or Aluminum Hydroxide, which of the following should a patient expect?

a)

long duration of action

b)

short duration of action

c)

side effect of belching

d)

side effect of a laxative

e)

side effect of constipation

62.

Which medications are histaminic antagonists?

a)

Pepcid

b)

Prilosec

c)

Axid

d)

Zantac

e)

Nexium

63.

Which medications are proton pump inhibitors?

a)

Prilosec

b)

Tagamet

c)

Prevacid

d)

Zantac

e)

Nexium

64.

In some drugs such as Dexlansoprazole, Rabeprazole, and Pantoprazole, they have a chiral center that make them racemates. What is this chiral center bond?

a)

C - S

b)

S - O

c)

N - S

d)

C - N

e)

S = O

65.

Sulcralfate (Carafate) is used as a (a)   .

66.

Most peptic ulcers occur in __________.

a)

small intestine

b)

large intestine

c)

stomach

d)

colon

e)

esophagus

67.

What are the two main risk factors of PUD?

a)

erosive esophagitis

b)

H. Pylori infection

c)

cigarette smoking

d)

hyper secretion of acid

e)

NSAID use

68.

Complications of PUD include which of the following?

a)

melena

b)

perforation

c)

esophageal strictures

d)

hematemesis

e)

gastric obstruction

69.

Alarm symptoms of gastric cancer include which of the following?

a)

iron deficiency anemia

b)

abdominal mass

c)

chest pain

d)

GI bleeding

e)

shortness of breath

70.

Which diagnostic test is always going to be positive if someone has been exposed to Helicobacter Pylori?

a)

urea breath test

b)

stool monoclonal antigen test

c)

serologic test

d)

endoscopy

e)

biopsy

71.

Misoprostol (Cytotec) is a cytoprotective agent that can be used in combination with NSAIDs in preventing ulcer recurrence. It is indicated for prophylaxis and treatment of NSAID-induced ulcer. There is a black box warning for this medication, what is it?

4 lines
72.

Proton pump inhibitors are most effective when taken __________.

4 lines
73.

Sort the following medications from lowest NSAID risk to highest NSAID risk: naproxen, meloxicam, celecoxib, ketorolac.

a)

meloxicam → naproxen → ketorolac → celecoxib

b)

ketorolac → celecoxib → meloxicam → naproxen

c)

celecoxib → meloxicam → naproxen → ketorolac

d)

naproxen → ketorolac → celecoxib → meloxicam

e)

meloxicam → celecoxib → ketorolac → naproxen

74.

Which treatment regimen guarantees cure of H. Pylori infection in 100% of patients?

a)

clarithromycin tripple (AOC)

b)

clarithromycin tripple (MOC)

c)

bismuth quadruple

d)

Pylera

e)

none of the above

75.

Treatment duration for eradication of H. Pylori is usually about how long?

a)

1 week

b)

2 weeks

c)

4 weeks

d)

6 weeks

e)

8 weeks

76.

Treatment duration for healing of a duodenal ulcer is usually about how long?

a)

1 week

b)

2 weeks

c)

4 weeks

d)

6 weeks

e)

8 weeks

77.

If a patient is in a region with macrolide resistance of 15% or greater, which therapy regimen would be used for H. Pylori treatment?

a)

clarithromycin triple (AOC)

b)

clarithromycin triple (MOC)

c)

bismuth triple

d)

bismuth quadruple

e)

Pylera

78.

The Pylera Regimen includes which of the following?

a)

omeprazole

b)

tetracycline

c)

clarithromycin

d)

bismuth subsalicylate

e)

metronidazole

79.

Bismuth subsalicylate has a bactericidal effect on H. Pylori. It may cause temporary, harmless darkening of the tongue and/or stool. Side effects include constipation, diarrhea, nausea and vomiting. Neurotoxicity may occur with large, excessive doses. Its use is contraindicated in which of the following patients?

a)

patients less than 18 with recent influenza or varicella

b)

patients who are pregnant

c)

patients with a penicillin allergy

d)

patients who cannot abstain from alcohol

e)

patients who live in a region with 15% macrolide resistance

80.

Tetracyclines are contraindicated in which of the following patients?

a)

patients less than 8

b)

patients who are pregnant

c)

patients with a penicillin allergy

d)

patients who cannot abstain from alcohol

e)

patients who live in a region with 15% macrolide resistance

81.

Amoxicillin is contraindicated in which of the following patients?

a)

patients less than 18

b)

patients who are pregnant

c)

patients with a penicillin allergy

d)

patients who cannot abstain from alcohol

e)

patients with history of QT prolongation

82.

Clarithromycin is contraindicated in which of the following patients?

a)

patients in a region with 15% macrolide resistance

b)

patients who are pregnant

c)

patients with a penicillin allergy

d)

patients who cannot abstain from alcohol

e)

patients with history of QT prolongation

83.

Metronidazole is contraindicated in which of the following patients?

a)

patients in a region with 15% macrolide resistance

b)

patients who are pregnant

c)

patients with a penicillin allergy

d)

patients who cannot abstain from alcohol for 10-14 days

e)

patients with history of QT prolongation

84.

Agent-related variables in the therapeutics of PUD involve which of the following?

a)

dosing frequency

b)

abstaining from alcohol

c)

salicylate allergy

d)

convenience of pre-packaged combination packs

e)

age of the patient

85.

Patient-related variables in the therapeutics of PUD involve which of the following?

a)

dosing frequency

b)

abstaining from alcohol

c)

salicylate allergy

d)

convenience of pre-packaged combination packs

e)

age of the patient

86.

With long-term use of PPIs, what should be monitored?

a)

osteoporosis

b)

vitamin C deficiency

c)

community acquired pneumonia

d)

clostridium difficile associated diarrhea

e)

clostridium difficile associated constipation

87.

Salvage therapy should be used __________.

4 lines
88.

Maintenance therapy is used for recurrent PUD only, after resolution of PUD. Dosing is given at bedtime in H. Pylori negative patients. What is the dosing for maintenance therapy?

a)

2X the usual dose of PPIs or H2RAs

b)

4X the usual dose of PPIs or H2RAs

c)

half the usual dose of PPIs or H2RAs

d)

the usual dose of PPIs or H2RAs

e)

none of the above

89.

Which of the following is the most common classification of GERD?

a)

non-erosive reflux disease (NERD)

b)

erosive esophagitis (EE)

c)

erosive reflux disease (ERD)

d)

peptic ulcer disease (PUD)

e)

H. Pylori GERD

90.

Which of the following are alarm symptoms of GERD?

a)

difficulty chewing

b)

shortness of breath

c)

severe constipation

d)

melena

e)

difficulty swallowing

91.

Which of the following are proper severity levels for GERD?

a)

intermittent, mild heartburn

b)

intermittent, persistent GERD

c)

symptomatic, mild heartburn

d)

symptomatic, persistent GERD

e)

treatment failure or complicated symptoms

92.

Weight loss has what effect as a lifestyle intervention/recommendation?

a)

improvement of GERD symptoms

b)

improvement of esophageal pH

c)

improved nocturnal gastric acidity

d)

improved PUD symptoms

e)

no effect on GERD symptoms

93.

Head of Bed Elevation has what effect as a lifestyle intervention/recommendation?

a)

improvement of GERD symptoms

b)

improvement of esophageal pH

c)

improved nocturnal gastric acidity

d)

improved PUD symptoms

e)

no effect on GERD symptoms

94.

What is the correct process of step-up?

a)

PPIs → antacids → H2RAs

b)

antacids → H2RAs → PPIs

c)

H2RAs → antacids → PPIs

d)

PPIs → H2RAs → antacids

e)

antacids → PPIs → H2RAs

95.

What is the correct process of step-down?

a)

PPIs → antacids → H2RAs

b)

antacids → H2RAs → PPIs

c)

H2RAs → PPIs → antacids

d)

PPIs → H2RAs → antacids

e)

antacids → PPIs → H2RAs

96.

Limitations of antacids include which of the following?

a)

rapid onset

b)

effective only in mild GERD

c)

short duration of action

d)

not effective in nighttime acid suppression

e)

development of tachyphylaxis

97.

Which of the following is used for acute symptomatic relief in GERD patients?

a)

H2RAs

b)

PPIs

c)

antacids

d)

NSAIDs

e)

antibiotics

98.

Which of the following is effective for healing erosive disease in mild GERD patients?

a)

H2RAs

b)

PPIs

c)

antacids

d)

NSAIDs

e)

antibiotics

99.

Which of the following is the therapy of choice for symptom relief and healing of erosive esophagitis?

a)

H2RAs

b)

PPIs

c)

antacids

d)

NSAIDs

e)

antibiotics

100.

Which PPI can be administered any time of day and will still have the same efficacy?

a)

omeprazole

b)

dexlansoprazole

c)

esomeprazole

d)

pantoprazole

e)

lansoprazole

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