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WorksheetsGERD, PUD Pt 2
Total questions: 60
Worksheet time: 30mins
Which symptom best differentiates GERD from occasional heartburn?
Burning sensation after eating spicy food
Heartburn occurring ≥2 days per week for ≥3 months
Bitter taste in the mouth after meals
Epigastric discomfort relieved by food
Which non-pharmacologic intervention is MOST effective for nocturnal GERD?
Using multiple pillows
Sleeping on the right side
Elevating the head of the bed with blocks or a wedge
Drinking water before bedtime
Which alarm symptom requires immediate referral to a physician?
Postprandial heartburn
Regurgitation after fatty meals
Dysphagia
Belching after meals
Which medication provides the fastest onset of symptom relief?
Antacid
H2 Receptor Antagonist
Proton Pump Inhibitors
P-CAB
Which antacid adverse effect is MOST associated with aluminum-containing products?
Diarrhea
Constipation
Hypercalcemia
Sodium retention
A patient with CrCl <30 mL/min should AVOID which antacid ingredient?
Calcium carbonate
Sodium bicarbonate
Magnesium hydroxide
Alginic acid
Which statement about alginic acid is CORRECT?
It neutralizes gastric acid
It prevents acid production
It forms a viscous barrier over gastric contents
It is effective as monotherapy
Which H₂-receptor antagonist has the HIGHEST potential for drug interactions?
Famotidine
Nizatidine
Cimetidine
All are equal
Which statement about proton pump inhibitors (PPIs) is CORRECT?
They provide immediate relief
They reversibly inhibit acid secretion
They inhibit only active proton pumps
They increase LES tone
Why must most PPIs be taken 30–60 minutes before meals?
To prevent gastric irritation
To coincide with food buffering
To ensure proton pumps are active
To increase bioavailability
Which PPI formulation may be taken WITHOUT regard to meals?
Omeprazole
Esomeprazole
Dexlansoprazole
Lansoprazole
A patient with difficulty swallowing capsules may safely take which option?
Crushing omeprazole tablets
Chewing lansoprazole capsules
Sprinkling lansoprazole granules on applesauce
Dissolving pantoprazole tablets in water
Which OTC PPI self-treatment regimen is CORRECT?
Daily use indefinitely
14-day course, repeat every 4 months if needed
Use only when symptoms occur
Twice-daily dosing for 14 days
Which intestinal gas medication PREVENTS gas formation rather than treating it after formation?
Simethicone
Activated charcoal
Alpha-galactosidase
Bismuth subsalicylate
When should alpha-galactosidase be taken?
After meals
At bedtime
With the first bite of food
When gas symptoms begin
Which product is MOST appropriate for lactose-intolerant patients?
Simethicone
Alpha-galactosidase
Lactase enzyme
Activated charcoal
Which statement about simethicone is CORRECT?
Prevents gas formation
Reduces gastric acid
Reduce surface tension of gas bubbles
Has significant drug interactions
Which factor MOST contributes to nocturnal GERD severity?
Increased gastric acid secretion at night
Increased LES tone during sleep
Decreased swallowing and salivation during sleep
Increased gastric emptying during sleep
Which prostaglandin effect helps PROTECT the gastric mucosa?
Increased gastric emptying
Increased acid secretion
Increased mucus and bicarbonate secretion
Reduced mucosal blood flow
Which patient is NOT appropriate for OTC self-treatment of GERD?
28-year-old with heartburn twice weekly for 1 month
52-year-old with new-onset dyspepsia
34-year-old with heartburn after spicy food
40-year-old with episodic reflux relieved by antacids
Which diagnostic test is the GOLD STANDARD for diagnosing Barrett’s esophagus?
Barium esophagram
PillCam ESO
Endoscopy with biopsy
PPI trial
Which drug interaction requires separation by AT LEAST 4 HOURS from antacids?
Iron
Quinolones
Levothyroxine
Ketoconazole
Which PPI contains sodium bicarbonate and allows rapid absorption?
Dexilant
Nexium
Zegerid
Protonix
Which mechanism explains why antacids reduce pepsin activity?
They inhibit pepsin production
They increase LES tone
They raise gastric pH above 4
They block histamine receptors
Which patient characteristic MOST increases risk of GERD?
Sleeping on the left side
High-protein meals
Obesity
Upright posture after meals
Which atypical GERD symptom requires referral because cardiac causes cannot be ruled out?
Hoarseness
Chronic cough
Chest pain
Dental erosions
Which diagnostic test allows visualization of the esophagus but CANNOT obtain biopsies?
Endoscopy
Barium swallow
PillCam ESO
PPI test
Which patient should NOT use bismuth subsalicylate?
Adult with traveler’s diarrhea
Adult with black stools after use
Teen recovering from influenza
Adult with mild nausea
Which GERD medication is recommended ONLY during pregnancy when necessary?
PPI
H₂-receptor antagonist
Sucralfate
Metoclopramide
Which counseling point is CORRECT for alpha-galactosidase?
Can be cooked into foods
Take after meals
Avoid if mold allergy
Safe in galactosemia
The most common sites of peptic ulcer disease are the:
Esophagus and jejunum
Stomach and colon
Duodenum and stomach
Ileum and cecum
Which patient population is most commonly associated with stress-related mucosal damage?
Ambulatory patients with H. pylori
Ambulatory patients taking NSAIDs
Critically ill hospitalized patients
Pediatric patients
Which receptors stimulate gastric acid secretion by parietal cells?
Dopamine, serotonin, prostaglandins
Histamine, gastrin, acetylcholine
Cholecystokinin, somatostatin, insulin
Norepinephrine, epinephrine, cortisol
Prostaglandins protect the gastric mucosa by doing all of the following EXCEPT:
Increasing mucus secretion
Increasing bicarbonate secretion
Maintaining mucosal blood flow
Increasing gastric acid secretion
Which factor contributes to ulcer recurrence?
Eradicated H. pylori
Smoking cessation
NSAID use
Medication adherence
Helicobacter pylori is best described as:
Gram-positive cocci
Gram-negative spiral-shaped bacterium
Acid-resistant virus
Anaerobic protozoan
H. pylori survives in the acidic stomach primarily by producing:
Protease
Lipase
Urease
Pepsin
Urease produced by H. pylori leads to the formation of:
Hydrochloric acid
Bicarbonate and carbon dioxide
Ammonia and carbon dioxide
Nitric oxide
Which mode of transmission is associated with H. pylori?
Airborne
Vector-borne
Fecal-oral
Sexual contact
NSAID-induced ulcers most commonly occur in the:
Esophagus
Duodenum
Stomach
Colon
NSAIDs cause mucosal damage primarily by inhibiting:
Histamine receptors
Proton pumps
Prostaglandin synthesis
Bicarbonate secretion
Which complication is associated with peptic ulcer disease?
Pancreatitis
Upper GI bleeding
Hepatitis
Appendicitis
Which symptom is characteristic of duodenal ulcer pain?
Pain worsens with food
Pain relieved by food
Pain only occurs in the morning
Pain absent at night
Which H. pylori test is the most accurate noninvasive method for initial diagnosis and confirmation of eradication?
Antibody serology
Stool antigen
Urea breath test
Rapid urease test
Which medication must be withheld for at least 2 weeks prior to urea breath testing?
Antibiotics
Bismuth
Proton pump inhibitors
Antacids
In NSAID-induced ulcers where NSAID therapy cannot be discontinued, the preferred treatment is:
H2RA monotherapy
Sucralfate
Proton pump inhibitor
Antacid therapy
Which statement best explains why NSAID-induced ulcers may go unrecognized?
NSAIDs increase gastric acid secretion
NSAIDs mask pain due to their analgesic effect
NSAIDs only cause asymptomatic ulcers
NSAIDs only affect the duodenum
Which NSAID combination significantly increases the risk of upper GI bleeding?
NSAID + acetaminophen
NSAID + SSRI
NSAID + calcium supplement
NSAID + proton pump inhibitor
Which patient characteristic increases the risk of NSAID-induced ulcers?
Age < 40 years
Absence of comorbidities
Concurrent corticosteroid use
Short-term NSAID use
Which patient should be tested and treated for H. pylori?
Asymptomatic adult with no risk factors
Patient with history of peptic ulcer disease
Patient with controlled GERD
Patient taking short-term NSAIDs
Which medication can cause false-negative results in rapid urease testing?
Antacids
Proton pump inhibitors
Acetaminophen
Iron supplements
Which noninvasive H. pylori test remains positive long after eradication?
Urea breath test
Stool antigen test
Antibody serology
Gastric biopsy
Eradication of H. pylori is defined as:
Absence of symptoms after therapy
Negative test immediately after therapy
No organism detected ≥4 weeks after treatment
Completion of antibiotic regimen
Which medication should be avoided in patients consuming alcohol during H. pylori treatment?
Clarithromycin
Amoxicillin
Metronidazole
Tetracycline
Optimized bismuth quadruple therapy should be administered for how long?
7 days
10 days
14 days
28 days
Which patient is an appropriate candidate for rifabutin triple therapy?
Penicillin-allergic patient
Treatment-naïve patient without penicillin allergy
Patient with macrolide allergy
Patient who refuses PPIs
Which medication is classified as a potassium-competitive acid blocker?
Pantoprazole
Omeprazole
Vonoprazan
Famotidine
Which medication is contraindicated with vonoprazan due to reduced absorption?
Acetaminophen
Rilpivirine
Metoprolol
Aspirin
Vonoprazan may reduce the effectiveness of which antiplatelet agent?
Aspirin
Ticagrelor
Clopidogrel
Prasugrel
The most common adverse effect of misoprostol is:
Constipation
Diarrhea
Nausea
Hypertension
