Q1. Which pathogen is strongly associated with peptic ulcer?
(a) Bifidobacterium bifidum
(b) Escherichia coli
(c) Helicobacter pylori
(d) Faecalibacterium prausnitzii
Rationale: (c) is the correct answer. H. Pylori is the most common infection associated with the development of peptic ulcers and is one of the most common risk factors for the patient later developing erosion or ulceration of their stomach lining. While other pathogens can be found in the gastrointestinal tract, there is no evidence that they are associated with Peptic Ulcer Disease, so (a) (b) and (d) are incorrect.
Q2. Gastric ulcers are most common in younger patients
(a) True
(b) False
Rationale: (b) is the correct answer. As we age, our bodies do not produce as much protective mucus. Added exposure to alcohol/tobacco and habitual use of NSAIDs/aspirin also weakens the protective mucosal layer. So younger patients would be less susceptible, making (a) incorrect.
Q3. How do NSAIDs contribute to peptic ulcer formation?
(a) By burning holes directly in the gastric mucosa when they hit the stomach.
(b)Increasing acid production
(c) Decreasing prostaglandin synthesis
Rationale: (c) is the correct answer. The mechanism of action for NSAIDs is inhibiting the COX-1 and COX-2 pathways, which decreases inflammation and thus relieves pain. The COX-1 pathway, however, is also known to be responsible for mucous secretion, which helps to coat the gastrointestinal lining and protect it from stomach acid. When the COX-1 pathway is inhibited, it would lead to decreased mucous secretion along the stomach lining which would leave the lining more vulnerable to being damaged by stomach acid and at risk for ulcer formation. The NSAIDs themselves do not act directly on the mucosal layer so (a) is incorrect. NSAIDs do not increase gastrin production, and therefore do not cause an increase in stomach acid production, so (b) is incorrect.
Q4. Your patient who has been diagnosed with Chronic Gastritis for 3 years presents to your primary care office complaining of worsening epigastric pain, stating “I’m still taking Protonix every day, but my symptoms have been getting worse.” How would you explain the main difference between Gastritis and Peptic Ulcer disease?
(a) You have actually had Peptic Ulcer disease this whole time.
(b) With your worsening symptoms, I think you may have developed a peptic ulcer in addition to Gastritis. I’m ordering a scope to see what’s going on.
(c) I wouldn’t worry about it, sometimes symptoms worsen during periods of stress
(d) Have you ingested any foreign objects recently?
Rationale: (b) is the correct answer. Gastritis can progress to Peptic Ulcer Disease when the inflammation of the stomach wall causes a breakage in the lining of the stomach, which would lead to the formation of an ulcer. If the patient’s symptoms are worsening despite taking appropriate medications, it would be good to check whether an ulcer may have formed and is causing additional symptoms. An ulcer would usually be diagnosed based on imaging and would not be assumed to have been the case all along (answer a). Considering the history of Gastritis, the symptoms would not be likely to be caused by any foreign objects (answer d) and should not be written off to stress (answer c).
Q5. An obese woman with chief complaints of heartburn, upper abdominal pain within one hour of eating came into the clinic without having the sighs of active bleeding. The Esophageal endoscopy shows that she is having the Barrett’s Esophagus. Which of the following disease do you suspect that cause her discomfort?
(a) Stress Ulcer
(b) Gastric Cancer
(c) Gastroesophageal reflux disease (GERD)
(d) None of the above
Rationale: (c) is the correct answer. the symptoms mentioned above can be possibly related to several GI diseases, i.e, gastritis and ulcer diseases; however, Barrett’s Esophagus is specifically due to gastroesophageal reflux, a disease that can lead to neoplastic transformation by chronically irritating the mucous in the esophagus. Answer (a) (b) are incorrect. Stress ulcers and gastric ulcers have no direct relation to Barrett’s Esophagus, which is more likely due to chronic irritation.