Peptic ulcer MCQs With Answer

Introduction: Peptic ulcer MCQs With Answer are essential study tools for B. Pharm students preparing for pharmacology and therapeutics exams. This concise, focused set covers pathophysiology, diagnosis, pharmacotherapy, drug mechanisms, adverse effects, H. pylori eradication regimens, NSAID-induced ulcers, and clinical complications. Each question reinforces core concepts such as proton pump inhibitors, H2 receptor antagonists, sucralfate, misoprostol, bismuth therapy, and antibiotic resistance patterns relevant to pharmacy practice. Designed to deepen understanding and improve clinical reasoning, these MCQs help link drug action to patient management and evidence-based treatment choices. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. What is the primary difference between gastric and duodenal peptic ulcers?

• Gastric ulcers are mainly due to H. pylori while duodenal ulcers are only due to stress
• Gastric ulcers tend to worsen with food, duodenal ulcers often improve with food
• Duodenal ulcers never bleed whereas gastric ulcers frequently bleed
• Gastric ulcers occur only in elderly patients

Correct Answer: Gastric ulcers tend to worsen with food, duodenal ulcers often improve with food

Q2. Which organism is most commonly associated with peptic ulcer disease worldwide?

• Staphylococcus aureus
• Escherichia coli
• Helicobacter pylori
• Clostridium difficile

Correct Answer: Helicobacter pylori

Q3. NSAID-induced peptic ulcers are primarily caused by inhibition of which enzyme?

• Cyclooxygenase-1 (COX-1)
• H+/K+ ATPase
• Histidine decarboxylase
• Neuraminidase

Correct Answer: Cyclooxygenase-1 (COX-1)

Q4. Which clinical feature is most characteristic of duodenal ulcer pain?

• Epigastric pain relieved by eating
• Epigastric pain immediately worsened on eating
• Colicky right lower quadrant pain
• Pain that radiates to the back and is constant

Correct Answer: Epigastric pain relieved by eating

Q5. What is the diagnostic gold standard for confirming a peptic ulcer and obtaining biopsies?

• Abdominal ultrasound
• Esophagogastroduodenoscopy (EGD)
• Urea breath test
• Plain abdominal X-ray

Correct Answer: Esophagogastroduodenoscopy (EGD)

Q6. Which noninvasive test is best for detecting active H. pylori infection and confirming eradication?

• Serology for H. pylori IgG
• Urea breath test
• Complete blood count
• Fecal occult blood test

Correct Answer: Urea breath test

Q7. Which test is useful for detecting H. pylori antigen noninvasively in stool?

• Stool antigen test
• Stool culture for H. pylori
• Rapid plasma reagin
• Fecal calprotectin

Correct Answer: Stool antigen test

Q8. During endoscopy, which rapid test detects urease activity of H. pylori?

• Rapid antigen chromatographic test
• Rapid urease test (CLO test)
• Gram stain
• Polymerase chain reaction for toxins

Correct Answer: Rapid urease test (CLO test)

Q9. A standard clarithromycin-based triple therapy for H. pylori typically contains a PPI and which two antibiotics?

• Clarithromycin and metronidazole
• Clarithromycin and amoxicillin
• Tetracycline and rifampin
• Vancomycin and ciprofloxacin

Correct Answer: Clarithromycin and amoxicillin

Q10. What is the currently recommended duration for most first-line H. pylori triple therapies to maximize eradication?

• 5 days
• 7 days
• 14 days
• 6 weeks

Correct Answer: 14 days

Q11. Clarithromycin resistance primarily reduces the efficacy of which therapy?

• Bismuth quadruple therapy
• Clarithromycin-based triple therapy
• PPI monotherapy
• Sucralfate therapy

Correct Answer: Clarithromycin-based triple therapy

Q12. Which regimen composes the bismuth quadruple therapy for H. pylori?

• PPI + amoxicillin + clarithromycin
• PPI + bismuth + tetracycline + metronidazole
• PPI + sucralfate + ranitidine + bismuth
• Bismuth + ciprofloxacin + rifampin + metronidazole

Correct Answer: PPI + bismuth + tetracycline + metronidazole

Q13. Proton pump inhibitors (PPIs) reduce gastric acid secretion by inhibiting which target?

• Gastrin receptors on ECL cells
• H+/K+ ATPase (proton pump) on parietal cells
• Histamine H2 receptors
• Pepsinogen activation

Correct Answer: H+/K+ ATPase (proton pump) on parietal cells

Q14. PPIs are prodrugs that require activation in which cellular environment?

• Neutral pH of the bloodstream
• Acidic canaliculus of the parietal cell
• Basic pH of the duodenum
• Alkaline pancreatic duct

Correct Answer: Acidic canaliculus of the parietal cell

Q15. Long-term PPI therapy is associated with which potential adverse effect?

• Increased risk of vitamin B12 deficiency
• Acute hemolytic anemia
• Immediate renal failure within hours
• Total inhibition of liver CYP enzymes

Correct Answer: Increased risk of vitamin B12 deficiency

Q16. Histamine H2 receptor antagonists reduce acid secretion by blocking which mediator?

• Gastrin release
• Histamine at H2 receptors on parietal cells
• Acetylcholine at muscarinic M3 receptors
• Pepsin activity

Correct Answer: Histamine at H2 receptors on parietal cells

Q17. Which phenomenon limits long-term efficacy of H2 receptor antagonists?

• Tachyphylaxis (tolerance) with continued use
• Permanent parietal cell loss
• Immediate allergic anaphylaxis in most patients
• Complete H. pylori eradication

Correct Answer: Tachyphylaxis (tolerance) with continued use

Q18. Antacids primarily provide symptom relief by which mechanism?

• Neutralizing gastric acid
• Inhibiting H. pylori adhesion
• Permanently blocking proton pumps
• Stimulating mucus secretion for weeks

Correct Answer: Neutralizing gastric acid

Q19. Sucralfate exerts its protective effect by which action?

• Neutralizing acid
• Forming a viscous adhesive barrier over ulcer bases
• Eradicating H. pylori directly
• Blocking histamine H2 receptors

Correct Answer: Forming a viscous adhesive barrier over ulcer bases

Q20. Misoprostol is effective in preventing NSAID-induced ulcers because it is a synthetic analog of which compound?

• Prostaglandin E1 (PGE1)
• Prostaglandin F2α
• Leukotriene B4
• Histamine

Correct Answer: Prostaglandin E1 (PGE1)

Q21. Bismuth compounds in H. pylori therapy act by which primary mechanisms?

• Systemic immunosuppression and gastric acid secretion
• Local antimicrobial effect and mucosal protection
• Direct systemic antibiotic action like penicillin
• Neutralizing gastric acid as antacids do

Correct Answer: Local antimicrobial effect and mucosal protection

Q22. Gastric ulcer pain is typically described as which of the following?

• Pain relieved by eating and occurring at night
• Pain worsened by eating with possible weight loss
• Pain that only occurs during exercise
• Pain exclusively in the lower abdomen

Correct Answer: Pain worsened by eating with possible weight loss

Q23. The most serious complications of peptic ulcers include which of the following?

• Perforation, bleeding, and gastric outlet obstruction
• Appendicitis and pancreatitis
• Viral hepatitis and cirrhosis
• Asthma exacerbation and COPD

Correct Answer: Perforation, bleeding, and gastric outlet obstruction

Q24. Which classification system grades the risk of rebleeding from peptic ulcers seen at endoscopy?

• Forrest classification
• Child-Pugh score
• Glasgow-Blatchford score
• APACHE II

Correct Answer: Forrest classification

Q25. Zollinger-Ellison syndrome causes peptic ulcers due to excess secretion of which hormone?

• Gastrin
• Somatostatin
• Insulin
• Secretin

Correct Answer: Gastrin

Q26. Gastrin promotes acid secretion primarily by stimulating which cell type to release histamine?

• Parietal cells directly to secrete HCl
• Enterochromaffin-like (ECL) cells
• Chief cells to release pepsinogen
• Goblet cells to produce mucus

Correct Answer: Enterochromaffin-like (ECL) cells

Q27. ECL cells secrete histamine which acts on which receptors to increase acid secretion?

• H1 receptors on parietal cells
• H2 receptors on parietal cells
• M3 receptors on chief cells
• Beta-adrenergic receptors on mucosal cells

Correct Answer: H2 receptors on parietal cells

Q28. Which PPI interaction is clinically significant due to CYP2C19 metabolism?

• Interaction decreasing warfarin effect only
• Interaction with clopidogrel reducing its activation
• Interaction causing increased insulin metabolism
• No clinically relevant interactions exist

Correct Answer: Interaction with clopidogrel reducing its activation

Q29. Sucralfate can interfere with absorption of other drugs; how should it be administered relative to other oral medications?

• Administered simultaneously with all drugs for synergy
• Given at least 2 hours apart from other oral drugs
• Only given intravenously to avoid interactions
• It enhances absorption so co-administration is recommended

Correct Answer: Given at least 2 hours apart from other oral drugs

Q30. Which H. pylori virulence factors are associated with increased ulcer risk and gastric cancer?

• CagA and VacA
• LPS and capsule only
• Protein A and coagulase
• Shiga toxin and cholera toxin

Correct Answer: CagA and VacA

Q31. In penicillin-allergic patients, which antibiotic commonly replaces amoxicillin in H. pylori triple therapy?

• Tetracycline
• Metronidazole
• Cefuroxime
• Vancomycin

Correct Answer: Metronidazole

Q32. High resistance to metronidazole in H. pylori is best addressed by which strategy?

• Shortening therapy to 3 days
• Using bismuth-containing quadruple therapy
• Switching to antacid monotherapy
• Doubling the PPI dose only

Correct Answer: Using bismuth-containing quadruple therapy

Q33. After completing H. pylori eradication therapy, which test is recommended to confirm cure?

• Repeat endoscopic biopsy immediately
• Urea breath test or stool antigen test after 4 weeks off antibiotics and 2 weeks off PPIs
• Serologic IgG antibody test right away
• Complete blood count

Correct Answer: Urea breath test or stool antigen test after 4 weeks off antibiotics and 2 weeks off PPIs

Q34. Which of the following is a major modifiable risk factor for peptic ulcer disease?

• Genetic age-related traits
• Smoking
• Blue eye color
• Left-handedness

Correct Answer: Smoking

Q35. Prostaglandins protect the gastric mucosa by which mechanism?

• Stimulating acid secretion
• Decreasing mucus and bicarbonate production
• Promoting mucosal blood flow and mucus/bicarbonate secretion
• Activating pepsinogen to pepsin

Correct Answer: Promoting mucosal blood flow and mucus/bicarbonate secretion

Q36. The mucous-bicarbonate layer defends gastric mucosa primarily by doing what?

• Enhancing pepsin activity
• Neutralizing acid at the epithelial surface
• Increasing parietal cell mass
• Stimulating H. pylori growth

Correct Answer: Neutralizing acid at the epithelial surface

Q37. Which clinical situations often require surgical management of peptic ulcer disease?

• Uncomplicated ulcers responding to PPI therapy
• Perforation, refractory bleeding, or gastric outlet obstruction
• Mild dyspepsia without blood loss
• Asymptomatic H. pylori infection

Correct Answer: Perforation, refractory bleeding, or gastric outlet obstruction

Q38. For optimum effect, when is it best to take an oral PPI each day?

• At bedtime after a heavy meal
• 30–60 minutes before the first meal of the day
• Immediately after taking antacids
• Only when pain occurs

Correct Answer: 30–60 minutes before the first meal of the day

Q39. Cessation of long-term PPI therapy can cause which rebound phenomenon?

• Rebound acid hypersecretion
• Immediate peptic ulcer healing
• Permanent loss of parietal cells
• Increased blood glucose for months

Correct Answer: Rebound acid hypersecretion

Q40. Which H2 receptor antagonist was widely withdrawn due to safety concerns but others like famotidine remain available?

• Cimetidine
• Ranitidine
• Famotidine
• Nizatidine

Correct Answer: Ranitidine

Q41. What adverse effect is commonly associated with the aluminum content of sucralfate?

• Diarrhea
• Constipation
• Hypoglycemia
• Severe hypertension

Correct Answer: Constipation

Q42. Which common side effect limits misoprostol use in some patients?

• Severe hypertension
• Diarrhea and abdominal cramping
• Permanent hearing loss
• Agranulocytosis

Correct Answer: Diarrhea and abdominal cramping

Q43. Bismuth compounds can cause which benign but notable clinical change?

• Green urine
• Black discoloration of stool and tongue
• Profound neutropenia
• Hypocalcemia

Correct Answer: Black discoloration of stool and tongue

Q44. Chronic H. pylori infection increases the risk of which serious gastric conditions?

• Gastric adenocarcinoma and MALT lymphoma
• Pancreatic adenocarcinoma exclusively
• Hepatocellular carcinoma only
• Renal cell carcinoma

Correct Answer: Gastric adenocarcinoma and MALT lymphoma

Q45. Sucralfate requires what gastric environment to form its protective complex effectively?

• Highly alkaline pH above 8
• Acidic environment (low pH)
• Neutral pH only
• Presence of bile acids

Correct Answer: Acidic environment (low pH)

Q46. If a patient is taking PPIs, how long before testing for H. pylori with a urea breath test should PPIs be stopped to avoid false negatives?

• No need to stop PPIs
• At least 2 weeks
• 8 hours
• 3 months

Correct Answer: At least 2 weeks

Q47. In acute peptic ulcer bleeding, which approach is recommended for acid suppression?

• Oral antacids only
• High-dose IV PPI infusion after endoscopic therapy
• Oral H2 blocker once daily
• No acid suppression is recommended

Correct Answer: High-dose IV PPI infusion after endoscopic therapy

Q48. Which patients taking NSAIDs should receive PPI prophylaxis to reduce ulcer risk?

• Low-risk young adults on short-term NSAIDs
• Patients with prior ulcer, age >65, or concomitant anticoagulant use
• Patients taking topical NSAIDs only
• Those with no cardiovascular risks

Correct Answer: Patients with prior ulcer, age >65, or concomitant anticoagulant use

Q49. How do COX-2 selective inhibitors compare to nonselective NSAIDs regarding ulcer risk?

• COX-2 inhibitors have no cardiovascular risks and reduce ulcer risk
• COX-2 inhibitors generally have lower gastric ulcer risk but may increase CV risk
• COX-2 inhibitors cause more peptic ulcers than nonselective NSAIDs
• COX-2 inhibitors eradicate H. pylori

Correct Answer: COX-2 inhibitors generally have lower gastric ulcer risk but may increase CV risk

Q50. Why do PPIs have a long antisecretory duration despite a short plasma half-life?

• They are stored in adipose tissue for months
• They irreversibly bind and inactivate the H+/K+ ATPase
• They are continuously secreted by the liver into the stomach
• They inhibit gene transcription of parietal cells

Correct Answer: They irreversibly bind and inactivate the H+/K+ ATPase

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