MCQ Quiz-Gastroenterology

MCQ Quiz: Gastroenterology

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Gastroenterology is a vast area of pharmacy practice, covering everything from common self-care issues like heartburn to complex chronic conditions like Inflammatory Bowel Disease and cirrhosis. A pharmacist’s expertise in pathophysiology, pharmacology, and patient counseling is crucial for managing these conditions. This quiz, designed for PharmD students, will test your knowledge on the diagnosis, treatment, and management of key GI and hepatic disorders.

1. Which of the following is a primary mechanism of action for proton pump inhibitors (PPIs) like omeprazole?

  • They neutralize existing stomach acid.
  • They form a protective barrier over an ulcer.
  • They irreversibly block the H+/K+ ATPase pump in gastric parietal cells.
  • They are antagonists at the histamine-2 receptor.

Answer: They irreversibly block the H+/K+ ATPase pump in gastric parietal cells.

2. A patient comes to the pharmacy asking for advice on heartburn that occurs immediately after large meals. Which OTC product provides the fastest relief for these symptoms?

  • Omeprazole
  • Famotidine
  • Calcium Carbonate (Antacid)
  • Bismuth subsalicylate

Answer: Calcium Carbonate (Antacid)

3. The “triple therapy” regimen for eradicating Helicobacter pylori infection most commonly includes:

  • A PPI, a beta-blocker, and a statin.
  • A PPI, clarithromycin, and amoxicillin.
  • Two different antibiotics and an H2 receptor antagonist.
  • An antacid, a prokinetic agent, and a mucosal protectant.

Answer: A PPI, clarithromycin, and amoxicillin.

4. Long-term use of proton pump inhibitors (PPIs) has been associated with an increased risk of:

  • Hypertensive crisis.
  • Clostridioides difficile infection and bone fractures.
  • Weight loss.
  • Acute pancreatitis.

Answer: Clostridioides difficile infection and bone fractures.

5. What is the primary pathophysiological difference between Crohn’s disease and Ulcerative Colitis?

  • Ulcerative Colitis can affect any part of the GI tract, while Crohn’s is limited to the colon.
  • Crohn’s disease is characterized by transmural inflammation and can affect any part of the GI tract, while Ulcerative Colitis involves superficial inflammation confined to the colon.
  • Only Crohn’s disease is treated with biologic agents.
  • Ulcerative Colitis is caused by an infection, while Crohn’s disease is not.

Answer: Crohn’s disease is characterized by transmural inflammation and can affect any part of the GI tract, while Ulcerative Colitis involves superficial inflammation confined to the colon.

6. Which medication is a 5-aminosalicylic acid (5-ASA) derivative commonly used as a first-line agent for mild-to-moderate ulcerative colitis?

  • Prednisone
  • Infliximab
  • Metronidazole
  • Mesalamine

Answer: Mesalamine

7. A patient with cirrhosis develops confusion, asterixis (flapping tremor), and disorientation. These are hallmark signs of which complication?

  • Spontaneous bacterial peritonitis
  • Hepatic encephalopathy.
  • Esophageal varices
  • Ascites

Answer: Hepatic encephalopathy.

8. What is the first-line treatment for managing hepatic encephalopathy?

  • Spironolactone
  • Propranolol
  • Vancomycin
  • Lactulose.

Answer: Lactulose.

9. In a patient with cirrhosis and ascites, which combination of diuretics is most commonly used?

  • Hydrochlorothiazide and chlorthalidone
  • Furosemide and bumetanide
  • Spironolactone and furosemide.
  • Metolazone and furosemide

Answer: Spironolactone and furosemide.

10. A patient presents with severe, watery diarrhea after a recent course of clindamycin. The pharmacist should suspect which of the following infections?

  • Viral gastroenteritis
  • Escherichia coli
  • Clostridioides difficile
  • Helicobacter pylori

Answer: Clostridioides difficile

11. Which of the following is considered a first-line treatment for an initial, non-severe episode of Clostridioides difficile infection?

  • Metronidazole
  • Vancomycin
  • Fidaxomicin.
  • Rifaximin

Answer: Fidaxomicin.

12. The mechanism of action for stimulant laxatives like bisacodyl and senna involves:

  • Drawing water into the colon via osmosis.
  • Adding bulk to the stool.
  • Stimulating nerve endings in the colon to increase peristalsis.
  • Softening the stool to allow for easier passage.

Answer: Stimulating nerve endings in the colon to increase peristalsis.

13. A patient needing to relieve constipation quickly (within hours) for a medical procedure would be best served by which type of laxative?

  • A bulk-forming agent like psyllium.
  • A stool softener like docusate.
  • An osmotic agent like polyethylene glycol 3350 or magnesium citrate.
  • A stimulant laxative like senna.

Answer: An osmotic agent like polyethylene glycol 3350 or magnesium citrate.

14. What is the primary mechanism of action for loperamide as an anti-diarrheal?

  • It absorbs excess fluid in the intestine.
  • It kills pathogenic bacteria.
  • It is a mu-opioid agonist that slows GI motility.
  • It coats the lining of the GI tract.

Answer: It is a mu-opioid agonist that slows GI motility.

15. Pharmacogenomic testing for CYP2C19 may be considered for patients taking PPIs because poor metabolizers may experience:

  • Reduced efficacy of the PPI.
  • Increased drug exposure and a higher rate of therapeutic success.
  • No difference in drug levels.
  • A severe allergic reaction.

Answer: Increased drug exposure and a higher rate of therapeutic success.

16. Non-selective beta-blockers like propranolol or nadolol are used in patients with cirrhosis to:

  • Lower blood pressure.
  • Prevent the first bleed or re-bleeding from esophageal varices.
  • Treat hepatic encephalopathy.
  • Reduce ascites.

Answer: Prevent the first bleed or re-bleeding from esophageal varices.

17. Chemotherapy-induced nausea and vomiting (CINV) is often managed with 5-HT3 receptor antagonists like:

  • Prochlorperazine
  • Metoclopramide
  • Ondansetron.
  • Dexamethasone

Answer: Ondansetron.

18. A key counseling point for a patient starting psyllium (Metamucil) for constipation is to:

  • Take it with a full glass of water to prevent esophageal obstruction.
  • Expect a bowel movement within 1-2 hours.
  • Take it at bedtime to avoid daytime drowsiness.
  • Avoid taking it with any other medications.

Answer: Take it with a full glass of water to prevent esophageal obstruction.

19. A patient is diagnosed with Irritable Bowel Syndrome with Diarrhea (IBS-D). Which of the following agents might be used to manage their symptoms?

  • Lubiprostone
  • Linaclotide
  • Loperamide
  • Polyethylene glycol

Answer: Loperamide

20. A patient with GERD experiences alarm symptoms such as dysphagia (difficulty swallowing) and unintentional weight loss. What is the most appropriate recommendation?

  • Increase the dose of their OTC PPI.
  • Add an H2 receptor antagonist at bedtime.
  • Refer the patient to a physician for further evaluation.
  • Switch to a different class of antacid.

Answer: Refer the patient to a physician for further evaluation.

21. TNF-alpha inhibitors like infliximab and adalimumab are biologic agents used to treat:

  • GERD
  • Gastroparesis
  • Moderate-to-severe Inflammatory Bowel Disease (IBD).
  • C. difficile infection.

Answer: Moderate-to-severe Inflammatory Bowel Disease (IBD).

22. Which of the following lifestyle modifications is recommended for a patient with GERD?

  • Lying down immediately after eating.
  • Eating large meals to absorb excess acid.
  • Elevating the head of the bed and avoiding trigger foods.
  • Increasing caffeine and alcohol intake.

Answer: Elevating the head of the bed and avoiding trigger foods.

23. The “gut-brain axis” is a concept that helps explain the relationship between:

  • The liver and the kidneys.
  • Stress, psychological state, and GI function, particularly in conditions like IBS.
  • The absorption of fats and proteins.
  • The mechanism of action of PPIs.

Answer: Stress, psychological state, and GI function, particularly in conditions like IBS.

24. The medicinal chemistry of H2 receptor antagonists like famotidine involves a structure that is a competitive inhibitor at the:

  • Proton pump.
  • Histamine H2 receptor on parietal cells.
  • Muscarinic receptor.
  • Gastrin receptor.

Answer: Histamine H2 receptor on parietal cells.

25. A patient with cirrhosis and ascites is prescribed spironolactone. The pharmacist should counsel the patient about which potential side effect?

  • Hypokalemia
  • Hyperkalemia.
  • Hypoglycemia
  • Hypertension

Answer: Hyperkalemia.

26. What is the primary goal of modern direct-acting antiviral (DAA) therapy for Hepatitis C?

  • To suppress the virus indefinitely.
  • To achieve a sustained virologic response (SVR), which is considered a cure.
  • To manage the symptoms of the infection only.
  • To prevent transmission to others without treating the patient.

Answer: To achieve a sustained virologic response (SVR), which is considered a cure.

27. Pancreatic enzyme replacement therapy (e.g., pancrelipase) is used for patients with:

  • Peptic ulcer disease.
  • Exocrine pancreatic insufficiency, such as in cystic fibrosis or chronic pancreatitis.
  • Viral hepatitis.
  • Gastroparesis.

Answer: Exocrine pancreatic insufficiency, such as in cystic fibrosis or chronic pancreatitis.

28. A patient is taking an iron supplement for anemia. The pharmacist should counsel them that it may cause which common GI side effect?

  • Diarrhea
  • Constipation and dark stools.
  • Heartburn
  • Nausea

Answer: Constipation and dark stools.

29. Which of the following is a prokinetic agent used to treat gastroparesis?

  • Ondansetron
  • Loperamide
  • Metoclopramide
  • Famotidine

Answer: Metoclopramide

30. Sucralfate is a mucosal protective agent that works by:

  • Neutralizing stomach acid.
  • Inhibiting the proton pump.
  • Forming a viscous, paste-like barrier that binds to ulcers and erosions.
  • Killing H. pylori.

Answer: Forming a viscous, paste-like barrier that binds to ulcers and erosions.

31. The primary cause of most peptic ulcers is:

  • Eating spicy foods.
  • Chronic stress.
  • H. pylori infection and/or NSAID use.
  • Excessive alcohol consumption.

Answer: H. pylori infection and/or NSAID use.

32. A patient asks if probiotics are helpful. A pharmacist could explain that some strains may be beneficial for:

  • Curing Crohn’s disease.
  • Preventing antibiotic-associated diarrhea.
  • Eradicating H. pylori.
  • Treating a GI bleed.

Answer: Preventing antibiotic-associated diarrhea.

33. In a patient with hepatic impairment, a pharmacist must be cautious because:

  • Drug metabolism may be significantly reduced, leading to increased drug levels and toxicity.
  • All drugs are eliminated faster by the liver.
  • The patient will not be able to absorb any oral medications.
  • The risk of kidney injury is eliminated.

Answer: Drug metabolism may be significantly reduced, leading to increased drug levels and toxicity.

34. Misoprostol is a synthetic prostaglandin E1 analog used to:

  • Treat severe diarrhea.
  • Prevent NSAID-induced gastric ulcers.
  • Increase gastric acid secretion.
  • Manage hepatic encephalopathy.

Answer: Prevent NSAID-induced gastric ulcers.

35. A patient with IBS-C might be prescribed which of the following agents?

  • Eluxadoline
  • Rifaximin
  • Lubiprostone
  • Loperamide

Answer: Lubiprostone

36. A key feature of the pathophysiology of GERD is:

  • An overproduction of protective mucus.
  • A transient relaxation or incompetence of the lower esophageal sphincter (LES).
  • The presence of gallstones.
  • A delayed gastric emptying time.

Answer: A transient relaxation or incompetence of the lower esophageal sphincter (LES).

37. When counseling a patient on using an over-the-counter H2 receptor antagonist like famotidine, it is important to advise them that:

  • Relief is immediate but short-lived.
  • It is best taken after symptoms have started for faster relief.
  • It is most effective for preventing heartburn when taken 30-60 minutes before a meal.
  • It should not be used for more than one day.

Answer: It is most effective for preventing heartburn when taken 30-60 minutes before a meal.

38. The Child-Pugh score is used to assess the severity of:

  • Inflammatory Bowel Disease
  • Peptic Ulcer Disease
  • Chronic liver disease/cirrhosis.
  • Acute pancreatitis

Answer: Chronic liver disease/cirrhosis.

39. A major risk factor for developing C. difficile infection is:

  • Recent travel abroad.
  • Recent antibiotic use.
  • High cholesterol.
  • A vegetarian diet.

Answer: Recent antibiotic use.

40. Bismuth subsalicylate (Pepto-Bismol) should be used with caution or avoided in children and teenagers recovering from a viral illness due to the risk of:

  • Reye’s syndrome.
  • Serotonin syndrome.
  • A hypertensive crisis.
  • Severe constipation.

Answer: Reye’s syndrome.

41. The mechanism of action of ursodiol involves:

  • Dissolving cholesterol gallstones and reducing the cholesterol content of bile.
  • Blocking dopamine receptors in the GI tract.
  • Neutralizing gastric acid.
  • Inhibiting viral replication.

Answer: Dissolving cholesterol gallstones and reducing the cholesterol content of bile.

42. A patient with Crohn’s disease affecting the terminal ileum may be at risk for which vitamin deficiency?

  • Vitamin C
  • Vitamin K
  • Vitamin B12
  • Vitamin D

Answer: Vitamin B12

43. A common non-pharmacologic recommendation for a patient with constipation is to:

  • Decrease fiber and fluid intake.
  • Increase physical activity, fiber, and fluid intake.
  • Avoid all fruits and vegetables.
  • Start a sedentary lifestyle.

Answer: Increase physical activity, fiber, and fluid intake.

44. What is the role of a step-down approach in GERD management?

  • Starting with the strongest acid suppression therapy (like a PPI) and then stepping down to a less potent agent (like an H2RA) as symptoms improve.
  • Starting with an antacid and adding multiple medications at once.
  • Increasing the dose of a PPI every two weeks.
  • Alternating between a PPI and an H2RA each day.

Answer: Starting with the strongest acid suppression therapy (like a PPI) and then stepping down to a less potent agent (like an H2RA) as symptoms improve.

45. Which of the following is an example of an intra-abdominal infection?

  • Community-acquired pneumonia
  • A simple urinary tract infection
  • Appendicitis or diverticulitis.
  • A skin and soft tissue infection

Answer: Appendicitis or diverticulitis.

46. A patient taking a biologic agent like infliximab for IBD must be screened for what before starting therapy?

  • Diabetes
  • Hypertension
  • Latent tuberculosis.
  • High cholesterol

Answer: Latent tuberculosis.

47. A key counseling point for a patient taking an oral bisacodyl tablet is:

  • To crush or chew the tablet for faster effect.
  • To take it with a large glass of milk or an antacid.
  • That the tablet is enteric-coated and should not be taken within an hour of milk or antacids to avoid premature dissolution and stomach cramps.
  • To expect relief within 30 minutes.

Answer: That the tablet is enteric-coated and should not be taken within an hour of milk or antacids to avoid premature dissolution and stomach cramps.

48. The “Rome criteria” are a set of diagnostic criteria used for:

  • Peptic ulcer disease
  • Functional gastrointestinal disorders like IBS.
  • Cirrhosis
  • Viral hepatitis

Answer: Functional gastrointestinal disorders like IBS.

49. Spontaneous bacterial peritonitis (SBP) is a serious infection of the:

  • Gallbladder
  • Pancreas
  • Ascitic fluid in patients with cirrhosis.
  • Stomach lining

Answer: Ascitic fluid in patients with cirrhosis.

50. The ultimate goal of managing chronic GI conditions like GERD or IBD is to:

  • Cure the disease with a short course of therapy.
  • Control symptoms, prevent complications, and improve the patient’s quality of life.
  • Ensure the patient is taking the newest and most expensive medication.
  • Eliminate the need for any dietary or lifestyle modifications.

Answer: Control symptoms, prevent complications, and improve the patient’s quality of life.

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