Disorders of GIT MCQs With Answer provides B. Pharm students a focused, Student-friendly post to gastrointestinal pharmacology, pathophysiology, diagnostics, and drug therapy for common GIT disorders. This resource emphasizes key topics such as peptic ulcer disease, GERD, H. pylori management, IBD pharmacotherapy, antiemetics, prokinetics, laxatives, antidiarrheals, and hepatobiliary drugs. Each MCQ reinforces drug mechanisms, therapeutic indications, adverse effects, dosing considerations, and clinically relevant interactions to strengthen exam readiness and clinical reasoning. Designed for pharmacy undergraduates, the questions target both conceptual understanding and application in patient care. Now let’s test your knowledge with 50 MCQs on this topic.
Q1. Which mechanism best describes how proton pump inhibitors (PPIs) reduce gastric acid secretion?
- Competitive antagonism of histamine H2 receptors on parietal cells
- Neutralization of gastric acid through alkaline salts
- Irreversible inhibition of the H+/K+ ATPase (proton pump) in parietal cell canaliculi
- Blockade of muscarinic receptors on parietal cells
Correct Answer: Irreversible inhibition of the H+/K+ ATPase (proton pump) in parietal cell canaliculi
Q2. Which drug is commonly used as the first-line prokinetic agent for diabetic gastroparesis and acts as a D2 receptor antagonist?
- Metoclopramide
- Omeprazole
- Loperamide
- Lansoprazole
Correct Answer: Metoclopramide
Q3. Which test is most specific for diagnosing active Helicobacter pylori infection?
- Serum anti-H. pylori IgG antibodies
- Urea breath test
- Plain abdominal X-ray
- Fecal occult blood test
Correct Answer: Urea breath test
Q4. Which antibiotic combination is a component of standard triple therapy for H. pylori eradication?
- Amoxicillin + Clarithromycin + PPI
- Rifampicin + Isoniazid + Ethambutol
- Metronidazole + Ciprofloxacin + Antacid
- Azithromycin + Doxycycline + Sucralfate
Correct Answer: Amoxicillin + Clarithromycin + PPI
Q5. Which drug is a bulk-forming laxative commonly recommended for chronic constipation and acts by absorbing water to increase stool bulk?
- Psyllium
- Bisacodyl
- Lactulose
- Senna
Correct Answer: Psyllium
Q6. Loperamide treats acute diarrhea primarily through which mechanism?
- Inhibition of muscarinic receptors in the gut
- Activation of peripheral mu-opioid receptors to decrease intestinal motility
- Neutralization of gastric acid
- Increasing chloride secretion into the lumen
Correct Answer: Activation of peripheral mu-opioid receptors to decrease intestinal motility
Q7. Which drug is an H2 receptor antagonist still widely used for reducing gastric acid secretion?
- Ranitidine
- Famotidine
- Omeprazole
- Sucralfate
Correct Answer: Famotidine
Q8. Which medication is a selective 5-HT3 receptor antagonist frequently used to prevent chemotherapy-induced nausea and vomiting?
- Ondansetron
- Metoclopramide
- Domperidone
- Prochlorperazine
Correct Answer: Ondansetron
Q9. Which antacid component works by providing rapid neutralization of gastric acid through direct chemical reaction?
- Sodium bicarbonate
- Sucralfate
- Misoprostol
- Omeprazole
Correct Answer: Sodium bicarbonate
Q10. Sucralfate exerts its therapeutic effect primarily by which mechanism in peptic ulcer disease?
- Neutralizing acid through alkaline salts
- Forming a protective viscous barrier over ulcer craters
- Inhibition of H+/K+ ATPase
- Eradication of H. pylori
Correct Answer: Forming a protective viscous barrier over ulcer craters
Q11. Which drug used in inflammatory bowel disease is a prodrug that delivers 5-aminosalicylic acid (5-ASA) to the colon via an azo bond?
- Sulfasalazine
- Azathioprine
- Budesonide
- Infliximab
Correct Answer: Sulfasalazine
Q12. Which immunosuppressant used in Crohn’s disease is metabolized to 6-mercaptopurine and requires TPMT activity consideration?
- Azathioprine
- Methotrexate
- Ciprofloxacin
- Mesalamine
Correct Answer: Azathioprine
Q13. Which biologic agent targets tumor necrosis factor-alpha (TNF-α) and is used for moderate to severe IBD?
- Infliximab
- Rifaximin
- Sulfasalazine
- Budesonide
Correct Answer: Infliximab
Q14. Lactulose is effective in hepatic encephalopathy primarily because it:
- Inhibits ammonia production by gut bacteria through direct antimicrobial action
- Acidifies colonic contents, converting ammonia to ammonium and promoting its excretion
- Acts as a cholestyramine to bind bile acids
- Inhibits hepatic urea cycle enzymes
Correct Answer: Acidifies colonic contents, converting ammonia to ammonium and promoting its excretion
Q15. Which agent is first-line therapy for primary biliary cholangitis to improve cholestasis?
- Ursodeoxycholic acid (UDCA)
- Cholestyramine
- Rifampicin
- Prednisone
Correct Answer: Ursodeoxycholic acid (UDCA)
Q16. Which laboratory marker is most commonly elevated in obstructive cholestasis?
- Serum amylase
- Alkaline phosphatase (ALP)
- Serum albumin
- C-reactive protein
Correct Answer: Alkaline phosphatase (ALP)
Q17. Metronidazole’s notable adverse interaction with alcohol produces which reaction?
- Serotonin syndrome
- Disulfiram-like reaction
- Hypertensive crisis
- Excessive sedation
Correct Answer: Disulfiram-like reaction
Q18. Which drug is used as a peripheral dopamine D2 antagonist with fewer central extrapyramidal side effects because it does not readily cross the blood-brain barrier?
- Domperidone
- Metoclopramide
- Prochlorperazine
- Ondansetron
Correct Answer: Domperidone
Q19. Which pancreatic enzyme levels are most specific and remain elevated longer in acute pancreatitis?
- Amylase
- Lipase
- Trypsin inhibitor
- Alkaline phosphatase
Correct Answer: Lipase
Q20. Which medication for constipation increases intestinal fluid secretion by activating chloride channels (ClC-2) on the apical membrane?
- Lubiprostone
- Psyllium
- Bisacodyl
- Docusate sodium
Correct Answer: Lubiprostone
Q21. Which of the following is a stool softener that lowers surface tension to allow water penetration into stool?
- Docusate sodium
- Senna
- Lactulose
- Psyllium
Correct Answer: Docusate sodium
Q22. Which drug is contraindicated or used with caution in ileus because it can precipitate intestinal ischemia when used as a prokinetic?
- Cisapride
- Prucalopride
- Metoclopramide
- Domperidone
Correct Answer: Prucalopride
Q23. Which adverse effect is most associated with long-term proton pump inhibitor therapy?
- Hyperkalemia
- Vitamin B12 deficiency
- Hypoglycemia
- Neutropenia
Correct Answer: Vitamin B12 deficiency
Q24. Which medication used in bile acid diarrhea and pruritus works by binding bile acids in the gut?
- Cholestyramine
- Ursodeoxycholic acid
- Rifaximin
- Metformin
Correct Answer: Cholestyramine
Q25. Which antibiotic is a non-absorbable rifamycin derivative used for hepatic encephalopathy and some IBS symptoms?
- Rifaximin
- Metronidazole
- Ciprofloxacin
- Amoxicillin
Correct Answer: Rifaximin
Q26. Which physiologic secretion increases gastric mucosal protection and is mimicked by misoprostol to prevent NSAID-induced ulcers?
- Gastrin
- Prostaglandin E1 analog effects
- Histamine
- Secretin
Correct Answer: Prostaglandin E1 analog effects
Q27. Which class of drugs reduces gastric acid by blocking H2 receptors on parietal cells and is useful for duodenal ulcers and GERD?
- Proton pump inhibitors
- H2 receptor antagonists
- Antimuscarinics
- Antacids only
Correct Answer: H2 receptor antagonists
Q28. Which condition is characterized by gastric acid hypersecretion due to a gastrin-secreting tumor?
- Peptic ulcer disease from H. pylori
- Zollinger-Ellison syndrome
- Achalasia
- Ulcerative colitis
Correct Answer: Zollinger-Ellison syndrome
Q29. Which drug commonly used for irritable bowel syndrome with predominant diarrhea exerts effects by slowing intestinal transit and has antisecretory properties?
- Loperamide
- Linaclotide
- Lubiprostone
- Polyethylene glycol
Correct Answer: Loperamide
Q30. Which of the following is the best initial pharmacologic therapy for moderate to severe ulcerative colitis flare requiring systemic control?
- Oral mesalamine only
- Systemic corticosteroids (e.g., prednisone)
- Oral cholestyramine
- Topical antacids
Correct Answer: Systemic corticosteroids (e.g., prednisone)
Q31. Which antiemetic acts as a neurokinin-1 (NK1) receptor antagonist and is often combined with 5-HT3 antagonists for chemotherapy-induced nausea?
- Aprepitant
- Prochlorperazine
- Domperidone
- Metoclopramide
Correct Answer: Aprepitant
Q32. Which laxative class works by drawing water into the bowel lumen via osmotic effect and includes polyethylene glycol (PEG)?
- Stimulant laxatives
- Osmotic laxatives
- Bulk-forming laxatives
- Surface-active agents
Correct Answer: Osmotic laxatives
Q33. Which of the following is the primary mechanism of action of bismuth subsalicylate in treating acute diarrhea and dyspepsia?
- Systemic antibiotic activity
- Local antimicrobial and mucosal protective effects
- Neutralization of gastric acid
- Peripheral opioid receptor agonism
Correct Answer: Local antimicrobial and mucosal protective effects
Q34. In peptic ulcer disease, the major role of eradication of H. pylori is to:
- Provide immediate analgesia for abdominal pain
- Reduce recurrence and promote ulcer healing long-term
- Neutralize gastric acid permanently
- Replace proton pump inhibitors
Correct Answer: Reduce recurrence and promote ulcer healing long-term
Q35. Which drug used in Crohn’s disease interferes with folate metabolism and can be given as an immunomodulator at low doses?
- Methotrexate
- Azathioprine
- Mesalamine
- Infliximab
Correct Answer: Methotrexate
Q36. Which adverse event is particularly concerning with use of long-term high-dose corticosteroids in gastrointestinal disease?
- Peptic ulcer formation and infection risk
- Immediate anaphylaxis
- Renal tubular necrosis
- Hypoglycemia
Correct Answer: Peptic ulcer formation and infection risk
Q37. Which drug is contraindicated in pregnancy for treatment of peptic ulcer disease because it is a prostaglandin analog that can cause uterine contractions?
- Misoprostol
- Omeprazole
- Ranitidine
- Sucralfate
Correct Answer: Misoprostol
Q38. Which agent is indicated to prevent NSAID-induced gastric ulcers by replacing protective prostaglandins?
- Misoprostol
- Omeprazole
- Metronidazole
- Sucralfate
Correct Answer: Misoprostol
Q39. Which diagnostic procedure is gold standard for direct visualization and biopsy of suspected gastric or colonic lesions?
- Ultrasound abdomen
- Endoscopy (EGD/colonoscopy)
- Plain radiography
- Urea breath test
Correct Answer: Endoscopy (EGD/colonoscopy)
Q40. Which of the following is a common pharmacokinetic requirement for oral PPIs to ensure appropriate delivery and activation?
- Immediate-release tablet without coating
- Enteric-coated formulation to avoid gastric acid degradation
- Co-administration with antacids for activation
- High-fat meal to increase absorption
Correct Answer: Enteric-coated formulation to avoid gastric acid degradation
Q41. Which condition is characterized by continuous mucosal inflammation limited to the colon and rectum and often treated with mesalamine?
- Crohn’s disease
- Ulcerative colitis
- Irritable bowel syndrome
- Peptic ulcer disease
Correct Answer: Ulcerative colitis
Q42. Which drug can cause constipation as a major adverse effect due to decreased gut motility via opioid receptors?
- Magnesium hydroxide
- Codeine
- Bisacodyl
- Rifaximin
Correct Answer: Codeine
Q43. What is the principal therapeutic action of pancrelipase preparations in exocrine pancreatic insufficiency?
- Acid suppression in stomach
- Provide digestive enzymes (lipase, amylase, protease) to aid macronutrient digestion
- Antisecretory stimulation of pancreatic bicarbonate
- Inhibition of pancreatic enzyme secretion
Correct Answer: Provide digestive enzymes (lipase, amylase, protease) to aid macronutrient digestion
Q44. Which medication used for small bowel bacterial overgrowth and some cases of IBS is minimally absorbed and exerts local effects in the gut?
- Rifaximin
- Vancomycin oral
- Amoxicillin
- Ciprofloxacin
Correct Answer: Rifaximin
Q45. Which of the following drug interactions is a concern with clarithromycin when used in H. pylori therapy?
- Induction of CYP2D6 leading to reduced warfarin levels
- Inhibition of CYP3A4 leading to increased levels of statins
- Activation of P-glycoprotein causing decreased digoxin absorption
- Potentiation of acetaminophen metabolism
Correct Answer: Inhibition of CYP3A4 leading to increased levels of statins
Q46. Which therapy is indicated for bile acid malabsorption causing chronic watery diarrhea and acts by binding bile acids?
- Cholestyramine
- Lactulose
- Mesalamine
- Ondansetron
Correct Answer: Cholestyramine
Q47. Which is the most appropriate initial management for a patient with acute variceal bleed due to portal hypertension?
- High-dose oral PPI only
- Vasoconstrictors (e.g., terlipressin) plus endoscopic therapy
- Immediate elective colonoscopy
- Oral laxatives
Correct Answer: Vasoconstrictors (e.g., terlipressin) plus endoscopic therapy
Q48. Which anti-secretory medication should be avoided in patients with significant liver disease due to primarily hepatic metabolism and altered clearance?
- Ranitidine
- Domperidone
- Omeprazole
- Misoprostol
Correct Answer: Omeprazole
Q49. Which agent is effective for bile acid diarrhea and also relieves pruritus in cholestatic liver disease by interrupting enterohepatic circulation?
- Ursodeoxycholic acid
- Cholestyramine
- Rifaximin
- Lactulose
Correct Answer: Cholestyramine
Q50. Which of the following statements about sucralfate is correct in clinical use for peptic ulcer disease?
- It systemically neutralizes gastric acid and raises pH
- It binds to ulcer bases forming a protective barrier and requires an acidic environment for activation
- It eradicates H. pylori as monotherapy
- It is a potent proton pump inhibitor
Correct Answer: It binds to ulcer bases forming a protective barrier and requires an acidic environment for activation
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