Welcome PharmD students to your MCQ quiz on Gastrointestinal (GI) Self-Care! GI complaints like heartburn, constipation, diarrhea, nausea, and gas are among the most common reasons patients seek advice from pharmacists. Mastering the principles of self-care for these conditions—including accurate symptom assessment, understanding non-prescription treatment options, recognizing when to refer, and providing effective patient counseling—is a cornerstone of community pharmacy practice. This quiz will challenge your knowledge of various GI disorders amenable to self-treatment and help you prepare to guide patients toward appropriate relief. Let’s begin!
1. A patient complains of a burning sensation in their chest that occurs after large meals, especially when lying down. This is most characteristic of:
- a) Constipation
- b) Heartburn
- c) Acute diarrhea
- d) Motion sickness
Answer: b) Heartburn
2. Which class of non-prescription medications provides the fastest relief for occasional heartburn symptoms by neutralizing stomach acid?
- a) Proton Pump Inhibitors (PPIs)
- b) H2-Receptor Antagonists (H2RAs)
- c) Antacids
- d) Bismuth subsalicylate
Answer: c) Antacids
3. What is a key counseling point for a patient purchasing an over-the-counter (OTC) proton pump inhibitor (e.g., omeprazole) for frequent heartburn?
- a) It provides immediate relief within minutes.
- b) It should be taken for a maximum of 14 days before consulting a doctor if symptoms persist.
- c) It can be taken with an H2RA for better effect.
- d) It is best taken after meals to neutralize acid.
Answer: b) It should be taken for a maximum of 14 days before consulting a doctor if symptoms persist.
4. Which of the following is a common side effect of magnesium-containing antacids?
- a) Constipation
- b) Diarrhea
- c) Black stools
- d) Dry mouth
Answer: b) Diarrhea
5. A patient reports infrequent bowel movements (less than 3 times a week) with hard, difficult-to-pass stools. This describes:
- a) Dyspepsia
- b) Diarrhea
- c) Constipation
- d) Gastritis
Answer: c) Constipation
6. Which type of laxative works by increasing the water content in the stool, making it softer and easier to pass, and is generally considered a first-line option for chronic constipation?
- a) Stimulant laxatives (e.g., senna)
- b) Bulk-forming laxatives (e.g., psyllium)
- c) Lubricant laxatives (e.g., mineral oil)
- d) Saline laxatives (e.g., magnesium citrate)
Answer: b) Bulk-forming laxatives (e.g., psyllium)
7. What is an important counseling point for patients taking bulk-forming laxatives?
- a) Take with minimal water to increase effectiveness.
- b) Expect immediate relief within 1-2 hours.
- c) Take with a full glass of water to prevent esophageal obstruction or choking.
- d) They are suitable for patients with fluid restrictions.
Answer: c) Take with a full glass of water to prevent esophageal obstruction or choking.
8. Polyethylene glycol 3350 (PEG 3350) is classified as which type of laxative?
- a) Stimulant laxative
- b) Emollient laxative
- c) Hyperosmotic laxative
- d) Saline laxative
Answer: c) Hyperosmotic laxative
9. Which of the following is an exclusion for self-treatment of constipation?
- a) Symptoms lasting less than one week.
- b) Concurrent use of medications known to cause constipation.
- c) Presence of severe abdominal pain, nausea, or vomiting.
- d) Age over 65 years.
Answer: c) Presence of severe abdominal pain, nausea, or vomiting.
10. Non-pharmacological recommendations for managing constipation include:
- a) Decreasing dietary fiber and fluid intake.
- b) Increasing dietary fiber, fluid intake, and physical activity.
- c) Relying solely on laxatives.
- d) Avoiding fruits and vegetables.
Answer: b) Increasing dietary fiber, fluid intake, and physical activity.
11. Which non-prescription medication is commonly used for the prevention and treatment of motion sickness?
- a) Loperamide
- b) Meclizine or Dimenhydrinate
- c) Omeprazole
- d) Simethicone
Answer: b) Meclizine or Dimenhydrinate
12. Bismuth subsalicylate is used in self-care for:
- a) Preventing motion sickness.
- b) Relieving heartburn, indigestion, nausea, and treating mild, non-specific diarrhea.
- c) Only as a bulk-forming laxative.
- d) Primarily for reducing intestinal gas.
Answer: b) Relieving heartburn, indigestion, nausea, and treating mild, non-specific diarrhea.
13. A common, harmless side effect of bismuth subsalicylate that patients should be counseled about is:
- a) Severe drowsiness
- b) Temporary darkening of the tongue and/or stools
- c) Increased blood pressure
- d) Rebound acidity
Answer: b) Temporary darkening of the tongue and/or stools
14. Oral Rehydration Solutions (ORS) are primarily recommended for:
- a) Preventing motion sickness.
- b) Managing dehydration due to diarrhea or vomiting.
- c) Treating heartburn.
- d) As a daily dietary supplement.
Answer: b) Managing dehydration due to diarrhea or vomiting.
15. Exclusions for self-treatment of nausea and vomiting include:
- a) Nausea due to overeating.
- b) Signs of severe dehydration (e.g., minimal urination, very dry mouth, dizziness).
- c) Mild motion sickness.
- d) Vomiting that lasts less than 6 hours.
Answer: b) Signs of severe dehydration (e.g., minimal urination, very dry mouth, dizziness).
16. Loperamide is an anti-diarrheal agent that works by:
- a) Adsorbing toxins in the gut.
- b) Slowing intestinal motility.
- c) Neutralizing stomach acid.
- d) Increasing fluid secretion into the bowel.
Answer: b) Slowing intestinal motility.
17. Which of the following is an exclusion for self-treatment of diarrhea?
- a) Diarrhea lasting less than 24 hours.
- b) Presence of high fever (>102.2°F or 39°C) or blood/mucus in the stool.
- c) Mild abdominal cramping.
- d) Diarrhea after consuming a new food.
Answer: b) Presence of high fever (>102.2°F or 39°C) or blood/mucus in the stool.
18. Simethicone is a non-prescription medication used to relieve symptoms of:
- a) Constipation
- b) Diarrhea
- c) Intestinal gas (bloating, pressure)
- d) Heartburn
Answer: c) Intestinal gas (bloating, pressure)
19. Alpha-galactosidase (e.g., Beano®) is an enzyme product that helps prevent gas produced from eating:
- a) Dairy products
- b) High-fiber foods like beans, broccoli, and grains
- c) Fatty foods
- d) Spicy foods
Answer: b) High-fiber foods like beans, broccoli, and grains
20. What is a common cause of dyspepsia (indigestion)?
- a) Insufficient stomach acid
- b) Overeating, eating too quickly, or consuming fatty/spicy foods
- c) Excessive fiber intake
- d) Viral infections
Answer: b) Overeating, eating too quickly, or consuming fatty/spicy foods
21. H2-Receptor Antagonists (e.g., famotidine) work by:
- a) Neutralizing existing stomach acid.
- b) Reducing stomach acid secretion by blocking histamine at H2 receptors on parietal cells.
- c) Forming a protective coating over the esophageal lining.
- d) Irreversibly inhibiting the proton pump.
Answer: b) Reducing stomach acid secretion by blocking histamine at H2 receptors on parietal cells.
22. Docusate sodium is classified as which type of laxative?
- a) Bulk-forming
- b) Stimulant
- c) Emollient (stool softener)
- d) Osmotic
Answer: c) Emollient (stool softener)
23. A “food coma” or postprandial somnolence is often related to indigestion. A lifestyle modification to help prevent this is:
- a) Eating one very large meal per day.
- b) Eating smaller, more frequent meals and avoiding overeating.
- c) Lying down immediately after eating.
- d) Consuming more carbonated beverages with meals.
Answer: b) Eating smaller, more frequent meals and avoiding overeating.
24. For acute, uncomplicated diarrhea, what is a primary non-pharmacological recommendation?
- a) Avoiding all fluids to rest the bowel.
- b) Maintaining adequate fluid and electrolyte intake (e.g., with ORS).
- c) Consuming a high-fat diet.
- d) Taking antibiotics immediately.
Answer: b) Maintaining adequate fluid and electrolyte intake (e.g., with ORS).
25. Senna and bisacodyl are examples of which class of laxatives, typically used for short-term relief of constipation?
- a) Bulk-forming laxatives
- b) Osmotic laxatives
- c) Stimulant laxatives
- d) Emollient laxatives
Answer: c) Stimulant laxatives
26. A patient with lactose intolerance may benefit from which type of digestive enzyme supplement when consuming dairy?
- a) Alpha-galactosidase
- b) Lactase enzyme
- c) Pancreatic enzymes
- d) Bromelain
Answer: b) Lactase enzyme
27. “Alarm symptoms” for heartburn that require medical referral include:
- a) Mild, infrequent heartburn.
- b) Heartburn relieved by antacids.
- c) Dysphagia (difficulty swallowing) or odynophagia (painful swallowing).
- d) Symptoms occurring only after spicy meals.
Answer: c) Dysphagia (difficulty swallowing) or odynophagia (painful swallowing).
28. Which non-prescription medication for nausea/vomiting works by decreasing smooth muscle contraction and delaying GI transit time, making it useful for motion sickness?
- a) Phosphorated carbohydrate solution
- b) Antihistamines like dimenhydrinate
- c) Bismuth subsalicylate
- d) Loperamide
Answer: b) Antihistamines like dimenhydrinate
29. Probiotics are live microorganisms that, when administered in adequate amounts, may confer a health benefit. They are sometimes used in self-care for:
- a) Curing peptic ulcers.
- b) Preventing all types of food poisoning.
- c) Helping to restore gut flora, potentially aiding in some types of diarrhea or IBS symptoms.
- d) Neutralizing stomach acid.
Answer: c) Helping to restore gut flora, potentially aiding in some types of diarrhea or IBS symptoms.
30. A key lifestyle modification for reducing heartburn symptoms is:
- a) Eating large meals just before bedtime.
- b) Elevating the head of the bed and avoiding trigger foods.
- c) Increasing intake of caffeine and chocolate.
- d) Lying flat after eating to aid digestion.
Answer: b) Elevating the head of the bed and avoiding trigger foods.
31. Mineral oil as a laxative is generally not recommended for routine self-care due to risks of:
- a) Severe dehydration.
- b) Lipid pneumonia if aspirated, and impaired absorption of fat-soluble vitamins.
- c) Causing electrolyte imbalances.
- d) Being highly addictive.
Answer: b) Lipid pneumonia if aspirated, and impaired absorption of fat-soluble vitamins.
32. When should a patient taking an OTC PPI for frequent heartburn expect to experience significant symptom relief?
- a) Within 10-15 minutes.
- b) It may take 1-4 days for full effect.
- c) Immediately after the first dose.
- d) Only after completing the 14-day course.
Answer: b) It may take 1-4 days for full effect.
33. Which population should generally avoid bismuth subsalicylate due to the risk of Reye’s syndrome if they have a concurrent viral illness?
- a) Elderly adults
- b) Pregnant women
- c) Children and teenagers
- d) Patients with hypertension
Answer: c) Children and teenagers
34. The mechanism of action of simethicone in relieving gas is:
- a) It absorbs gas in the intestines.
- b) It reduces the surface tension of gas bubbles, causing them to coalesce and be eliminated more easily.
- c) It inhibits gas-producing bacteria.
- d) It neutralizes stomach acid that produces gas.
Answer: b) It reduces the surface tension of gas bubbles, causing them to coalesce and be eliminated more easily.
35. Long-term, frequent use of stimulant laxatives can potentially lead to:
- a) Improved natural bowel function.
- b) Dependence and cathartic colon.
- c) Weight gain.
- d) Increased absorption of nutrients.
Answer: b) Dependence and cathartic colon.
36. Which of the following is a dietary source of insoluble fiber that can help with constipation?
- a) White bread
- b) Apple juice
- c) Wheat bran, vegetables
- d) Cheese
Answer: c) Wheat bran, vegetables
37. A patient complains of nausea and vomiting that began shortly after eating at a new restaurant. This could be indicative of:
- a) Motion sickness
- b) Food poisoning
- c) Morning sickness (if applicable)
- d) Heartburn
Answer: b) Food poisoning (While self-care is limited, recognizing cause is important for referral if severe).
38. The “BRAT” diet (Bananas, Rice, Applesauce, Toast) for diarrhea:
- a) Is the current gold standard recommendation.
- b) Is no longer universally recommended as it is too restrictive and low in nutrients; focus is on rehydration and resuming a normal diet as tolerated.
- c) Should be followed for at least two weeks.
- d) Includes spicy foods to kill bacteria.
Answer: b) Is no longer universally recommended as it is too restrictive and low in nutrients; focus is on rehydration and resuming a normal diet as tolerated.
39. An antacid containing aluminum hydroxide as its primary ingredient may cause which side effect with chronic use?
- a) Diarrhea
- b) Constipation
- c) Gas and bloating
- d) Metabolic acidosis
Answer: b) Constipation
40. What is an appropriate non-pharmacological measure for managing flatulence?
- a) Increasing intake of carbonated beverages.
- b) Avoiding gas-producing foods and eating slowly to reduce swallowed air.
- c) Chewing gum frequently.
- d) Lying down immediately after meals.
Answer: b) Avoiding gas-producing foods and eating slowly to reduce swallowed air.
41. Self-care for heartburn is NOT appropriate if the patient also experiences:
- a) Mild, occasional indigestion.
- b) Symptoms after eating a large, fatty meal.
- c) Unexplained weight loss or recurrent vomiting.
- d) A desire to try an OTC medication first.
Answer: c) Unexplained weight loss or recurrent vomiting.
42. Glycerin suppositories are useful for constipation because they:
- a) Stimulate nerve endings in the colon.
- b) Add bulk to the stool.
- c) Act as an osmotic laxative and local irritant, drawing water into the rectum and stimulating evacuation.
- d) Soften stool throughout the entire GI tract.
Answer: c) Act as an osmotic laxative and local irritant, drawing water into the rectum and stimulating evacuation.
43. What is the primary goal of oral rehydration therapy (ORT) in cases of diarrhea or vomiting?
- a) To stop the diarrhea or vomiting immediately.
- b) To prevent or treat dehydration and electrolyte imbalances.
- c) To kill the causative pathogen.
- d) To provide caloric intake.
Answer: b) To prevent or treat dehydration and electrolyte imbalances.
44. If a patient is using loperamide for diarrhea, they should be counseled to discontinue use and see a doctor if:
- a) Diarrhea improves within 24 hours.
- b) They experience one loose stool after taking it.
- c) Diarrhea persists for more than 48 hours despite treatment, or if fever or abdominal pain develops.
- d) They feel slightly tired.
Answer: c) Diarrhea persists for more than 48 hours despite treatment, or if fever or abdominal pain develops.
45. Which lifestyle factor is a common contributor to both heartburn and constipation?
- a) Regular vigorous exercise
- b) High fluid intake
- c) A diet low in fiber and high in processed foods
- d) Adequate sleep
Answer: c) A diet low in fiber and high in processed foods (Low fiber for constipation; certain processed/fatty foods for heartburn).
46. A patient asks for a product to “cleanse their colon.” Pharmacists should advise that:
- a) Regular colon cleansing with OTC products is necessary for good health.
- b) The colon is self-cleaning, and most OTC colon cleanse products lack evidence and can be harmful.
- c) Only prescription colon cleanses are effective.
- d) They should use a stimulant laxative daily for this purpose.
Answer: b) The colon is self-cleaning, and most OTC colon cleanse products lack evidence and can be harmful.
47. For a patient seeking relief from gas associated with eating beans, the most appropriate enzyme supplement would be:
- a) Lactase
- b) Pancrelipase
- c) Alpha-galactosidase
- d) Simethicone (which is not an enzyme, but an anti-foaming agent)
Answer: c) Alpha-galactosidase
48. A key difference in onset of action between antacids and H2RAs for heartburn is:
- a) H2RAs work faster than antacids.
- b) Antacids provide faster relief, while H2RAs have a slower onset but longer duration of action.
- c) Both have the exact same onset and duration.
- d) Antacids have a delayed onset but very long duration.
Answer: b) Antacids provide faster relief, while H2RAs have a slower onset but longer duration of action.
49. What is a critical piece of advice for parents regarding self-treatment of vomiting or diarrhea in infants and young children?
- a) Withhold all fluids for 24 hours.
- b) Focus on preventing dehydration with ORS and seek medical attention promptly if signs of dehydration occur or symptoms are severe/persistent.
- c) Administer adult doses of anti-diarrheals.
- d) Assume it’s always due to teething and no treatment is needed.
Answer: b) Focus on preventing dehydration with ORS and seek medical attention promptly if signs of dehydration occur or symptoms are severe/persistent.
50. When a patient presents with multiple GI symptoms (e.g., heartburn, bloating, and altered bowel habits), and is seeking self-care, it is crucial for the pharmacist to:
- a) Recommend a product for each individual symptom without further questions.
- b) Assess for alarm symptoms or exclusions that warrant medical referral before recommending any self-treatment.
- c) Tell the patient to try a probiotic first.
- d) Assume it is irritable bowel syndrome (IBS) and recommend dietary changes only.
Answer: b) Assess for alarm symptoms or exclusions that warrant medical referral before recommending any self-treatment.