Peptic ulcer disease: medical management and eradication therapy MCQs With Answer

Peptic ulcer disease: medical management and eradication therapy MCQs With Answer

This question set is designed for M.Pharm students studying Pharmacotherapeutics I (MPP 102T) to deepen understanding of peptic ulcer disease (PUD) pharmacology and eradication strategies. It emphasizes drug mechanisms, dose considerations, pharmacokinetics, adverse effects, drug interactions, and evidence-based H. pylori eradication regimens. Questions cover NSAID-induced ulcers, acid suppression therapies (PPIs and H2 blockers), mucosal protective agents, prostaglandin analogs, and first-line and rescue eradication therapies with diagnostics and resistance implications. Use these MCQs to test clinical reasoning, therapeutic selection, and practical considerations in managing PUD and optimizing eradication outcomes.

Q1. Which mechanism primarily explains how proton pump inhibitors (PPIs) reduce gastric acid secretion?

• Competitive inhibition of H2 receptors on parietal cells
• Irreversible inhibition of the H+/K+ ATPase proton pump in parietal cells
• Neutralization of gastric acid by chemical buffering
• Stimulation of prostaglandin E2 synthesis to reduce acid secretion

Correct Answer: Irreversible inhibition of the H+/K+ ATPase proton pump in parietal cells

Q2. Which of the following is the most appropriate first-line triple therapy for H. pylori in regions with low clarithromycin resistance?

• Proton pump inhibitor + amoxicillin + clarithromycin for 14 days
• Proton pump inhibitor + metronidazole + levofloxacin for 7 days
• Bismuth subsalicylate + tetracycline + metronidazole for 10 days
• H2 blocker + amoxicillin + clarithromycin for 14 days

Correct Answer: Proton pump inhibitor + amoxicillin + clarithromycin for 14 days

Q3. Which diagnostic test is most appropriate to confirm eradication of H. pylori after completion of therapy?

• Serologic IgG antibody test immediately after therapy
• Urea breath test or stool antigen test performed ≥4 weeks after therapy
• Rapid urease test on gastric biopsy within 1 week of finishing therapy
• Plain abdominal X-ray to detect residual infection

Correct Answer: Urea breath test or stool antigen test performed ≥4 weeks after therapy

Q4. Which adverse effect is most commonly associated with long-term high-dose PPI therapy?

• Hypomagnesemia and increased risk of bone fractures
• Acute pancreatitis
• Renal cell carcinoma
• Severe hypoglycemia

Correct Answer: Hypomagnesemia and increased risk of bone fractures

Q5. Sucralfate promotes ulcer healing primarily by which mechanism?

• Alkalinizing gastric contents to neutral pH
• Forming a viscous, protective barrier that binds to ulcer base proteins
• Inhibiting H. pylori urease activity directly
• Stimulating gastrin release to enhance mucosal blood flow

Correct Answer: Forming a viscous, protective barrier that binds to ulcer base proteins

Q6. A patient on clopidogrel is to start omeprazole. What is the primary pharmacokinetic concern?

• Omeprazole induces CYP2C19 increasing clopidogrel activation
• Omeprazole inhibits CYP2C19 reducing clopidogrel activation and antiplatelet effect
• Clopidogrel increases renal clearance of omeprazole leading to loss of efficacy
• No interaction exists; both can be co-administered safely without concern

Correct Answer: Omeprazole inhibits CYP2C19 reducing clopidogrel activation and antiplatelet effect

Q7. Which regimen is recommended as first-line in areas with high clarithromycin resistance or after prior macrolide exposure?

• Clarithromycin-based triple therapy
• Bismuth-based quadruple therapy (PPI + bismuth + tetracycline + metronidazole) for 10–14 days
• PPI alone for 8 weeks
• H2 blocker plus sucralfate

Correct Answer: Bismuth-based quadruple therapy (PPI + bismuth + tetracycline + metronidazole) for 10–14 days

Q8. Which NSAID-related strategy most effectively reduces risk of peptic ulcer in a patient who requires chronic NSAID therapy?

• Switch from nonselective NSAID to a COX-2 selective inhibitor plus PPI prophylaxis if high risk
• Co-prescribe sucralfate only without stopping NSAID
• Use H2 receptor antagonists alone as equally protective as PPIs for NSAID ulcers
• Continue NSAID and add oral bismuth for prevention

Correct Answer: Switch from nonselective NSAID to a COX-2 selective inhibitor plus PPI prophylaxis if high risk

Q9. Which antibiotic resistance primarily threatens the success of standard clarithromycin-based triple therapy?

• Metronidazole resistance
• Amoxicillin resistance
• Clarithromycin resistance due to 23S rRNA mutations
• Tetracycline resistance

Correct Answer: Clarithromycin resistance due to 23S rRNA mutations

Q10. Misoprostol is used in prevention of NSAID-induced ulcers by which mechanism?

• Directly neutralizing gastric acid
• Replacing endogenous prostaglandin E1 activity to increase mucus and bicarbonate secretion and maintain mucosal blood flow
• Inhibiting H. pylori adhesion to mucosa
• Blocking histamine H2 receptors on parietal cells

Correct Answer: Replacing endogenous prostaglandin E1 activity to increase mucus and bicarbonate secretion and maintain mucosal blood flow

Q11. Which PPI has the least interaction potential via CYP2C19 and may be preferred in patients on clopidogrel?

• Omeprazole
• Esomeprazole
• Pantoprazole
• Lansoprazole

Correct Answer: Pantoprazole

Q12. Which statement about bismuth subsalicylate in eradication therapy is correct?

• Bismuth has systemic bactericidal action against H. pylori but increases gastric acidity
• Bismuth compounds provide topical antimicrobial effect, enhance mucosal protection, and are used in quadruple therapy
• Bismuth is contraindicated with tetracycline due to antagonism
• Bismuth replaces the need for a PPI in eradication regimens

Correct Answer: Bismuth compounds provide topical antimicrobial effect, enhance mucosal protection, and are used in quadruple therapy

Q13. Which of the following is the recommended duration for most first-line H. pylori eradication regimens to maximize cure rates?

• 5 days
• 7 days
• 10–14 days, with 14 days often preferred
• 28 days

Correct Answer: 10–14 days, with 14 days often preferred

Q14. Which H2 receptor antagonist is most likely to cause antiandrogenic effects such as gynecomastia with long-term use?

• Ranitidine
• Famotidine
• Cimetidine
• Nizatidine

Correct Answer: Cimetidine

Q15. Which eradication strategy is most appropriate for a patient with penicillin (amoxicillin) allergy?

• PPI + amoxicillin + clarithromycin
• PPI + clarithromycin + metronidazole (14 days) if clarithromycin resistance low
• PPI + amoxicillin + metronidazole
• H2 blocker + tetracycline + bismuth

Correct Answer: PPI + clarithromycin + metronidazole (14 days) if clarithromycin resistance low

Q16. Which laboratory abnormality should be monitored in patients on long-term sucralfate therapy?

• Hyperkalemia due to potassium retention
• Hypophosphatemia due to aluminum binding phosphate
• Hypercalcemia due to calcium loading
• Elevated transaminases due to hepatic metabolism

Correct Answer: Hypophosphatemia due to aluminum binding phosphate

Q17. Which is a key pharmacodynamic reason for giving PPIs before meals when used in eradication regimens?

• PPIs need acidic environment to be absorbed, so fasting reduces absorption
• PPIs require active proton pumps (stimulated by food) to be present in canalicular membranes for irreversible binding
• Food chemically inactivates PPIs unless given before meals
• Timing has no relevance; PPIs work equally at any time

Correct Answer: PPIs require active proton pumps (stimulated by food) to be present in canalicular membranes for irreversible binding

Q18. Which factor is most associated with treatment failure of H. pylori eradication?

• High gastric pH during therapy
• Poor patient adherence to multi-drug regimens
• Use of high-dose PPI
• Short duration of proton pump inhibitor pre-treatment only

Correct Answer: Poor patient adherence to multi-drug regimens

Q19. In a patient with bleeding peptic ulcer requiring urgent acid suppression, which intravenous agent is preferred for rapid potent acid suppression?

• Oral ranitidine
• Intravenous high-dose proton pump inhibitor infusion (e.g., pantoprazole infusion)
• Intravenous misoprostol bolus
• Oral sucralfate only

Correct Answer: Intravenous high-dose proton pump inhibitor infusion (e.g., pantoprazole infusion)

Q20. Which statement about sequential or concomitant non-bismuth quadruple therapies is correct?

• Sequential therapy uses PPI+amoxicillin followed by PPI+clarithromycin+metronidazole and may improve eradication in some settings
• These regimens avoid use of PPIs entirely to reduce drug interactions
• Concomitant therapy combines PPI with only two antibiotics to reduce side effects
• Sequential therapy is always inferior to standard triple therapy regardless of resistance patterns

Correct Answer: Sequential therapy uses PPI+amoxicillin followed by PPI+clarithromycin+metronidazole and may improve eradication in some settings

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