Acid-Peptic Disease Therapeutics — MCQs
Mechanism of action of teduglutide in short bowel syndrome:
What is the drug of choice for drug-induced peptic ulcer?
Which of the following is an H2 receptor antagonist used as an anti-ulcer drug?
Which of the following is the most common adverse effect of omeprazole?
A patient presents with hematemesis and is diagnosed with esophageal varices. What is the first line of treatment?
What is the treatment of choice in duodenal ulcer without any complications of hemorrhage?
Which of the following is NOT a feature of Refsum disease?
Nucleic acid is not found in -
Which one of the following statements is not correct regarding Gastric outlet obstruction associated with long standing peptic ulcer disease?
Identify the procedure shown in the image, which is performed in a patient with recurrent GERD.
Acid-Peptic Disease Therapeutics Indian Medical PG Practice Questions and MCQs
Question 1: Mechanism of action of teduglutide in short bowel syndrome:
- A. GLP-2 analog that inhibits apoptosis (Correct Answer)
- B. HT1A inhibitor
- C. C-peptide analog
- D. GLP-1 analog that inhibits apoptosis
Explanation: ***GLP-2 analog that inhibits apoptosis*** - **Teduglutide** is a synthetic analog of **glucagon-like peptide-2 (GLP-2)**, which is a naturally occurring human hormone [1]. - Its primary mechanism in **short bowel syndrome** involves promoting mucosal growth and inhibiting epithelial cell apoptosis, thereby enhancing nutrient absorption and gut adaptation. *GLP-1 analogs that inhibits apoptosis* - **GLP-1 analogs** like exenatide or liraglutide are primarily used for **type 2 diabetes mellitus** to stimulate insulin secretion and suppress glucagon [2]. - While they can have some effects on gut motility, their main role is not in promoting mucosal growth or inhibiting apoptosis in the context of short bowel syndrome. *HT1A inhibitor* - **HT1A inhibitors** (5-HT1A receptor antagonists) are typically involved in modulating serotonin pathways, often with applications in conditions like **anxiety** or **depression**. - There is no known direct link between HT1A inhibition and the treatment of short bowel syndrome. *C-peptide analogs* - **C-peptide** is a byproduct of insulin production and has been studied for potential roles in preventing diabetes complications, particularly in relation to **microvascular complications** [3], [4]. - It does not play a direct role as a therapeutic agent for promoting intestinal adaptation or inhibiting apoptosis in short bowel syndrome.
Question 2: What is the drug of choice for drug-induced peptic ulcer?
- A. Prostaglandin analogues
- B. H2-receptor antagonists
- C. Proton pump inhibitors (Correct Answer)
- D. Antacids
Explanation: ***Proton pump inhibitors*** - **PPIs** are the most effective agents for treating and preventing **NSAID-induced peptic ulcers** by profoundly suppressing gastric acid secretion. - They provide **rapid symptom relief** and promote ulcer healing by creating an environment conducive to mucosal repair. *Prostaglandin analogues* - **Misoprostol**, a prostaglandin E1 analogue, can prevent NSAID-induced ulcers, but its use is limited by **gastrointestinal side effects** such as diarrhea and abdominal cramping. - While they protect the gastric mucosa, their efficacy in healing established ulcers is generally **inferior to PPIs**. *H2-receptor antagonists* - **H2-blockers** are effective in reducing gastric acid, but they are **less potent** than PPIs and typically do not heal **gastric ulcers** as effectively, especially those induced by NSAIDs. - They are more commonly used for preventing **duodenal ulcers** and managing symptoms of GERD. *Antacids* - Antacids provide **immediate, temporary relief** of ulcer symptoms by neutralizing existing stomach acid. - They do not address the underlying pathology or promote **ulcer healing** and are therefore not considered the drug of choice for treatment.
Question 3: Which of the following is an H2 receptor antagonist used as an anti-ulcer drug?
- A. Pirenzepine
- B. Famotidine (Correct Answer)
- C. Rabeprazole
- D. Sucralfate
Explanation: ***Famotidine*** - **Famotidine** is a potent and selective **H2 receptor antagonist** that works by blocking histamine H2 receptors on parietal cells, thereby reducing gastric acid secretion. - It is widely used for the treatment of **peptic ulcers**, gastroesophageal reflux disease (**GERD**), and other acid-related disorders. *Pirenzepine* - **Pirenzepine** is a **selective M1 muscarinic antagonist**, which inhibits gastric acid secretion by blocking cholinergic pathways. - While it was previously used as an anti-ulcer drug, its mechanism of action is distinct from H2 receptor antagonism. *Rabeprazole* - **Rabeprazole** is a **proton pump inhibitor (PPI)** that irreversibly blocks the H+/K+-ATPase pump in gastric parietal cells, leading to a profound and prolonged reduction in gastric acid production. - Its mechanism is different from H2 receptor antagonists. *Sucralfate* - **Sucralfate** is a **cytoprotective agent** that forms a viscous, protective gel that adheres to ulcerated areas, shielding them from acid, pepsin, and bile. - It does not directly inhibit acid secretion but rather provides a physical barrier and promotes healing.
Question 4: Which of the following is the most common adverse effect of omeprazole?
- A. Headache (Correct Answer)
- B. Constipation
- C. Liver dysfunction
- D. Upper gastrointestinal bleeding
Explanation: ***Headache*** - **Headache** is the most frequently reported adverse effect of omeprazole and other proton pump inhibitors (PPIs), occurring in approximately 2-7% of patients. - While generally mild and self-limiting, it is the most common reason for patients to report side effects during PPI therapy. - Other common adverse effects include diarrhea, nausea, and abdominal pain, but headache remains the most prevalent. *Constipation* - Constipation can occur with omeprazole use, but it is less common than headache or diarrhea. - Gastrointestinal side effects like constipation typically occur in a smaller proportion of patients compared to headache. *Liver dysfunction* - Mild **transient elevation of liver enzymes** can occur with omeprazole, but clinically significant liver dysfunction is rare. - Routine monitoring of liver function is generally not required unless there is pre-existing hepatic impairment. *Upper gastrointestinal bleeding* - Omeprazole is used to **treat and prevent** upper gastrointestinal bleeding by reducing gastric acid secretion in conditions like peptic ulcers and erosive esophagitis. - It is a therapeutic agent for this condition, not a causative factor.
Question 5: A patient presents with hematemesis and is diagnosed with esophageal varices. What is the first line of treatment?
- A. Surgery
- B. Steroid therapy
- C. Endoscopic banding (Correct Answer)
- D. Proton pump inhibitors
Explanation: ***Endoscopic banding*** - **Endoscopic variceal ligation (EVL)**, or banding, is the **first-line treatment** for acute variceal bleeding [1]. - It involves placing elastic bands over the varices to **occlude blood flow** and prevent further hemorrhage [1]. *Surgery* - **Surgical shunting procedures** or **liver transplantation** are generally reserved for patients who fail endoscopic and pharmacologic therapies [1]. - These are **invasive options** with significant risks and are not considered first-line for acute bleeding. *Steroid therapy* - **Steroids** are typically used as **anti-inflammatory agents** and are not indicated for controlling bleeding from esophageal varices. - Their use would have **no direct impact** on stopping the hemorrhage. *Proton pump inhibitors* - **Proton pump inhibitors (PPIs)** are used to **reduce gastric acid production**, which is beneficial in conditions like peptic ulcer disease or reflux esophagitis [2]. - They are **not effective** in treating or preventing bleeding from esophageal varices, as the bleeding source is venous [2].
Question 6: What is the treatment of choice in duodenal ulcer without any complications of hemorrhage?
- A. Highly selective vagotomy
- B. Trunkal vagotomy
- C. Proton pump inhibitors (Correct Answer)
- D. None of the options
Explanation: ***Proton pump inhibitors*** - **Proton pump inhibitors (PPIs)** are the first-line and most effective treatment for uncomplicated duodenal ulcers due to their potent and sustained acid suppression [1]. - They work by irreversibly inhibiting the **H+/K+-ATPase pump** in the stomach's parietal cells, reducing acid secretion and allowing the ulcer to heal [1]. *Highly selective vagotomy* - This is a surgical procedure that was historically used to reduce acid secretion by denervating the acid-producing parietal cells of the stomach, but it is **not the primary treatment** for uncomplicated ulcers today due to the availability of effective medical therapy [1]. - It carries surgical risks and is generally reserved for **refractory cases** or those with complications not amenable to endoscopic or medical management [1]. *Trunkal vagotomy* - **Trunkal vagotomy** involves cutting the main vagal trunks, which leads to significant side effects such as **gastric stasis** (delayed emptying) and diarrhea, often requiring a drainage procedure (e.g., pyloroplasty). - It was used in the past but is **rarely performed** for uncomplicated duodenal ulcers due to its associated morbidity and the effectiveness of modern medical treatments [1]. *None of the options* - This option is incorrect because **proton pump inhibitors** are indeed a highly effective and standard treatment for uncomplicated duodenal ulcers [1].
Question 7: Which of the following is NOT a feature of Refsum disease?
- A. Retinitis pigmentosa
- B. Ataxia
- C. CCF (Correct Answer)
- D. Ichthyosis
Explanation: ***CCF*** - **Congestive cardiac failure (CCF)** is generally **not a primary feature** or common complication of Refsum disease. While some cardiac abnormalities can occur, severe CCF is rare. - Refsum disease is characterized by the accumulation of **phytanic acid**, which primarily affects the nervous system, skin, and eyes. *Ataxia* - **Cerebellar ataxia** is a very common and prominent neurological symptom in Refsum disease, due to damage to the cerebellum. - Patients often present with **unsteady gait and poor coordination**. *Ichthyosis* - **Ichthyosis** (dry, scaly skin) is a characteristic dermatological manifestation of Refsum disease, occurring in nearly all patients. - It is caused by the disruption of **lipid metabolism** in the skin due to phytanic acid accumulation. *Retinitis pigmentosa* - **Retinitis pigmentosa** is one of the classic ocular features of Refsum disease, leading to **night blindness** and progressive **visual field loss**. - It involves the degeneration of photoreceptor cells in the retina.
Question 8: Nucleic acid is not found in -
- A. Bacteria
- B. Fungus
- C. Prions (Correct Answer)
- D. Virus
Explanation: ***Prions*** - **Prions** are infectious protein particles that lack **nucleic acids (DNA or RNA)**. - They cause transmissible spongiform encephalopathies by inducing abnormal folding of normal cellular proteins. *Bacteria* - **Bacteria** are prokaryotic organisms that contain **double-stranded DNA** as their genetic material, organized in a circular chromosome. - They also rely on **RNA** for protein synthesis and gene regulation. *Fungus* - **Fungi** are eukaryotic organisms that possess genetic material in the form of **DNA**, organized into chromosomes within a nucleus. - They utilize various types of **RNA** for essential cellular processes including transcription and translation. *Virus* - **Viruses** are obligate intracellular parasites that contain either **DNA or RNA** as their genetic material. - This nucleic acid is enclosed within a protein coat (capsid) and is essential for viral replication.
Question 9: Which one of the following statements is not correct regarding Gastric outlet obstruction associated with long standing peptic ulcer disease?
- A. Medical therapy has no role in the treatment of this condition. (Correct Answer)
- B. Endoscopic biopsy is essential to exclude malignancy.
- C. Hypochloraemic alkalosis is the usual metabolic abnormality in such cases.
- D. Operation is frequently required along with a drainage procedure.
Explanation: ***Medical therapy has no role in the treatment of this condition.*** - This statement is incorrect because **medical management**, including **proton pump inhibitors (PPIs)**, can be effective in reducing inflammation and ulcer healing, which may alleviate symptoms of **gastric outlet obstruction (GOO)**, especially in cases where the obstruction is due to an active ulcer and associated edema. - While surgery is often required for persistent or severe obstruction, initial medical therapy can be attempted to confirm the reversibility of the obstruction or to optimize the patient's condition before surgical intervention. *Endoscopic biopsy is essential to exclude malignancy.* [1] - **Endoscopic biopsy** is crucial because **malignancy** (e.g., gastric adenocarcinoma) can present with symptoms similar to peptic ulcer disease and lead to **gastric outlet obstruction**. - Distinguishing between benign and malignant causes is critical for appropriate management, as the treatment strategies differ significantly. [1] *Hypochloraemic alkalosis is the usual metabolic abnormality in such cases.* [1] - **Hypochloremic alkalosis** occurs due to the repeated **vomiting of gastric contents**, which are rich in hydrochloric acid. [1] - This loss of acid and chloride, along with fluid depletion, leads to increased bicarbonate retention by the kidneys and can cause a metabolic alkalosis with low chloride levels. *Operation is frequently required along with a drainage procedure.* [1] - When medical therapy fails or the obstruction is severe due to **scarring and fibrosis** from chronic peptic ulcer disease, surgical intervention is often necessary. - A drainage procedure, such as **gastrojejunostomy**, is performed to bypass the obstructed pylorus and restore gastric emptying.
Question 10: Identify the procedure shown in the image, which is performed in a patient with recurrent GERD.
- A. Nissen fundoplication (Correct Answer)
- B. Partial gastrectomy
- C. Esophageal banding
- D. Toupet fundoplication
Explanation: ***Nissen fundoplication*** - The image clearly depicts the **fundus of the stomach** being wrapped completely around the lower esophagus and sutured in place, which is the hallmark of a **360-degree Nissen fundoplication**. - This procedure aims to strengthen the **lower esophageal sphincter (LES)** to prevent reflux in patients with recurrent GERD. *Partial gastrectomy* - This procedure involves the **surgical removal of a portion of the stomach** and is typically performed for conditions like gastric cancer or severe ulcers, not primarily for GERD. - The image shows the stomach intact and being wrapped, not resected. *Esophageal banding* - Esophageal banding is a procedure used to treat **esophageal varices** by placing elastic bands around dilated veins, not a surgical intervention for GERD that alters stomach anatomy. - The image shows a gastric maneuver, not banding of the esophagus. *Toupet fundoplication* - A Toupet fundoplication involves a **partial (270-degree) wrap** of the fundus around the esophagus, leaving a small portion unwrapped. - The image distinctly illustrates a **complete 360-degree wrap**, distinguishing it from a Toupet fundoplication.
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