Stomach and Duodemum

The best duration of treatment to ensure 90% duodenal ulcer healing with H2 receptor antagonist is:

A1

A. 1 week
B. 2 weeks
C. 4 weeks
D. 8 weeks
E. 1 year

Though shorter treatment periods are frequently used, only 6 to 8 weeks therapy will reliably heal 90% or more of duodenal ulcers

False
False
False
True
False

Effective ulcer treatment which works without any action on gastric acid secretion is:

A2

A. Lactulose
B. Aluminium hydroxide
C. Sucralfate
D. Lactitol
E. Magnesium trisilicate

Sucralfate functions as a mucosal protective

False
False
True
False
False

Antacid therapy relieves symptoms:

A3

A. Rapidly
B. By complete neutralisation of gastric acid
C. By eradicating Helicobacter pylori
D. Indefinitely
E. By protecting the mucosa from acid

If antacid therapy works, it works quickly but needs to be given by repeated doses

True
False
False
False
False

Basal and peak acid output are most important in the diagnosis of:

A4

A. Duodenal ulcer
B. Gastrinoma
C. Gastric ulcer
D. Gastric carcinoma
E. Rickets

Classically basal and peak acid output after pentagastrin stimulation are the same in gastrinoma. These tests do not contribute to the diagnosis of the other conditions

False
True
False
False
False

Gastric atony can occur in:

A5

A. Motor neurone disease
B. Marfan’s syndrome
C. Friedreich’s ataxia
D. Diabetes insipidus
E. Diabetes mellitus

Motility disorders in diabetes mellitus are common and often difficult to treat

False
False
False
False
True

Gastric surgery may be followed by:

A6

A. Osteomalacia
B. Weight loss
C. Pulmonary tuberculosis
D. Gallstones
E. Gastric cancer

Partial gastrectomy is associated with many health problems in its own right.

True
True
True
True
True

The success of peptic ulcer surgery can be judged by:

A7

A. Insulin test meal
B. Sham feeding
C. Pre- and post-operative pentagastrin test meals
D. Symptoms
E. Gastric pH monitoring

All of these techniques have been used in assessment of peptic ulcer surgery, but are seldom required now

True
True
True
True
True

Helicobacter pylori bacteria:

A8

A. Live in gastric acid
B. Adhere to the gastric mucosa in an alkaline layer
C. Are never seen in healthy people
D. Can be simply identified in the endoscopy room by their urease activity
E. Are associated with peptic ulcer relapse

50% of the world’s population carry Helicobacter pylori, which lives closely applied to the gastric epithelium under the mucus layer. It is a combination of gastric acid and Helicobacter pylori together with other factors which is responsible for peptic ulcer disease. Urease test may be rapidly positive but requires review the following morning.

False
True
False

True
True

The stomach is sometimes involved in:

A9

A. Coeliac disease
B. Lymphoma
C. Crohn’s disease
D. Alactasia
E. Barrett’s oesophagus

Gastric lymphoma (MALToma) is a discrete problem strongly linked with H. pylori infection

False
True
True
False
False

Prostaglandin analogues heal peptic ulcers but:

A10

A. Are slow to take effect
B. Have some action on gastric acid
C. Have an unusually high relapse rate
D. Cause diarrhoea
E. Are unlikely to be drugs of first choice

Prostaglandin analogues probably work mainly via their weak gastric acid suppression activity, but diarrhoea is a major limitation to effective treat-ment

False
True
False
True
True

Chagas’ disease may be suspected if a patient has:

A11

A. Constipation
B. Dysphagia
C. Heart failure
D. Jaundice
E. Reflux oesophagitis

This interesting condition is only a problem in Latin America.

True
True
True
False
False

A patient with a third episode of gastrointestinal haemorrhage from an unknown site should be offered first:

A12

A. Early endoscopy
B. Barium radiology
C. Laparotomy
D. Intravenous acid-suppressing therapy
E. A Sengstaken tube

Early diagnosis is the only effective way to plan management.

True
False
False
False
False

Body mass index is measured by:

A13

A. Weight / height
B. Weight² / height
C. Weight / height²
D. Weight² / height²
E. Weight³ / height

Body mass index (BMI or Quelet’s Index) is calculated from weight in kilograms divided by the square of the height in metres. The ideal is 20-25. Over 30 is obese and over 40 is morbidly obese.

False
False
True
False
False

Fibre-optic upper digestive endoscopy:

A14

A. Is less accurate than video endoscopy
B. Is superior to barium meal examination
C. Replaces the need for small bowel biopsy capsules in coeliac disease
D. Has no mortality
E. Usually requires IV sedation which may be reversed with flumazenil

Video and fibre-optic gastroscopy yields equivalent results and are more reliable than barium meal examination overall. Procedures may be conducted without sedation and this is often safer. Complications and deaths often relate to cardio-respiratory problems in the elderly.

False
True

True
False

False