GERD Flashcards
1
Q
- Which one of the following GERD symptom is considered complicated and requires further diagnostic evaluation?
A. Heartburn
B. Regurgitation
C. Chronic cough
D. Difficulty swallowing
E. Hiatal hernia
A
D
2
Q
- Extraesophageal syndrome associated with GERD refers to:
A. Erosions of the esophagus
B. Gastroesophageal reflux symptoms associated with disease processes in organs other than the esophagus
C. Inflammation of the esophagus
D. Replacement of the squamous epithelial lining in the esophagus with columnar
epithelial lining
E. Barrett esophagus
A
B
3
Q
- Which of the following PPI regimens is/are preferred as initial treatment in a 60-year-old patient with erosive esophagitis?
A. Lansoprazole 30 mg once daily × 3 weeks
B. Pantoprazole 40 mg twice daily × 24 weeks
C. Esomeprazole 20 mg once daily × 8 weeks
D. Rabeprazole 20 mg once daily as needed
E. Any of the above would be a preferred treatment
A
C
4
Q
- Which of the following PPIs would offer dosing flexibility relative to meal timing?
A. Dexlansoprazole
B. Lansoprazole
C. Omeprazole/sodium bicarbonate
D. Omeprazole
E. A and C only
A
E
5
Q
- Which one of the following medications may worsen the symptoms of GERD by
decreasing lower esophageal sphincter pressure?
A. Nifedipine
B. Alendronate
C. Naproxen
D. Quinidine
E. Ferrous sulfate
A
A
6
Q
- What is the best treatment regimen for a 55-year-old patient who complains of difficulty swallowing for the last 3 months?
A. Patient-directed therapy with OTC PPI for 2 months. If no improvement, then
refer to physician for further evaluation
B. An 8-week course of metoclopramide 10 mg three times daily. If no
improvement, then refer to physician for further evaluation
C. An 8-week course of standard dose PPI (once daily) plus further diagnostic
evaluation by physician for complicated symptoms
D. An 8-week course of standard dose PPI (once daily) plus standard dose H2-
receptor antagonist for breakthrough symptoms
A
C
7
Q
- On-demand therapy would be most appropriate in patients with:
A. Atypical symptoms
B. Intermittent reflux symptoms
C. Barrett esophagus
D. Erosive esophagitis
E. Strictures
A
B
8
Q
- The goals of treatment of GERD are to:
A. Alleviate symptoms
B. Promote healing of mucosal injury
C. Prevent complications
D. Decrease esophageal pH to less than 2
E. A, B, and C are all correct
A
E
9
Q
- Which of the following risk factors would not be a justification for using a PPI in a
patient on clopidogrel?
A. Prior history of upper GI bleed
B. Advanced age
C. Dual antiplatelet therapy
D. Erosive esophagitis
E. Intermittent GERD symptoms
A
E
10
Q
- Which recommendation would be most appropriate regarding calcium supplementation for prevention of bone fractures in a healthy 24-year-old woman taking omeprazole 20 mg once daily for GERD?
A. Elemental calcium 2000 mg daily in divided doses
B. No calcium is needed because she does not have risk factors for osteoporosis or
fractures
C. Elemental calcium 2000 mg daily plus vitamin D 800 units daily
D. Calcium citrate 500 mg four times daily
E. Calcium gluconate 1 gram IV every month
A
B
11
Q
- What is the best treatment option for a patient with GERD symptoms that are refractory to the initial PPI regimen?
A. Change to a different PPI
B. Increase the frequency of the current PPI to twice daily
C. Change to a high-dose H2-receptor antagonist regimen (eg, rantidine 150 mg four
times daily)
D. A and B only
E. A, B, and C
A
D
12
Q
- PPIs decrease stomach acid by which of the following mechanisms?
A. Inhibiting gastric H+ /K+
-adenosine triphosphatase in gastric parietal cells
B. Inhibiting histamine2 receptors in gastric parietal cells
C. Forming a viscous solution that floats on the surface of the gastric contents
D. Forming a protective coating over the damaged mucosa
E. Increasing GI motility
A
A
13
Q
- Maintenance therapy is indicated for patients with:
A. Continued symptoms after PPI discontinued
B. Barrett esophagus
C. Erosive esophagitis
D. Extraesophageal syndromes associated with GERD
E. All of the above
A
E
14
Q
- Which of the following is not considered a potential risk associated with the use of PPIs?
A. Clostridium difficile infections
B. Community-acquired pneumonia
C. Hyperkalemia
D. Bone fractures
E. Hypomagnesemia
A
C
15
Q
- Which of the following surgical options for GERD would be preferred in a morbidly
obese patient?
A. Transoral incisionless fundoplication
B. Vertical banded gastroplasty
C. Application of radiofrequency energy to the lower esophageal sphincter
D. Bariatric surgery with Roux-en-Y gastric bypass
E. Any of the above options would be acceptable
A
D
16
Q
- Which one of the following GERD symptom is considered atypical and requires further diagnostic evaluation?
A. Heartburn
B. Regurgitation
C. Wheezing
D. None of the above symptoms is considered atypical
A
C
17
Q
- Which of the following represents the correct order of gastric acid suppression from most suppression to least suppression?
A. PPI > H 2 RA > Antacid
B. PPI > Antacid > H 2 RA
C. Antacid > H 2 RA > PPI
D. H 2 RA > PPI > Antacid
A
A
Option A: Correct. Dexlansoprazole can be taken without regard to meals.
Option B: Incorrect. Lansoprazole should be taken 30 to 60 minutes prior to a meal.
Option C: Incorrect. Omeprazole should be taken 30 to 60 minutes prior to a meal.
Option D: Incorrect. Pantoprazole should be taken 30 to 60 minutes prior to a meal.
18
Q
- What would be the best initial pharmacologic option in addition to lifestyle modification for a patient with typical GERD symptoms 1 day per week?
A. Pantoprazole 20 mg BID
B. Omeprazole 20 mg daily
C. Lansoprazole 15 mg daily as needed for GERD symptoms (on-demand)
D. Famotidine 20 mg daily as needed for GERD symptoms (on-demand)
A
D
Option D: Correct. The patient has symptoms once per week and is receiving initial treatment, so an on-demand H 2 RA is indicated.
19
Q
- Which one of the following medications may worsen GERD symptoms by decreasing lower esophageal sphincter pressure?
A. Nifedipine
B. Alendronate
C. Naproxen
D. Doxycycline
A
A
20
Q
- Which of the following would be the LEAST appropriate medication for treating GERD in pregnancy?
A. Calcium carbonate tablets
B. Esomeprazole capsules
C. Aluminum hydroxide/agnesium trisilicate tablets
D. Lansoprazole capsules
A
C
Option A: Incorrect. Calcium containing antacids are appropriate initial treatment in mild-to- moderate GERD in pregnancy.
Option B: Incorrect. It is appropriate to use a PPI to treat GERD in pregnant women with
frequent, severe heartburn.
Option C: Correct. Magnesium trisilicate-containing antacids should be avoided in pregnancy.
Option D: Incorrect. It is appropriate to use a PPI to treat GERD in pregnant women with
frequent, severe heartburn.
21
Q
- PPIs decrease stomach acid by which of the following mechanisms?
A. Inhibiting gastric H+/K+-adenosine triphosphatase in gastric parietal cells
B. Inhibiting histamine-2 receptors in gastric parietal cells
C. Forming a viscous solution that floats on the surface of the gastric contents
D. Increasing GI motility
A
A
22
Q
- Which of the following would be recommended for preventing complications due to PPI use?
A. Magnesium supplementation for potential hypomagnesemia
B. Sodium bicarbonate supplementation for potential acute kidney injury
C. Memantine prophylaxis for PPI-associated dementia
D. Calcium citrate supplementation for documented hypocalcemia
A
D
23
Q
- Which of the following drug classes provides the most effective relief from GERD symptoms?
A. Antacids
B. H 2 RAs
C. PPIs
D. Prokinetics
A
C
24
Q
- In which of the following scenarios would endoscopy be indicated?
A. A 24-year-old pregnant woman with daily heartburn symptoms
B. A 2-week-old infant who regurgitates with every third feeding
C. A 67-year-old man with recent unexplained weight loss
D. A 13-year-old boy with a history of asthma and heartburn 2 days per week
A
C
Option C: Correct. Weight loss is an alarm symptom.
25
10. A 5'5" (165 cm), 120-kg woman presents to the clinic with daily uncontrolled typical GERD symptoms. She is currently taking omeprazole 20 mg daily. The patient states that she is not willing to increase to twice-daily PPIs. What is the most appropriate nonpharmacologic
recommendation for controlling her GERD?
A. Recommend weight loss
B. Increase the head of bed with a foam wedge to a 45-degree angle when sleeping
C. Increase peppermint consumption during heartburn episodes
D. Drink a glass of red wine daily
A
Option A: Correct. The patient in the case is obese, and weight loss is the most impactful lifestyle intervention for controlling her GERD symptoms.
26
11. A patient with typical GERD symptoms 3 days a week was started on a trial of daily
lansoprazole for 8 weeks with good symptom control and is deescalated to H 2 RA on-demand therapy. The patient reports having heartburn symptoms with use of her H 2 RA once weekly.
What is the next recommended step?
A. Start once daily PPI therapy
B. Start twice daily PPI therapy
C. Continue current regimen
D. Refer to Gastroenterology Service for endoscopy and uncontrolled GERD symptoms
C
Option C: Correct. The patient was able to taper off her PPI, and now is having symptoms only once a week. She should continue with the on-demand H 2 RA therapy.
27
12. A 53-year-old woman with a history of erosive esophagitis was started on omeprazole 20 mg
twice daily. Three weeks later, she was admitted to the hospital for an ST-elevation myocardial
infarction (STEMI), which resulted in placement of two drug-eluting stents. The patient was
started on clopidogrel, aspirin, metoprolol tartrate, and lisinopril. The cardiologist asks you about
the safety of continuing omeprazole with clopidogrel. Which of the following would be an
inappropriate response?
A. There has been concern about a drug–drug interaction with omeprazole and clopidogrel;
however, this interaction has not been shown to be clinically relevant, and both can be
continued as ordered.
B. Clopidogrel may be substituted with prasugrel or ticagrelor to avoid a possible drug
interaction.
C. The COGENT trial found no increased incidence in myocardial infarction with
concomitant clopidogrel and PPI therapies.
D. The patient should be switched to famotidine 20 mg twice daily in place of the PPI to
avoid the potential interaction between clopidogrel and omeprazole.
D
Option D: Correct. Switching the patient to an H 2 RA would be inappropriate given that she has only been treated for 3 weeks with twice-daily PPI therapy for erosive esophagitis.
28
13. Which of the following PPI regimens would be preferred as initial treatment in a 60-year-old
patient with erosive esophagitis?
A. Lansoprazole 30 mg once daily × 3 weeks
B. Pantoprazole 40 mg twice daily × 24 weeks
C. Esomeprazole 40 mg twice daily × 8 weeks
D. Rabeprazole 20 mg once daily as needed
C
Options A, B, and D: Incorrect. Initial treatment duration should be 8 weeks of a twice-daily PPI.
Option C: Correct. Initial treatment duration should be 8 weeks of a twice-daily PPI.
29
14. A 12-year-old child has been complaining of heartburn symptoms about once a week. She
denies having any atypical or alarm symptoms. Which of the following recommendations would
be an inappropriate recommendation?
A. Start calcium carbonate 1000 mg as needed for heartburn symptoms
B. Reduce consumption of carbonated beverages
C. Start esomeprazole 20 mg daily
D. Avoid eating within 3 hours of falling asleep
C
Option C: Correct. A PPI is not indicated when a patient is having GERD symptoms less than 2 times a week.
30
15. What is the best treatment option for a patient with GERD who continues to have symptoms after an 8-week course of lansoprazole 30 mg twice daily?
A. Refer for further evaluation.
B. Start lansoprazole 30 mg three times daily.
C. Start on-demand pantoprazole 40 mg as needed.
D. Add famotidine 20 mg daily to current regimen.
A
Option A: Correct. The patient continues to have GERD symptoms despite an adequate trial of a twice daily PPI. This patient should be further evaluated and may require an endoscopy.
