GERD Leik

Question 1

380. All of the following may help relieve the symptom(s) of gastroesophageal reflux
disease (GERD) except:
A) Losing weight
B) Stopping caffeine intake
C) Chewing breath mints
D) Stopping alcohol intake

Answer 1

C) Chewing breath mints

Gastroesophageal reflux disease (GERD) is a condition in which food comes up the esophagus from the stomach because of a weak sphincter. The reflux is usually worsened by lying down, and can cause a cough and esophageal irritation if not treated. Effective treatment may include weight loss, decreased caffeine intake, and avoidance of alcohol.

Question 2

641. A middle-aged male smoker with chronic gastroesophageal reflux disease
     (GERD) was diagnosed with Barrett’s esophagus 5 years ago. He is being seen
     by the nurse practitioner for a physical exam. The patient reports that he ran out of his proton-pump inhibitor (PPI) medication and he has not taken it for 5 days. He is complaining of severe episodes of daily heartburn. His gastroenterologist is out of
     town for 1 week.

Which of the following is the best plan to follow during this visit?
A) Write a prescription for the same PPI and give a 1-week supply without refills
B) Give the patient free samples of an H2 blocker
C) Prescribe another PPI because worsening of symptoms is a sign that the
previously prescribed PPI is not effective
D) Advise the patient to take over-the-counter antacids PRN

Answer 2

A) Write a prescription for the same PPI and give a 1-week supply without refills

This patient is having severe rebound symptoms caused by abrupt cessation of
the proton-pump inhibitor (PPI).

In addition, he has Barrett’s esophagus, which increases the risk of esophageal cancer.

Neither an antacid nor an H2 blocker is likely to be effective in controlling his symptoms. This question is a good example of the ethical concept of beneficence

Question 3

666. A 42-year-old obese White man presents to the clinic with a history of recurrent heartburn. He is diagnosed by the nurse practitioner with gastroesophageal reflux
     disease (GERD).

Which of the following drug classes is preferred initially to treat symptoms of GERD?
A) Histamine-2 receptor antagonist
B) Proton-pump inhibitor
C) Antibiotic
D) Antiviral

Answer 3

A) Histamine-2 receptor antagonist A histamine-2 receptor antagonist (H2
receptor antagonist) is the initial drug considered in treating a patient with GERD
whose symptoms are not responding to lifestyle changes.

If a patient’s symptoms do not respond to the H2 receptor antagonist, the next step is a trial of a proton-pump inhibitor.