PEPTIC ULCER DISEASE (PUD) EXAM QUESTIONS
AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026
Questions 1–15: Definitions, Epidemiology, and Etiology
Question 1
What is the definition of a peptic ulcer?
A. Inflammation of the gastric mucosa without mucosal break
B. A break in the mucosal lining of the stomach or duodenum (≥5 mm) that
extends through the muscularis mucosae
C. Erosion limited to the superficial epithelium
D. Malignant lesion of the stomach
Rationale: A peptic ulcer is a full-thickness mucosal break (excavated lesion) that
extends through the muscularis mucosae into the submucosa. This distinguishes it
from erosions (superficial). Ulcers occur most commonly in the duodenal bulb
(duodenal ulcer) and stomach (gastric ulcer).
Question 2
What is the most common location of a peptic ulcer?
A. Gastric antrum
B. Duodenal bulb (first part of duodenum)
C. Gastric body
D. Oesophagus
*Rationale: Duodenal ulcers are more common than gastric ulcers (ratio approx
3:1). The duodenal bulb is the most frequent site. Gastric ulcers most often occur
on the lesser curvature at the antrum-corpus junction.*
,Question 3
What are the two most common causes of peptic ulcer disease?
A. Stress and alcohol
B. Helicobacter pylori infection and non-steroidal anti-inflammatory drugs
(NSAIDs)
C. Corticosteroids and smoking
D. Spicy foods and caffeine
*Rationale: H. pylori infection accounts for 60-80% of duodenal ulcers and 40-60%
of gastric ulcers. NSAID use accounts for most of the remaining cases (20-40%).
Other causes: Zollinger-Ellison syndrome (gastrinoma), Crohn's disease,
cytomegalovirus (CMV), and stress (rarely).*
Question 4
What is the approximate global prevalence of H. pylori infection?
A. 10-20%
B. 25-35%
C. 40-60%
D. 80-90%
*Rationale: H. pylori prevalence varies widely: 30-40% in developed countries
(North America, Western Europe), 70-90% in developing countries. Prevalence is
higher with age, lower socioeconomic status, and crowding in childhood.*
Question 5
What is the lifetime risk of a peptic ulcer in a patient with H. pylori infection?
A. <1%
B. 5-10%
C. 10-20%
D. 50%
*Rationale: Only 10-20% of H. pylori-infected individuals develop a peptic ulcer.
Most have asymptomatic chronic gastritis. CagA-positive strains (more virulent)
increase ulcer risk.*
,Question 6
What is the relative risk of peptic ulcer in chronic NSAID users compared to non-
users?
A. 2-fold
B. 4-5 fold (increases with dose and duration)
C. 10-fold
D. 20-fold
*Rationale: NSAID use increases the risk of peptic ulcer by 4-5 times. Risk factors:
high dose, long duration, age >60, prior ulcer, concomitant corticosteroid or
anticoagulant use, H. pylori co-infection.*
Question 7
Which NSAID has the highest risk of peptic ulcer?
A. Ibuprofen
B. Naproxen
C. Ketorolac and piroxicam (long half-life)
D. Celecoxib (COX-2 selective)
*Rationale: NSAIDs with long half-lives and high COX-1 selectivity (ketorolac,
piroxicam, indomethacin) have higher ulcer risk. COX-2 selective inhibitors
(celecoxib, etoricoxib) have lower ulcer risk but not zero (especially in high-risk
patients or without PPI cover).*
Question 8
What is the mechanism of NSAID-induced mucosal injury?
A. Increased gastric acid secretion
B. Inhibition of cyclooxygenase (COX-1), reducing prostaglandin synthesis (PGE2,
PGI2), which are cytoprotective (mucus, bicarbonate, blood flow)
C. Direct erosion of the mucosa
D. H. pylori activation
*Rationale: COX-1 is constitutively expressed in the gastric mucosa, producing
prostaglandins that maintain mucosal integrity (mucus secretion, bicarbonate
, production, epithelial cell protection, blood flow). COX-1 inhibition disrupts this
defence, leading to injury.*
Question 9
What is the most common site of NSAID-induced gastric ulcer?
A. Fundus
B. Body
C. Antrum (pre-pyloric)
D. Oesophagus
Rationale: NSAID-induced gastric ulcers are usually located in the gastric antrum
(unlike H. pylori-related ulcers, which can be in the duodenum or gastric body).
They are often multiple and may be asymptomatic ("silent ulcers") in elderly
patients.
Question 10
What is the male-to-female ratio for duodenal ulcers?
A. 1:1
B. 2-3:1 (more common in males)
C. 1:2
D. 5:1
Rationale: Duodenal ulcers are more common in males. Gastric ulcers have a more
equal gender distribution. This male predominance may reflect differences in
smoking, NSAID use, and H. pylori prevalence.
Question 11
What is the prevalence of H. pylori in patients with duodenal ulcer?
A. 20%
B. 40%
C. 80-90%
D. 100%
AND CORRECT ANSWERS (VERIFIED ANSWERS)
PLUS RATIONALES 2026
Questions 1–15: Definitions, Epidemiology, and Etiology
Question 1
What is the definition of a peptic ulcer?
A. Inflammation of the gastric mucosa without mucosal break
B. A break in the mucosal lining of the stomach or duodenum (≥5 mm) that
extends through the muscularis mucosae
C. Erosion limited to the superficial epithelium
D. Malignant lesion of the stomach
Rationale: A peptic ulcer is a full-thickness mucosal break (excavated lesion) that
extends through the muscularis mucosae into the submucosa. This distinguishes it
from erosions (superficial). Ulcers occur most commonly in the duodenal bulb
(duodenal ulcer) and stomach (gastric ulcer).
Question 2
What is the most common location of a peptic ulcer?
A. Gastric antrum
B. Duodenal bulb (first part of duodenum)
C. Gastric body
D. Oesophagus
*Rationale: Duodenal ulcers are more common than gastric ulcers (ratio approx
3:1). The duodenal bulb is the most frequent site. Gastric ulcers most often occur
on the lesser curvature at the antrum-corpus junction.*
,Question 3
What are the two most common causes of peptic ulcer disease?
A. Stress and alcohol
B. Helicobacter pylori infection and non-steroidal anti-inflammatory drugs
(NSAIDs)
C. Corticosteroids and smoking
D. Spicy foods and caffeine
*Rationale: H. pylori infection accounts for 60-80% of duodenal ulcers and 40-60%
of gastric ulcers. NSAID use accounts for most of the remaining cases (20-40%).
Other causes: Zollinger-Ellison syndrome (gastrinoma), Crohn's disease,
cytomegalovirus (CMV), and stress (rarely).*
Question 4
What is the approximate global prevalence of H. pylori infection?
A. 10-20%
B. 25-35%
C. 40-60%
D. 80-90%
*Rationale: H. pylori prevalence varies widely: 30-40% in developed countries
(North America, Western Europe), 70-90% in developing countries. Prevalence is
higher with age, lower socioeconomic status, and crowding in childhood.*
Question 5
What is the lifetime risk of a peptic ulcer in a patient with H. pylori infection?
A. <1%
B. 5-10%
C. 10-20%
D. 50%
*Rationale: Only 10-20% of H. pylori-infected individuals develop a peptic ulcer.
Most have asymptomatic chronic gastritis. CagA-positive strains (more virulent)
increase ulcer risk.*
,Question 6
What is the relative risk of peptic ulcer in chronic NSAID users compared to non-
users?
A. 2-fold
B. 4-5 fold (increases with dose and duration)
C. 10-fold
D. 20-fold
*Rationale: NSAID use increases the risk of peptic ulcer by 4-5 times. Risk factors:
high dose, long duration, age >60, prior ulcer, concomitant corticosteroid or
anticoagulant use, H. pylori co-infection.*
Question 7
Which NSAID has the highest risk of peptic ulcer?
A. Ibuprofen
B. Naproxen
C. Ketorolac and piroxicam (long half-life)
D. Celecoxib (COX-2 selective)
*Rationale: NSAIDs with long half-lives and high COX-1 selectivity (ketorolac,
piroxicam, indomethacin) have higher ulcer risk. COX-2 selective inhibitors
(celecoxib, etoricoxib) have lower ulcer risk but not zero (especially in high-risk
patients or without PPI cover).*
Question 8
What is the mechanism of NSAID-induced mucosal injury?
A. Increased gastric acid secretion
B. Inhibition of cyclooxygenase (COX-1), reducing prostaglandin synthesis (PGE2,
PGI2), which are cytoprotective (mucus, bicarbonate, blood flow)
C. Direct erosion of the mucosa
D. H. pylori activation
*Rationale: COX-1 is constitutively expressed in the gastric mucosa, producing
prostaglandins that maintain mucosal integrity (mucus secretion, bicarbonate
, production, epithelial cell protection, blood flow). COX-1 inhibition disrupts this
defence, leading to injury.*
Question 9
What is the most common site of NSAID-induced gastric ulcer?
A. Fundus
B. Body
C. Antrum (pre-pyloric)
D. Oesophagus
Rationale: NSAID-induced gastric ulcers are usually located in the gastric antrum
(unlike H. pylori-related ulcers, which can be in the duodenum or gastric body).
They are often multiple and may be asymptomatic ("silent ulcers") in elderly
patients.
Question 10
What is the male-to-female ratio for duodenal ulcers?
A. 1:1
B. 2-3:1 (more common in males)
C. 1:2
D. 5:1
Rationale: Duodenal ulcers are more common in males. Gastric ulcers have a more
equal gender distribution. This male predominance may reflect differences in
smoking, NSAID use, and H. pylori prevalence.
Question 11
What is the prevalence of H. pylori in patients with duodenal ulcer?
A. 20%
B. 40%
C. 80-90%
D. 100%
