MN 553 UPDATED EXAM SCRIPT QUESTIONS AND
SOLUTIONS RATED A+
✔✔Jim presents with complaints of "heartburn" that is minimally relieved with Tums
(calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An
appropriate first-step therapy would be:
1. Omeprazole (Prilosec) twice a day
2. Ranitidine (Zantac) twice a day
3. Famotidine (Pepcid) once a day
4. Metoclopramide (Reglan) four times a day - ✔✔2. Ranitidine (Zantac) twice a day
✔✔patients who are on chronic long-term proton pump inhibitor therapy require
monitoring for: - ✔✔iron deficiency anemia, vitamin b12 and calcium deficiency
✔✔Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic
long-term omeprazole use places her at increased risk for:
1. Megaloblastic anemia
2. Osteoporosis
3. Hypertension
4. Strokes - ✔✔Megaloblastic anemia
✔✔Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along
with diet changes, a laxative is ordered to provide more rapid relief of constipation. An
appropriate choice of medication for a 10-year-old child would be:
1. PEG 3350 (Miralax)
2. Bisacodyl (Dulcolax) suppository
3. Docusate (Colace) suppository
4. Polyethylene glycol electrolyte solution - ✔✔Bisacodyl (Dulcolax) suppository
✔✔methylnaltrexone is used to treat constipation in: - ✔✔opioid-associated constipation
✔✔An elderly person has been prescribed lactulose for treatment of chronic
constipation. monitoring with long-term treatment would include: - ✔✔electrolytes,
including potassium and chloride
✔✔gastroesophageal reflux disease (GERD) may be aggravated by the following
medication that affects lower esophageal sphincter (LES) tone: - ✔✔Estrogen
✔✔Life style changes are the first step in the treatment of GERD. Food or drink that
may aggravate GERD include: - ✔✔Caffeine
✔✔metoclopramide improves GERD symptoms by - ✔✔increasing lower esophageal
tone
, ✔✔Antacids treat gastroesophageal reflux disease by:
1. Increasing lower esophageal tone
2. Increasing gastric pH
3. Inhibiting gastric acid secretion
4. Increasing serum calcium level - ✔✔2. Increasing gastric pH
✔✔when treating patients using the "step-down" approach, the patient with GERD is
started on ______________first - ✔✔proton pump inhibitors
✔✔If a patient with symptoms of GERD states that he has been self-treating at home
with OTC ranitidine daily, the appropriate treatment would be - ✔✔proton pump inhibitor
(omeprazole) for 12 weeks
✔✔If a patient with GERD who is taking a PPI daily is not improving, the plan of care
would by: - ✔✔PPI (omeprazole) twice a day for 4-8 weeks
✔✔The next step in treatment when a patient has been on proton pump inhibitors twice
daily for 12 weeks and not improving is:
1. Add a prokinetic (metoclopramide)
2. Referral for endoscopy
3. Switch to another proton pump inhibitor
4. Add a cytoprotective drug - ✔✔2. Referral for endoscopy
✔✔Infants with reflux are initially treated with:
1. Histamine2 receptor antagonist (ranitidine)
2. Proton pump inhibitor (omeprazole)
3. Anti-reflux maneuvers (elevate head of bed)
4. Prokinetic (metoclopramide) - ✔✔3. Anti-reflux maneuvers (elevate head of bed)
✔✔Long term use of protein pump inhibitors may lead to: - ✔✔hip fractures in at-risk
persons
✔✔An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test
is:
1. Histamine2 receptor antagonists for 4 to 8 weeks
2. Proton pump inhibitor bid for 12 weeks until healing is complete
3. Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days
4. Proton pump inhibitor bid and levofloxacin for 14 days - ✔✔3. Proton pump inhibitor
bid plus clarithromycin plus amoxicillin for 14 days
✔✔Treatment failure in patients with peptic ulcer disease associated with H. pylori may
be because of:
1. Antimicrobial resistance
2. An ineffective antacid
SOLUTIONS RATED A+
✔✔Jim presents with complaints of "heartburn" that is minimally relieved with Tums
(calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An
appropriate first-step therapy would be:
1. Omeprazole (Prilosec) twice a day
2. Ranitidine (Zantac) twice a day
3. Famotidine (Pepcid) once a day
4. Metoclopramide (Reglan) four times a day - ✔✔2. Ranitidine (Zantac) twice a day
✔✔patients who are on chronic long-term proton pump inhibitor therapy require
monitoring for: - ✔✔iron deficiency anemia, vitamin b12 and calcium deficiency
✔✔Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic
long-term omeprazole use places her at increased risk for:
1. Megaloblastic anemia
2. Osteoporosis
3. Hypertension
4. Strokes - ✔✔Megaloblastic anemia
✔✔Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along
with diet changes, a laxative is ordered to provide more rapid relief of constipation. An
appropriate choice of medication for a 10-year-old child would be:
1. PEG 3350 (Miralax)
2. Bisacodyl (Dulcolax) suppository
3. Docusate (Colace) suppository
4. Polyethylene glycol electrolyte solution - ✔✔Bisacodyl (Dulcolax) suppository
✔✔methylnaltrexone is used to treat constipation in: - ✔✔opioid-associated constipation
✔✔An elderly person has been prescribed lactulose for treatment of chronic
constipation. monitoring with long-term treatment would include: - ✔✔electrolytes,
including potassium and chloride
✔✔gastroesophageal reflux disease (GERD) may be aggravated by the following
medication that affects lower esophageal sphincter (LES) tone: - ✔✔Estrogen
✔✔Life style changes are the first step in the treatment of GERD. Food or drink that
may aggravate GERD include: - ✔✔Caffeine
✔✔metoclopramide improves GERD symptoms by - ✔✔increasing lower esophageal
tone
, ✔✔Antacids treat gastroesophageal reflux disease by:
1. Increasing lower esophageal tone
2. Increasing gastric pH
3. Inhibiting gastric acid secretion
4. Increasing serum calcium level - ✔✔2. Increasing gastric pH
✔✔when treating patients using the "step-down" approach, the patient with GERD is
started on ______________first - ✔✔proton pump inhibitors
✔✔If a patient with symptoms of GERD states that he has been self-treating at home
with OTC ranitidine daily, the appropriate treatment would be - ✔✔proton pump inhibitor
(omeprazole) for 12 weeks
✔✔If a patient with GERD who is taking a PPI daily is not improving, the plan of care
would by: - ✔✔PPI (omeprazole) twice a day for 4-8 weeks
✔✔The next step in treatment when a patient has been on proton pump inhibitors twice
daily for 12 weeks and not improving is:
1. Add a prokinetic (metoclopramide)
2. Referral for endoscopy
3. Switch to another proton pump inhibitor
4. Add a cytoprotective drug - ✔✔2. Referral for endoscopy
✔✔Infants with reflux are initially treated with:
1. Histamine2 receptor antagonist (ranitidine)
2. Proton pump inhibitor (omeprazole)
3. Anti-reflux maneuvers (elevate head of bed)
4. Prokinetic (metoclopramide) - ✔✔3. Anti-reflux maneuvers (elevate head of bed)
✔✔Long term use of protein pump inhibitors may lead to: - ✔✔hip fractures in at-risk
persons
✔✔An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test
is:
1. Histamine2 receptor antagonists for 4 to 8 weeks
2. Proton pump inhibitor bid for 12 weeks until healing is complete
3. Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days
4. Proton pump inhibitor bid and levofloxacin for 14 days - ✔✔3. Proton pump inhibitor
bid plus clarithromycin plus amoxicillin for 14 days
✔✔Treatment failure in patients with peptic ulcer disease associated with H. pylori may
be because of:
1. Antimicrobial resistance
2. An ineffective antacid
