Gastrointestinal Practice Questions

Correct Answer: B) Elevate head of bed 30-45 degrees and avoid eating 3-4 hours before sleep

Rationale: Nocturnal GERD occurs because gravity no longer helps keep stomach contents in the stomach when lying flat. Head-of-bed elevation promotes gastric emptying and prevents reflux. Avoiding food 3-4 hours before sleep reduces gastric volume and pressure. Large meals increase gastric pressure and worsen reflux. While antacids help temporarily, they don't address the underlying mechanical problem.

Key Concept: GERD management uses multiple strategies: positional changes, dietary modifications, medications (H2 blockers, PPIs), and weight management. Lifestyle changes are the foundation of treatment.

Correct Answer: A) PPI + clarithromycin + amoxicillin

Rationale: Standard triple therapy for H. pylori includes a proton pump inhibitor (PPI) + two antibiotics. Common combinations are PPI + clarithromycin + amoxicillin, or PPI + metronidazole + clarithromycin. The PPI reduces stomach acidity, allowing antibiotics to work more effectively. This regimen eradicates H. pylori in 80-90% of cases, typically given for 10-14 days.

Key Concept: H. pylori eradication is crucial to prevent ulcer recurrence. Different triple therapy regimens exist; clarithromycin resistance is becoming common, so metronidazole-based regimens are sometimes preferred. Quadruple therapy (adding bismuth) is used for resistant strains.

Correct Answer: B) Corticosteroids (prednisone) for anti-inflammatory effect

Rationale: During acute flares of IBD, corticosteroids are the standard anti-inflammatory treatment. They reduce inflammation and symptoms quickly. Loperamide is contraindicated in acute IBD (risk of toxic megacolon). Mesalamine and methotrexate are used for maintenance remission, not acute exacerbations. The severe symptoms described require rapid anti-inflammatory action, which corticosteroids provide.

Key Concept: IBD management uses different strategies for acute flares vs. remission maintenance. Acute: corticosteroids and biologics (TNF inhibitors). Remission: 5-ASA compounds (mesalamine), immunosuppressants. Never use antimotility agents in acute IBD—risk of perforation.

Correct Answer: B) Acute pain related to pancreatic inflammation

Rationale: Acute pancreatitis presents with severe epigastric pain radiating to the back, caused by pancreatic inflammation and enzyme release. Pain management is the priority in the acute phase. While nutritional, infection, and coping are concerns during recovery, the defining feature and most pressing concern in acute pancreatitis is severe pain. Treatment includes NPO status (nutrition not a current focus), analgesics, and addressing the underlying cause.

Key Concept: Acute pancreatitis causes severe pain and potential complications (sepsis, ARDS, DIC). Management: NPO, IV fluids, analgesics, and treat underlying cause (alcohol, gallstones). Avoid morphine (can increase sphincter of Oddi pressure)—use other opioids.

Correct Answer: B) When bowel sounds return and patient is fully alert (6-24 hours)

Rationale: Post-op diet progression depends on return of GI motility and patient alertness. Early oral intake is now encouraged (within 6-24 hours) even for abdominal surgery, based on evidence for faster recovery and fewer complications. Starting with ice chips/sips and advancing as tolerated is safer than waiting for flatus/BM. Immediate feeding after surgery risks aspiration; delayed feeding increases complications.

Key Concept: Enhanced recovery after surgery (ERAS) protocols encourage early nutrition, mobility, and oral intake. Assess readiness: alert patient, bowel sounds present, no severe pain/distention. Progress diet gradually: clear liquids → full liquids → soft diet → regular diet.