HELICOBACTER PYROLI: (refer notes as well)

Helicobacter pylori is a type of bacteria that is known to be a major cause of

peptic ulcers. H. pylori testing detects an infection of the digestive tract caused
by the bacteria to help diagnose the cause of symptoms and/or ulcers.
H. pylori infections of the digestive tract are very common, with as many as
half of the world's population infected. However, most people with H. pylori
never have any symptoms. Still, H. pylori infection increases the risk of
developing ulcers (peptic ulcer disease), persistent stomach inflammation
(gastritis), and gastric (stomach) cancer. The bacteria decrease the stomach's
ability to produce mucus, making the stomach prone to damage from
digestive acid and peptic ulcers.
1. H pylori is a risk factor for all the following conditions except?
A. Gastric adenocarcinoma
B. Gastroesophageal reflux disorder (GERD)
C. Mucosa-associated lymphoid tissue (MALT) lymphoma
D. Duodenal ulcers
2. Which is false about helicobacter pylori?
A. Is a known cause of gastric ulcers
B. Produces urease which breaks down urea
C. Is known to cause Barrett’s dysplasia
D. Very rarely spreads to the systemic circulation from the duodenal area
3. Where is the best place to biopsy H. pylori?
a. Gastric body
b. Antrum
c. Lesser curvature
d. Greater curvature
e. Lower esophageal sphincter
4. A patient with H. Pylori infection is treated with drugs. The best method to
detect presence of residual H.Pylori infection in this person is :
A. Rapid urease test
B. Urea breath test
C. Endoscopy and biopsy
D. Serum anti H.Pylori titre
5. Recommended test for confirmation of H.pylori eradication – urea breath
test.

6) Who discovered H Pylori and was later awarded Nobel prize?

A) Dr Barry J. Marshall and Dr J. Robin Warren
B) Dr.Watson J.Marshall and Dr.Weber Jobs
C) Dr.Michael Cook and Dr.Watson J.Marshall
D) Dr.Edvard I. Moser and John O’Keefe
5) H pylori colonises in all of the following tissues, except?
A) Gastric epithelium
B) Gastric metaplasia of esophagus and duodenum
C) Meckel’s diverticulum.
D) Zenker diverticulum
Q6) The burden of risk of gastric cancer is considered largely attributable to
H pylori infection with strain?
A) PAI–bearing strains
B) PCI–bearing strains
C) API–bearing strains
D) BPI–bearing strains
Q7) H pylori has been strongly associated with all of the following, except?
A) Peptic ulcer disease
B) Gastric carcinoma
C) MALT lymphoma
D) Burkitt lymphoma
Q8) All of the following are used for the Triple therapy of H. pylori infection,
except?
A) PPI
B) Rifabutin
C) Levofloxacin
D) Doxycycline
CASE-1
A 58-year-old woman has progressively worsening epigastric pain. Upper
endoscopy showed a 4-mm duodenal ulcer; biopsy specimens revealed mild
gastritis with no evidence of malignancy. Histologic evaluation of the tissue
showed infection with Gram negative bacilli..
A. Which one of the following is the most likely causative organism:
A. klebsiella
B. E.coli
C. Helicobacter pylori
D. Streptococcus Pneumoniae .
B. Why did you choose that? what do you need to confirm your choice?
H. pylori is the most common cause of ulcer.
C. How did she get it?
The exact way H. pylori infects someone is still unknown. H. pylori bacteria may
be passed from person to person through direct contact with saliva, vomit or fecal
matter. H. pylori may also be spread through contaminated food or water
D. For the previous scenario, what is the most appropriate treatment:
A. PPI b.d. + clarithromycin 500mg b.d + Amoxicillin 1000mg b.d. minimum of 7
days
B. PPI b.d. + clarithromycin 1000mg b.d +Tetracycline 120mg b.d. minimum of 7
days
C. PPI b.d. + metronidazole 250mg b.d +subcitrate 120mg b.d. minimum of 7 days
E. Why do we use PPI in all combination to treat ulcer?

CASE-2
A 26-year-old African American woman presented with a 1-month history of
intermittent, burning epigastric abdominal pain that was moderately severe in
intensity. She also noted nausea and vomited once. The patient denied having
signs and symptoms of melena, hematochezia, or hematemesis. Histologic
evaluation of the tissue showed infection with H.pylori..
A. What is the Morphology of H.pylori?
Refer notes
B. Why is the blood test for H. pylori antibodies not recommended?
A. Takes long time.
B. We can’t find it
C. We can’t know if it’s new or old infection
D. No antigene for it.
C. Does everyone with H. pylori get ulcers? - No
D. If the patient doesn’t respond to triple therapy, what do we use?

E. What are the consequences of ulcer with H.pylori?

1-Which medium is used to H.pylori?

A. ClED agar
B. Chocolate agar
C. Blood agar
D. Nutrition agar
2- H.Pylori produce urease enzyme that breaks down urea into:
A.NH3 + CO2
B.NH4 + CO2
C.NH3 +O2
3-H. Pylori culture in:
A. Aerobic
B. Anaerobic
C. microaerophilic
4-Lymphoma associated with H. Pylori infection is:
A. Lympho blastoma
B. MALT Lymphoma
C. Burkitt’s lymphoma
D. Follicular lymphoma
5-Most reliable method for diagnosing H.pylori infections is :
A. Carbon urea breath test
B. Blood antibody test
C. Endoscope
D. Stool antigen test
Helicobacter pylori are not associated with:
a) Gastrointestinal lymphoma
b) Gastric cancer
c) gastric leiomyoma
d) Peptic ulcer
All are used in the treatment of Helicobacter pylori
a) colloid bismuth
b) Crsapade
c) Clarithromycin
d) Metronidazole
Endoscopic biopsy from a case of H.pylori related duodenal ulcer is most
likely to reveal:
a) antral predominant gastritis
b) multifocal atrophic gastritis
c) acute erosive gastric
d) gastric atrophy
Common sites for Cushing ulcers includes all of the following except:
a) Esophagus
b) Stomach
c) 1st part of the duodenum
d) distal duodenum
H.pylori is known to cause all of the following except:
a) gastric ulcer
b) duodenal ulcer
c) gastric lymphoma
d) fundal atrophic gastric
The commonest site of peptic ulcer is:
1st part of Duodenum
IInd part of the duodenum
Distal 1/3 of stomach
pylorus of the stomach
Ans()
Diagnostic tests for H.Pylori include all of the following except:
a) Urea -breath test
b) rapid urease test
 c) gastric biopsy & Warthin -stay
d) SAFA test
The most common site of a benign gastric ulcer is:
a) the upper third of lesser curvature
b) greater curvature
c) Pyloric antrum
d) lesser curvature near incisura angular
Epidemiological studies of H.pylori are done by using:
a) Urea-breath test
b) serological markers
c) culture
d) gastric -biopsy urease test
A most common complication of chronic gastric ulcer is:
a) Teapot stomach
b) scirrhous carcinoma
c) perforation
d) hemorrhage
Which of the following is false regarding H.pylori infection
a) With chronic infection urease, breath test becomes negative
b) H.pylori infection remain lifelong if untreated
c) endoscopy is diagnostic
d) toxigenic strains usually cause an ulcer
Artery to bleed in duodenal ulcer hemorrhage
a) splenic artery
b) gastroduodenal artery
c) left gastric artery
d) superior mesenteric artery
A patient with H/pylori infection is treated with drugs. The best method to
detect the presence of residual H.pylori infection in this person is:
rapid urease test
a) urea breath test
 b) endoscopy and biopsy
c) serum anti-H.pylori titer
the preferred test for confirming H. pylori eradication is:
a) urease breath test
b) culture
c) serological test
d) biopsy urease test
Ans(1)
All of the following are true regarding a patient with acid peptic disease
except:
a) misoprostol is the drug of choice in patients on NSAIDs
b) DU is preventable by the use of single night time H2 blockers
c) Omeprazole may help ulcers refractory to H2 blockers
d) Misoprostol is DOC in pregnant patients
All are true regarding Helicobacter pylori except:
a) less prevalent in developing countries
b) Toxicogenic strains usually cause ulcers
c) A urea breath test is positive
d) Gram-negative organism
Surgery of choice for chronic duodenal ulcer is:
a) Vagotomy + antrectomy
b) total gastrectomy
c) truncal vagotomy +pyloroplasty
d) highly selective vagotomy
Which of the following statements about peptic ulcer disease is true:
a) helicobacter pylori eradication increase the likelihood of occurrence of
complications
b) The incidence of complications has remained unchanged
c) The incidence of Helicobacter pylori reinfection in India is very low
d) Helicobacter pylori eradication does not alter the recurrence ratio
patient presents with recurrent duodenal ulcer of 2.5 cm size; the procedure
of choice
a) truncal vagotomy and antrectomy
b) truncal vagotomy and gastrojejunostomy
c) highly selective vagotomy
d) laparoscopic vagotomy and gastrojejunostomy
Which drug is not effective against H.pylori
a) Colloidal Bismuth
b) metronidazole
c) Amoxicillin
d) erythromycin
H.pylori is known to cause all of the following except:
a) gastric ulcer
b) duodenal ulcer
c) gastric lymphoma
d) fundal atrophic gastric
All of the following are used for the treatment of H.pylori except
a) gentamycin
b) clarithromycin
c) metronidazole
d) Amoxicillin
The lowest recurrence of peptic ulcer is associated with
a) gastric resection
b) vagotomy +drainage
c) vagotomy +Antrectomy
d) highly selective vagotomy
All of the following drugs are commonly used in regimens against H. pylori
except:
a) Oxytetracycline
b) amoxicillin
c) bismuth Subcontract
d) Omeprazole
NSAID-induced ulcers differ from H. pylori-associated ulcers in that patients
with an NSAID-induced ulcer are more likely to have
A) a duodenal ulcer.
B) more severe upper gastrointestinal bleeding.
C) ulcer-related epigastric pain.
D) gastric cancer.
The preferred noninvasive test to confirm H. pylori eradication is
A) a stool antigen test.
B) a whole-blood antibody-detection test.
C) a serologic antibody detection test.
D) a urea breath test.

The following statements best characterize the current status of H. pylori

testing and treating except
A) asymptomatic patients with a documented history of PUD should be tested for
H. pylori, and if positive, should receive eradication therapy.
B) symptomatic patients with uninvestigated dyspepsia should be tested for H.
pylori, and if positive, should receive eradication therapy.
C) symptomatic patients with an active peptic ulcer should be tested for H. pylori,
and if positive, should receive eradication therapy.
D) asymptomatic patients who do not have an active ulcer or a documented history
of an ulcer but who were tested for H. pylori and found to be positive should be
offered eradication therapy.
Antimicrobial resistance to H. pylori is most likely to occur with which of the
following agents?
A) Metronidazole and clarithromycin
B) Clarithromycin and tetracycline
C) Metronidazole and amoxicillin
D) Amoxicillin and tetracycline
The preferred drug treatment regimen for a penicillin-allergic H. pylori-
positive 35-year-old man with epigastric pain and a duodenal ulcer
documented by radiography is
A) lansoprazole + metronidazole.
B) ranitidine bismuth citrate + clarithromycin.
C) omeprazole + metronidazole + clarithromycin.
D) bismuth subsalicylate + metronidazole + tetracycline.

The most important parameter to monitor to assess ulcer healing in an H.

pylori-positive 25-year-old man who has just completed eradication therapy
for his first ulcer is
A) symptom relief 1 to 2 weeks after completion of drug treatment.
B) upper endoscopy on completion of drug treatment.
C) a urea breath test 4 to 6 weeks after completion of drug treatment.
D) a serology antibody detection 4 weeks after completion of drug treatment.
The preferred H. pylori eradication regimen for a patient with an active ulcer
who is admittedly noncompliant is
A) amoxicillin + omeprazole ( 14 days.
B) bismuth subsalicylate + metronidazole + tetracycline + ranitidine ( 7 days.

C) lansoprazole + amoxicillin + clarithromycin ( 10 days.

D) ranitidine bismuth citrate + clarithromycin + metronidazole ( 10 days.
The most important counseling information to convey to a patient prescribed
an H. pylori eradication regimen containing ranitidine bismuth citrate (RBC)
is
A) RBC may cause ringing in the ears.
B) RBC may cause your urine to turn orange.
C) RBC may cause dry mouth.
D) RBC may cause your stool to turn dark brown or black.
The preferred management of a 70-year-old woman with rheumatoid
arthritis who is at risk of developing an NSAID-induced ulcer or ulcer-
related complication is
A) misoprostol 100 µg twice daily.
B) famotidine 40 mg twice daily.
C) pantoprazole 40 mg daily.
D) omeprazole 40 mg twice daily.

The preferred management of an H. pylori-negative 60-year-old woman with

a documented NSAID-induced ulcer is
A) misoprostol 100 µg four times a day.
B) ranitidine 150 mg twice daily.
C) famotidine 20 mg twice daily + sucralfate 1 g four times a day.
D)lansoprazole 30 mg twice daily.
The most important parameter to monitor to assess the effectiveness of
misoprostol cotherapy in a 70-year-old woman taking ibuprofen is
A) prothrombin time.
B) absence of blood in the stool.
C) absence of epigastric pain.
D) stool consistency.
The most important parameter to monitor in an ulcer patient receiving long-
term maintenance therapy with a PPI is
A) fasting serum gastrin concentrations.
B) recurrence of ulcer symptoms.
C) vitamin B12 concentrations.
D) hemoglobin and hematocrit.
A 30-year-old woman prescribed misoprostol co therapy for the prevention of
an NSAID-induced ulcer should be counseled to do all the following except
A. discontinue the NSAID before beginning the misoprostol.
B. use adequate contraceptive measures.
C. have a serum pregnancy test within 2 weeks of starting treatment.
D. avoid magnesium-containing antacids.

The most important counseling information to convey to a 40-year-old man

taking omeprazole for an NSAID-induced ulcer is
A) take the omeprazole at the same time you take the NSAID.
B) take the omeprazole 15 to 30 minutes before breakfast.
C) take the omeprazole 1 hour before or 2 hours after a meal.
D) take omeprazole at bedtime.
Which of the following statement best characterizes the current status of drug
therapy in the prevention of stress-related mucosal bleeding?
A) Large randomized, controlled trials confirm that an intravenous proton pump
inhibitor is superior to an intravenous H2-receptor antagonist.
B) Antacids are the drugs of choice because they are effective and least costly.
C) Continuous infusion of an H2-receptor antagonist provides similar efficacy
as intermittent intravenous administration.
D) Sucralfate is not effective.
13) Helicobacter pylori infection is most prevalent in developing countries, in what
age people the chances of infection is the highest?
a) 10 to 30
b) 30 to 50
c) 60 and above
d) Infant
12) Aeromonas hydrophila mostly causes infections to fish and amphibians and
less pathogenic to humans, one of the most common infection in human is
gastroenteritis. What is the other common human disease caused by bacteria?
a) Peptic ulcer
b) Cellulitis
c) Asthma
d) Gastritis

10) Which one of these is not the common laboratory tests for the identification of
Helicobacter pylori?
a) Biopsy test
b) Urease breath test
c) Stool antigen test
d) Urine test
9) Which one of the following virulence factors may be associated with the
pathogenesis of infection caused by Helicobacter pylori?
a) Flagella
b) Lipopolysaccharides
c) Exotoxins
d) Endotoxins
8) Helicobacter pylori is associated with all of the following, EXCEPT?
a) Malt lymphoma
b) Gastric carcinoma
c) Peptic ulcer
d) Burkitt lymphoma
The best method to detect presence of residual H.Pylori infection in this
person is :
A. Rapid urease test
B. Urea breath test
C. Endoscopy and biopsy
D. Serum anti H.Pylori titre

Treatment of H. pyroli infection:

H. pylori infections are usually treated with at least two different antibiotics at
once, to help prevent the bacteria from developing a resistance to one particular
antibiotic. Your doctor also will prescribe or recommend an acid-suppressing drug,
to help your stomach lining heal.
Drugs that can suppress acid include:
Proton pump inhibitors (PPIs). These drugs stop acid from being produced in the
stomach. Some examples of PPIs are omeprazole (Prilosec), esomeprazole
(Nexium), lansoprazole (Prevacid) and pantoprazole (Protonix).
Histamine (H-2) blockers. These medications block a substance called histamine,
which triggers acid production. One example is cimetidine (Tagamet HB).
Bismuth subsalicylate. More commonly known by the brand name Pepto-Bismol,
this drug works by coating the ulcer and protecting it from stomach acid.