Pathophysiology and Microbiology
1. Which virulence factor of H. pylori is associated with increased gastric cancer risk?
a) Urease
b) VacA
c) CagA
d) Flagella
2. What is the primary role of H. pylori urease in gastric colonization?
a) Inhibits acid secretion
b) Converts urea to ammonia
c) Enhances mucosal adherence
d) Disrupts tight junctions
3. H. pylori predominantly colonizes which part of the stomach?
a) Fundus
b) Corpus
c) Antrum
d) Cardia
4. How does the VacA toxin primarily induce cellular damage?
a) By inhibiting T-cell responses
b) By forming anion-selective channels
c) By disrupting mucosal barriers
d) By inducing apoptosis
5. The H. pylori cag pathogenicity island encodes a type IV secretion system responsible for delivering which molecule into gastric epithelial cells?
a) VacA
b) CagA
c) Lipopolysaccharide
d) Urease
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Epidemiology
6. Which region has the highest prevalence of H. pylori infection?
a) North America
b) Western Europe
c) Sub-Saharan Africa
d) South Asia
7. Which of the following factors is least likely to be associated with H. pylori transmission?
a) Crowded living conditions
b) Contaminated water
c) Blood transfusion
d) Poor sanitation
8. Which age group is most commonly infected with H. pylori in endemic regions?
a) Neonates
b) Preschool children
c) Adolescents
d) Adults
9. What is the approximate percentage of global gastric cancer cases attributable to H. pylori infection?
a) 10%
b) 30%
c) 50%
d) 90%
10. Infections with H. pylori are inversely correlated with the prevalence of which condition?
a) Esophageal adenocarcinoma
b) Gastric lymphoma
c) Gastric adenocarcinoma
d) Gastroesophageal reflux disease (GERD)
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Clinical Manifestations
11. What is the most common clinical manifestation of chronic H. pylori infection?
a) Dyspepsia
b) Hematemesis
c) Weight loss
d) Diarrhea
12. H. pylori-associated peptic ulcers are most frequently found in which location?
a) Gastric fundus
b) Gastric antrum
c) Duodenum
d) Esophagus
13. Which condition is least likely to be directly linked to H. pylori infection?
a) MALT lymphoma
b) Pernicious anemia
c) Gastric adenocarcinoma
d) Duodenal ulcers
14. How does H. pylori infection typically alter gastric acid secretion in the early stages?
a) Increases acid secretion
b) Decreases acid secretion
c) Does not alter secretion
d) Causes fluctuating secretion
15. Which of the following is NOT a mechanism by which H. pylori promotes peptic ulcer disease?
a) Cytotoxin-mediated mucosal damage
b) Hypergastrinemia-induced acid hypersecretion
c) Inhibition of prostaglandin synthesis
d) Increased epithelial permeability
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Diagnostics
16. Which diagnostic test for H. pylori is considered the gold standard?
a) Urea breath test
b) Stool antigen test
c) Rapid urease test
d) Histology
17. Which test is most appropriate for confirming eradication of H. pylori?
a) Serology
b) Histology
c) Urea breath test
d) PCR
18. The 13C urea breath test measures the presence of:
a) Carbon dioxide
b) Ammonia
c) Methane
d) Nitrogen
19. In patients with upper gastrointestinal bleeding, which diagnostic test for H. pylori is least reliable?
a) Urea breath test
b) Stool antigen test
c) Rapid urease test
d) Serology
20. Serological testing for H. pylori is limited by its inability to:
a) Detect active infection
b) Be cost-effective
c) Identify specific strains
d) Detect eradication
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Management
21. The standard first-line treatment for H. pylori infection includes:
a) Amoxicillin, clarithromycin, and a proton pump inhibitor (PPI)
b) Metronidazole and a PPI
c) Ranitidine and tetracycline
d) Bismuth subsalicylate and rifabutin
22. What is the minimum duration recommended for H. pylori eradication therapy?
a) 5 days
b) 7 days
c) 10 days
d) 14 days
23. Which antibiotic resistance is most commonly encountered in H. pylori treatment failure?
a) Amoxicillin
b) Clarithromycin
c) Metronidazole
d) Levofloxacin
24. Which regimen is used as a salvage therapy in H. pylori treatment?
a) Sequential therapy
b) Levofloxacin-based triple therapy
c) Bismuth quadruple therapy
d) High-dose dual therapy
25. What is the primary advantage of bismuth quadruple therapy?
a) Lower cost
b) Higher efficacy in resistant strains
c) Simpler dosing
d) Fewer side effects
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Complications
26. H. pylori-associated gastric cancer primarily involves which histological subtype?
a) Diffuse-type adenocarcinoma
b) Intestinal-type adenocarcinoma
c) Signet-ring cell carcinoma
d) Squamous cell carcinoma
27. H. pylori-associated MALT lymphoma typically responds to:
a) Radiation therapy
b) Surgical resection
c) Eradication therapy
d) Chemotherapy
28. How does H. pylori infection contribute to iron deficiency anemia?
a) Enhances iron sequestration
b) Reduces gastric acid secretion
c) Increases gastrointestinal bleeding
d) Alters iron absorption
29. The development of H. pylori-associated atrophic gastritis increases the risk of which vitamin deficiency?
a) Vitamin B6
b) Vitamin D
c) Vitamin B12
d) Vitamin E
30. What is the most significant factor linking H. pylori infection to gastric carcinogenesis?
a) Chronic inflammation
b) Hyperchlorhydria
c) Reactive oxygen species production
d) DNA repair inhibition
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Advanced Research
31. What is the function of the H. pylori BabA adhesin?
a) Binding to Lewis b antigens
b) Neutralizing gastric acid
c) Inducing T-cell suppression
d) Enhancing epithelial apoptosis
32. Which cytokine is predominantly upregulated in H. pylori-induced inflammation?
a) IL-2
b) IL-4
c) IL-8
d) IL-10
33. Genetic polymorphisms in which host gene are associated with increased gastric cancer risk in H. pylori-infected individuals?
a) p53
b) IL-1β
c) TNF-α
d) VEGF
34. Which mechanism does H. pylori use to evade host immune responses?
a) Antigenic mimicry
b) Production of immunoglobulin proteases
c) Inhibition of phagocytosis
d) Alteration of MHC class I expression
35. What role does the H. pylori DupA gene play in infection?
a) Promotes gastric cancer
b) Enhances inflammation and ulcer formation
c) Inhibits neutrophil activity
d) Reduces gastric acid secretion
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Miscellaneous
36. Which dietary factor may inhibit H. pylori growth?
a) High salt intake
b) Vitamin C
c) Omega-3 fatty acids
d) Vitamin B12
37. Which probiotic species shows evidence of reducing H. pylori colonization?
a) Lactobacillus acidophilus
b) Saccharomyces boulardii
c) Bifidobacterium bifidum
d) Streptococcus thermophilus
38. H. pylori infection is inversely associated with the development of which allergic condition?
a) Asthma
b) Atopic dermatitis
c) Allergic rhinitis
d) Urticaria
39. Antibiotic resistance in H. pylori is primarily driven by:
a) Overuse of antibiotics in agriculture
b) Use of antibiotics without culture testing
c) Mutation in ribosomal RNA genes
d) Biofilm formation
40. Which of the following is a potential biomarker for H. pylori eradication?
a) Serum gastrin levels
b) Serum pepsinogen levels
c) Fecal calprotectin
d) Serum C-reactive protein
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Case Scenarios
41. A 45-year-old patient with chronic dyspepsia tests positive for H. pylori. Which therapy is recommended if they have a history of penicillin allergy?
a) Clarithromycin triple therapy
b) Metronidazole-based triple therapy
c) Bismuth quadruple therapy
d) Sequential therapy
42. A patient with iron deficiency anemia unresponsive to oral iron supplementation is found to have H. pylori infection. What is the next step?
a) Start iron injections
b) Perform upper GI endoscopy
c) Treat H. pylori infection
d) Assess for coeliac disease
43. A patient treated with triple therapy for H. pylori reports persistent symptoms. Which is the most appropriate next step?
a) Repeat triple therapy
b) Switch to bismuth quadruple therapy
c) Test for clarithromycin resistance
d) Perform serological testing
44. A 55-year-old patient with MALT lymphoma undergoes H. pylori eradication therapy. What is the next step in management if the lymphoma persists?
a) Chemotherapy
b) Surgery
c) Radiotherapy
d) Watchful waiting
45. A 32-year-old pregnant woman is diagnosed with H. pylori-associated dyspepsia. Which treatment is appropriate?
a) Bismuth quadruple therapy
b) Amoxicillin and PPI
c) Clarithromycin triple therapy
d) Defer treatment until postpartum
46. A 60-year-old man presents with gastric ulcer and positive H. pylori testing. Which additional test is essential?
a) Fecal occult blood test
b) Serum gastrin levels
c) Endoscopic biopsy for malignancy
d) Urea breath test
47. A 25-year-old asymptomatic individual is found to be H. pylori-positive. What is the best course of action?
a) Treat with eradication therapy
b) Perform endoscopy
c) Monitor without treatment
d) Treat only if family history of gastric cancer
48. A patient previously treated for H. pylori now presents with symptoms of GERD. What is the likely explanation?
a) Persistent H. pylori infection
b) Eradication-induced hypergastrinemia
c) Increased gastric acid production
d) Reduced mucosal protective mechanisms
49. A 50-year-old male smoker with a history of H. pylori infection presents with gastric cancer. Which subtype is most likely?
a) Diffuse-type adenocarcinoma
b) Intestinal-type adenocarcinoma
c) Signet-ring carcinoma
d) Squamous cell carcinoma
50. A patient with refractory H. pylori infection is found to have levofloxacin resistance. What is the recommended alternative?
a) Bismuth quadruple therapy
b) Clarithromycin triple therapy
c) Rifabutin-based therapy
d) High-dose dual therapy