PPAU CME-CPD Portal

Question 1 of 25

Mukasa, aged 58, asks for an "ulcer medicine." He is pale, feels dizzy on standing and passed a black, sticky stool this morning. What should you do first?

A. Sell an antacid and arrange review tomorrow. B. Give omeprazole and ask him to return if the stool remains black. C. Arrange immediate emergency assessment for suspected gastrointestinal bleeding. D. Give bismuth subsalicylate to settle his stomach.

Question 2 of 25

A patient taking bismuth as part of an H. pylori regimen reports a dark tongue and dark stool. She feels well and has no dizziness, weakness or abdominal pain. What is the best response?

A. Explain that bismuth can cause this effect, but ask about bleeding symptoms before reassuring her. B. Tell her black stool always means the treatment has failed. C. Stop every medicine in the regimen immediately. D. Add an antacid to reverse the colour change.

Question 3 of 25

Okello, aged 70, takes diclofenac to treat his osteoarthritis. He develops sudden severe abdominal pain. His abdomen is rigid and painful to touch. What is the most appropriate action in a community pharmacy?

A. Offer an oral antacid and observe him for an hour. B. Arrange immediate transfer to the hospital. C. Give omeprazole and review him the next morning. D. Advise him to stop diclofenac and book the doctor for his next week appointment.

Question 4 of 25

Which one of the following is NOT a well documented risk factor for the development of peptic ulcer disease?

A. Excessive drinking of alcohol B. Eating food late past the usual time C. Prolonged use of drugs like indomethacin D. Cigarette smoking

Question 5 of 25

A 40-year-old customer says, I get ulcers whenever I am stressed, and asks for omeprazole. Which question is most important before recommending treatment?

A. Which brand do you prefer? B. Have you had vomiting of blood, black tarry stools, difficulty swallowing or unexplained weight loss? C. Do you take your breakfast before 8 a.m.? D. Would you like an antacid as well?

Question 6 of 25

A 72-year-old man with a previous bleeding ulcer brings a prescription for piroxicam 40 mg once daily for low back pain. What should you do?

A. Dispense it without discussion because it is prescribed. B. Contact the prescriber about his high bleeding risk and a safer pain-management plan. C. Add an antacid and advise him that this removes the bleeding risk. D. Tell him to take piroxicam on an empty stomach.

Question 7 of 25

A patient takes omeprazole each morning after breakfast and says it is not working. Before concluding that treatment has failed, what should you advise?

A. Take the usual morning dose 30-60 minutes before breakfast and arrange review if symptoms persist. B. Crush the delayed-release capsule into tea. C. Take twice the prescribed dose at bedtime. D. Stop the PPI and use antibiotics instead.

Question 8 of 25

A patient prescribed sucralfate 1 g four times daily asks when to take it. Which instruction is best?

A. With each main meal and at bedtime. B. On an empty stomach, approximately one hour before each main meal and at bedtime. C. Only when pain occurs. D. At the same time as every other medicine.

Question 9 of 25

A patient takes sucralfate four times daily and has been prescribed oral ciprofloxacin. Which dispensing plan addresses the interaction?

A. Take both together to improve adherence. B. Schedule ciprofloxacin at least 2 hours before or 6 hours after sucralfate. C. Take ciprofloxacin 30 minutes after sucralfate. D. Increase the ciprofloxacin dose to overcome the interaction.

Question 10 of 25

A patient collecting ciprofloxacin asks for a magnesium-aluminium antacid. What is the best advice?

A. Take them together after food. B. Take ciprofloxacin at least 2 hours before or 6 hours after the antacid. C. Take the antacid 30 minutes before ciprofloxacin. D. Stop ciprofloxacin whenever heartburn occurs.

Question 11 of 25

A customer says the first doses from her antacid bottle were thin, while the last doses were thick. What practical instruction should you give?

A. Shake the bottle well before measuring each dose. B. Add water to the bottle every morning. C. Take a double dose from the thinner portion. D. Store the bottle upside down between doses.

Question 12 of 25

A woman who is 22 weeks pregnant requests bismuth subsalicylate for persistent heartburn. What is the best response?

A. Recommend it for 2 days because treatment is short. B. Avoid recommending it; assess for warning symptoms and discuss an appropriate pregnancy-safe approach. C. Reduce the bismuth dose by half. D. Tell her that all heartburn in pregnancy is harmless.

Question 13 of 25

A patient presents a prescription for misoprostol to prevent NSAID-associated ulcers. Which finding requires you to pause dispensing and contact the prescriber?

A. The patient takes the NSAID with food. B. The patient may be pregnant. C. The patient drinks water with tablets. D. The patient has previously used a PPI.

Question 14 of 25

A non-pregnant patient is prescribed misoprostol 200 micrograms four times daily while continuing an NSAID. Which explanation is most useful?

A. Take it after meals and at bedtime as prescribed; diarrhoea and abdominal cramps can occur. B. Take all four tablets once each morning. C. Stop it as soon as the arthritis pain improves, even if you still take the NSAID. D. It eradicates H. pylori, so no other treatment is needed.

Question 15 of 25

A patient with a documented immediate allergic reaction to amoxicillin presents an H. pylori prescription containing amoxicillin. No antibiotic-susceptibility result is available. What should the dispenser do?

A. Dispense it because allergy matters only at higher doses. B. Replace amoxicillin with clarithromycin independently. C. Withhold the amoxicillin-containing regimen and promptly contact the prescriber for an appropriate alternative such as clarithromycin. D. Dispense only the PPI for 14 days and mark treatment complete.

Question 16 of 25

A treatment-naive patient has confirmed H. pylori. The prescription is for a PPI, amoxicillin and clarithromycin for 14 days; no clarithromycin-susceptibility result is documented. What is the best action?

A. Dispense it without review because triple therapy is always first-line. B. Contact the prescriber to review the regimen in light of possible clarithromycin resistance. C. Remove the PPI and dispense the antibiotics alone. D. Shorten the treatment to seven days.

Question 17 of 25

A patient with a duodenal ulcer has a confirmed H. pylori infection. Which prescribed combination should a pharmacy professional query because it is NOT a standard H. pylori eradication regimen?

A. Omeprazole, amoxicillin and metronidazole B. Omeprazole, amoxicillin and clarithromycin C. Tinidazole, omeprazole and clarithromycin D. Omeprazole, co-amoxiclav and metronidazole

Question 18 of 25

A patient is booked for an H. pylori stool antigen test next week but is taking a PPI. What should you do?

A. Tell him to take an extra PPI dose on the test day. B. Check with the requesting clinician whether the test should be rescheduled so the PPI can be withheld for approximately two weeks, if clinically safe. C. Tell him to stop the PPI for only 24 hours. D. Cancel testing permanently because he has used a PPI.

Question 19 of 25

A patient finishes a 14-day H. pylori regimen today and asks whether feeling better proves the infection is gone. Which follow-up plan is best?

A. No further action if pain has settled. B. Arrange a test of cure at least four weeks after treatment; withhold the PPI for two weeks and antibiotics and bismuth for four weeks before testing. C. Perform a stool antigen test tomorrow. D. Repeat the same antibiotics immediately as a precaution.

Question 20 of 25

Zakayo has been diagnosed with peptic ulcer disease. His doctor explains that a Gram-negative bacterium may be responsible. Which bacterium is commonly associated with peptic ulcers?

A. Escherichia coli B. Helicobacter pylori C. Neisseria gonorrhoeae D. All of the above

Question 21 of 25

What is one practical advantage of oral vonoprazan over most proton pump inhibitors (PPIs)?

A. It is always cheaper than PPIs. B. It suppresses acid more rapidly and can be taken with or without food. C. It both neutralises stomach acid and suppresses acid production. D. It has no drug interactions.

Question 22 of 25

Catherine, aged 43, has peptic ulcer disease and also experiences acid reflux. Which antacid combination is most useful for relieving her reflux symptoms?

A. An antacid combined with simethicone B. An antacid combined with peppermint C. An antacid combined with alginate D. An antacid combined with a local anaesthetic

Question 23 of 25

Nuru, aged 34, comes to a community pharmacy with heartburn and abdominal bloating. Which condition is least likely to explain these symptoms?

A. Peptic ulcer disease B. Reflux oesophagitis C. Gastritis D. Syphilis

Question 24 of 25

Peter has a confirmed gastric ulcer and has tested negative for H. pylori. Which omeprazole regimen is an appropriate course for ulcer healing?

A. 20 mg twice daily for 2 weeks B. 20 mg twice daily for 3 weeks C. 20 mg once daily for 8 weeks D. 20 mg once daily for 7 days

Question 25 of 25

Mugisha smokes and drinks alcohol and has been diagnosed with peptic ulcer disease. Which counselling statement is NOT appropriate?

A. Stop smoking and avoid alcohol. B. You must eat every four hours to prevent the ulcer from getting worse. C. Avoid ibuprofen and diclofenac unless your clinician specifically advises you to take them. D. Get adequate sleep and find practical ways to manage stress.

Assessment