H. pylori: ABFM practice questions

4 board-style questions on h. pylori in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 35-year-old woman presents with a 3-month history of gnawing epigastric pain that improves with eating but recurs 2 to 3 hours after meals. She has no alarm symptoms, takes no NSAIDs, and has no history of peptic ulcer disease. She has never been tested for H. pylori. A urea breath test is positive. What is the most appropriate next step in management?

1. Start a proton pump inhibitor alone and retest in 8 weeks
2. Treat with bismuth quadruple therapy: PPI, bismuth subsalicylate, metronidazole, and tetracycline for 14 days
3. Perform upper endoscopy before initiating any treatment
4. No treatment is needed since H. pylori is a normal commensal organism

Sample question 2

A 48-year-old man was treated for H. pylori infection 6 weeks ago with clarithromycin-based triple therapy (omeprazole, clarithromycin, and amoxicillin for 14 days). A follow-up urea breath test performed 4 weeks after completing all medications remains positive. He has a documented penicillin allergy (anaphylaxis). Which of the following is the most appropriate salvage regimen?

1. PPI and amoxicillin dual high-dose therapy for 14 days
2. Repeat the same clarithromycin-based triple therapy for an additional 14 days
3. Discontinue treatment and monitor symptoms only since one treatment failure is acceptable
4. Bismuth quadruple therapy: PPI, bismuth subsalicylate, metronidazole, and tetracycline for 14 days

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