Gastroenterology and hepatology: pill oesophagitis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Gastroenterology and hepatology: pill oesophagitis

Sample item

A 25-year-old woman with acne is prescribed doxycycline. She takes it with a sip of water just before lying down and the next day has severe retrosternal pain and pain on swallowing. Endoscopy shows discrete ulcers in the mid-oesophagus. What is the best preventive advice?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Take it with a full glass of water and stay upright for 30 minutes

Tablets such as doxycycline, bisphosphonates, potassium chloride and NSAIDs can lodge at the point where the aortic arch and left atrium indent the mid-oesophagus. Taking them with plenty of water and staying upright for at least 30 minutes prevents injury.

Option by option

  • A. Take it at bedtime with a little milk

    A bedtime dose with little fluid is the pattern that caused the injury.

  • B. Take it with a hot drink while lying flat

    Lying flat makes tablet retention more likely.

  • C. Chew the tablet before swallowing

    Chewing the tablet leaves the drug in contact with the mucosa and does not help.

  • D. Take it with a full glass of water and stay upright for 30 minutes (correct)

    Correct. Plenty of water and staying upright help the tablet clear the oesophagus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Take it with a full glass of water and stay upright for 30 minutes. Tablets such as doxycycline, bisphosphonates, potassium chloride and NSAIDs can lodge at the point where the aortic arch and left atrium indent the mid-oesophagus.

Why is "Take it at bedtime with a little milk" not the answer?

A bedtime dose with little fluid is the pattern that caused the injury.

Why is "Take it with a hot drink while lying flat" not the answer?

Lying flat makes tablet retention more likely.

Why is "Chew the tablet before swallowing" not the answer?

Chewing the tablet leaves the drug in contact with the mucosa and does not help.

What concept does this question test?

It tests Gastroenterology and hepatology: pill oesophagitis in General Medicine. Taking them with plenty of water and staying upright for at least 30 minutes prevents injury.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastroenterology and hepatology: pill oesophagitis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.