Paper II
2025 March (Supplementary (SAY)) (2019 Scheme) · 100 marks · 180 min

Question

Patient: Mr. John Taylor, a 45-year-old man presents with the chief complaint: Severe heartburn and regurgitation of food after meals, especially at night. Medical History: Overweight (BMI: 29), Occasional alcohol use. No known drug allergies. Presenting Symptoms: Heartburn and acid regurgitation after meals for the past 3 months. Symptoms are worse when lying down, particularly at night. Difficulty swallowing at times. Has been self-medicating with over-the-counter antacids but reports no significant relief. Physical Examination: Normal vital signs, No signs of systemic illness, abdominal tenderness or masses and not anaemic. Diagnosis: Gastroesophageal reflux disease (GERD)

The known side effect of long-term use of proton pump inhibitors (PPIs) is

  • a) Hyperglycemia
  • b) Hypercalcemia
  • c) Vitamin B12 deficiency
  • d) Relapse of GERD
Qxiii1 marksMCQs (Case)

Answer

Correct answer: c) Vitamin B12 deficiency

Long-term PPI use is a recognized cause of vitamin B12 deficiency — gastric acid is needed to release B12 from dietary protein for absorption, and profound acid suppression impairs this process over time. Long-term PPI use is also associated with hypomagnesemia and increased fracture risk (not hypercalcemia), and does not cause hyperglycemia.

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