Block 14 Peptic Ulcer H Pylori Ulcer Cancer

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Block 14 Peptic Ulcer H Pylori Ulcer Cancer - Quiz

CTL Week 7 - Stomach: ulcerations, gastritis, cancer
CTL Week 7 - Peptic ulcer dz: H. Pylori


Questions and Answers
  • 1. 

    A 28-year-old man who has recently run a marathon presents with a complaint of intermittent burning abdominal pain. He states that he has been taking ibuprofen since the race and that antacids relieve it. He also says that recently his stools appear much darker than normal. Physical exam is unremarkable and his vital signs are within normal limits.  Endoscopy reveals a diffusely erythematous mucosa with multiple punctate red foci. What is the most likely diagnosis?  

    • A.

      Chronic gastritis

    • B.

      Linitis plastic

    • C.

      Acute gastric ulceration

    • D.

      Peptic ulcer

    • E.

      Zollinger-Ellison syndrome

    Correct Answer
    C. Acute gastric ulceration
    Explanation
    The most likely diagnosis in this case is acute gastric ulceration. The patient's symptoms of intermittent burning abdominal pain, relief with antacids, and dark stools suggest an ulcer in the stomach. The endoscopy findings of diffusely erythematous mucosa with multiple punctate red foci further support this diagnosis. The patient's recent marathon run and use of ibuprofen may have contributed to the development of the ulcer.

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  • 2. 

    A 50-year-old Caucasian man develops massive hematemesis after a drinking binge.  He is reported to drink one bottle of whiskey per day and has been doing that for 5 years.  It is reported that he has had many occasions in which he has suffered severe retching, but this the first time hematemesis has occurred.  He has no history of liver cirrhosis.  Which of the following would be the most likely lesions seen in the esophagus and/or stomach of this patient on endoscopic examination?

    • A.

      Mallory-Weiss lacerations

    • B.

      Chronic gastritis

    • C.

      Esophageal candidiasis

    • D.

      Peptic ulcer disease

    • E.

      Ruptured esophageal varices

    Correct Answer
    A. Mallory-Weiss lacerations
    Explanation
    The most likely lesions seen in the esophagus and/or stomach of this patient on endoscopic examination would be Mallory-Weiss lacerations. Mallory-Weiss lacerations are linear mucosal tears that occur at the gastroesophageal junction due to severe retching or vomiting. They are commonly seen in individuals who consume excessive amounts of alcohol and have a history of retching or vomiting. In this case, the patient's history of heavy alcohol consumption and previous episodes of severe retching suggest that Mallory-Weiss lacerations are the most likely cause of his hematemesis.

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  • 3. 

    A 28-year-old man who has recently run a marathon presents with a complaint of intermittent burning abdominal pain. He states that antacids relieve it. He also says that recently his stools appear much darker than normal. Physical exam is unremarkable and his vital signs are within normal limits.  Endoscopy reveals multiple punctate red foci in the stomach. The stomach mucosa is diffusely erythematous. Which of the following is the most likely cause of his condition?

    • A.

      Autoimmune mechanisms

    • B.

      High doses of aspirin

    • C.

      Clostridium difficile

    • D.

      Diet of smoked fish and red meat

    • E.

      Ménétrier disease

    Correct Answer
    B. High doses of aspirin
    Explanation
    The most likely cause of the man's condition is high doses of aspirin. The intermittent burning abdominal pain, relief with antacids, and dark stools suggest gastrointestinal bleeding. The multiple punctate red foci and diffuse erythematous mucosa seen on endoscopy are consistent with gastric mucosal injury, which can be caused by high doses of aspirin. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that can irritate the stomach lining and increase the risk of gastric ulcers and bleeding. The other options, such as autoimmune mechanisms, Clostridium difficile infection, diet of smoked fish and red meat, and Ménétrier disease, are less likely to cause these specific findings.

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  • 4. 

    A 35-year-old man presents with a burning sensation in his chest.  He says it occurs after he eats spicy food, although recently it has been occurring more frequently and with different kinds of food.  His vital signs are within normal range and there are no significant signs on physical examination.  Endoscopy reveals the lesion seen in Image #13.   Which of the following is the most likely complication of this condition in the esophagus?

    • A.

      Achalasia

    • B.

      Barrett esophagus

    • C.

      Adenocarcinoma

    • D.

      Sliding hiatal hernia

    • E.

      Zenker diverticulum

    Correct Answer
    C. Adenocarcinoma
    Explanation
    The most likely complication of the condition described is adenocarcinoma. The patient's symptoms of a burning sensation in the chest that occurs after eating spicy food, along with the increasing frequency and occurrence with different kinds of food, suggest gastroesophageal reflux disease (GERD). GERD is a risk factor for the development of Barrett esophagus, a condition characterized by the replacement of normal squamous epithelium with columnar epithelium. Over time, Barrett esophagus can progress to adenocarcinoma, making it the most likely complication in this case.

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  • 5. 

    A 50-year-old Caucasian man, hospitalized for liver failure, develops massive hematemesis and dies.  The man has a history of liver cirrhosis.  Which of the following would be the most likely autopsy finding that would reveal the cause of death?

    • A.

      Acute gastric ulceration

    • B.

      Acute gastritis

    • C.

      Mallory-Weiss lacerations

    • D.

      Peptic ulcer disease

    • E.

      Ruptured esophageal varices

    Correct Answer
    E. Ruptured esophageal varices
    Explanation
    The most likely autopsy finding that would reveal the cause of death in this case is ruptured esophageal varices. Esophageal varices are enlarged veins in the lower part of the esophagus that occur due to portal hypertension, which is commonly associated with liver cirrhosis. Rupture of these varices can lead to massive bleeding, resulting in hematemesis (vomiting blood) and potentially fatal outcomes. Given the patient's history of liver cirrhosis, the presence of ruptured esophageal varices is the most likely cause of his massive hematemesis and subsequent death.

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  • 6. 

    A female medical student does some serious celebrating after Mini 2.  The following day she is not feeling well and has a burning sensation in her abdomen.  This photograph is from a similar case in an individual who was not as lucky as our medical student.  What is your diagnosis?

    • A.

      Acute gastric ulcers

    • B.

      Acute gastritis

    • C.

      Chronic gastritis

    • D.

      Linitis plastica

    • E.

      Peptic ulcer

    Correct Answer
    B. Acute gastritis
    Explanation
    The photograph shows a similar case to the female medical student who celebrated after an exam and then experienced abdominal discomfort. Acute gastritis is a possible diagnosis in this scenario as it is characterized by inflammation of the stomach lining, often caused by excessive alcohol consumption or certain medications. This aligns with the symptoms described in the question and the context provided.

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  • 7. 

    This gross specimen was taken from a 55 year old man who complained of a gnawing and burning pain below his sternum.  He reported that pain was worse at night and 2 hours after eating.  Eating seems to relieve this pain most of the time.  Physical examination reveals an obese man with a soft abdomen with normal bowel sounds and epigastric tenderness on deep palpation. A digital rectal exam reveals Guiac positive stool.  Which of the following is the most likely complication?

    • A.

      Perforation

    • B.

      Bleeding

    • C.

      Obstruction

    • D.

      Chronic renal failure

    • E.

      Cirrhosis

    Correct Answer
    B. Bleeding
    Explanation
    The most likely complication in this case is bleeding. The patient's symptoms, including gnawing and burning pain, which worsens at night and after eating, along with the presence of Guiac positive stool, suggest that there may be bleeding in the gastrointestinal tract. This could be due to conditions such as peptic ulcer disease or gastric cancer. The other options, including perforation, obstruction, chronic renal failure, and cirrhosis, are less likely based on the given information.

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  • 8. 

    A 25-year-old healthy male insurance salesman acquires Helicobacter pylori infection of his stomach. What is the most likely result over the next 10 years?

    • A.

      Multiple episodes of gastritis causing nausea and vomiting

    • B.

      Development of a duodenal ulcer with epigastric pain and occult blood in his stools

    • C.

      Development of adenocarcinoma of the gastric antrum

    • D.

      Asymptomatic but will show diagnostic serum antibodies if tested

    • E.

      Immune-mediated clearance of the bacteria within a year

    Correct Answer
    D. Asymptomatic but will show diagnostic serum antibodies if tested
    Explanation
    Helicobacter pylori infection is a common bacterial infection that can lead to various gastrointestinal conditions. In this case, the individual is a healthy male, and it is mentioned that he will be asymptomatic over the next 10 years. However, if tested, he is likely to show diagnostic serum antibodies, indicating the presence of the infection. This suggests that the individual may not experience any symptoms, but the infection can still be detected through laboratory testing.

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  • 9. 

    A 60-year-old Hispanic woman with epigastric pain is evaluated for peptic ulcer and shown to have serum antibodies against Helicobacter pylori. What is true about acquisition of this organism?

    • A.

      It is acquired at earlier ages in developing countries than in USA

    • B.

      Children are more likely than adults to show antibodies against Helicobacter pylori

    • C.

      It is acquired earlier in life in white persons than in African Americans and Hispanic persons in USA

    • D.

      Nausea and vomiting usually develop after acquisition

    • E.

      A normal immune system will clear the organism from the stomach within a month of acquisition.

    Correct Answer
    A. It is acquired at earlier ages in developing countries than in USA
    Explanation
    Helicobacter pylori is a bacterium that is commonly acquired during childhood. In developing countries, where sanitation and hygiene practices may be poorer, the acquisition of H. pylori tends to occur at earlier ages compared to developed countries like the USA. This is because the transmission of the bacterium is more likely to occur through contaminated food, water, or close contact with infected individuals in areas with lower socio-economic conditions. Therefore, the statement that H. pylori is acquired at earlier ages in developing countries than in the USA is true.

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  • 10. 

    ) A 32-year-old white male store supervisor began a month ago to notice burning sensations in his chest about an hour after eating that was relieved by antacids. What is likely in regard to the role of H. pylori in his symptoms?

    • A.

      Infection was recently acquired and was causing symptomatic gastritis

    • B.

      Infection was acquired several years ago and is now causing symptoms

    • C.

      Infection was never acquired because the patient practiced meticulous hand hygiene and dietary habits

    • D.

      Infection was acquired several years ago and was treated a year ago with antibiotics

    • E.

      His esophagitis was unrelated to H. pylori, likely caused by Candida albicans or cytomegalovirus

    Correct Answer
    D. Infection was acquired several years ago and was treated a year ago with antibiotics
    Explanation
    The burning sensations in the chest that are relieved by antacids suggest the presence of gastritis, which is commonly caused by H. pylori infection. The fact that the infection was acquired several years ago and was treated a year ago with antibiotics indicates that the symptoms are likely a result of previous H. pylori infection.

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  • 11. 

     Your patient has just been diagnosed with a gastric ulcer. He was curious as to how he acquired this condition and you tell him that a bacterium is very strongly linked. The patient looks incredulous until you explain how the bacterium can damage the stomach wall. What do you tell him?

    • A.

      The bacterium can invade the tissues through the stomach wall by increasing local acidity which then causes the actual ulcer

    • B.

      The bacterium invades the tissue and causes an alkaline environment, which causes the stomach to produce more acid leading to tissue damage and an ulcer

    • C.

      The bacterium doesn’t invade the tissue, but it does decrease the protective mucous layer by increasing acidity, causing local stomach damage

    • D.

      The bacterium doesn’t actually invade the tissues but it does damage them, allowing stomach acid to damage the underlying tissues and cause the actual ulcer

    Correct Answer
    D. The bacterium doesn’t actually invade the tissues but it does damage them, allowing stomach acid to damage the underlying tissues and cause the actual ulcer
    Explanation
    The bacterium in question does not directly invade the tissues of the stomach. However, it does cause damage to the tissues, which then allows stomach acid to further damage the underlying tissues and ultimately lead to the development of a gastric ulcer. The bacterium weakens the protective mucous layer of the stomach, increasing the acidity and causing local damage. This damage, combined with the corrosive effects of stomach acid, results in the formation of an ulcer.

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  • 12. 

    A 44-year-old white male bank employee complained of 2 months of epigastric pain 1-2 hours after meals that was relieved by antacids. After passing a black tarry stool, he went to the clinic. A stool test was guaiac positive and a blood test showed antibody to Helicobacter pylori. What happened in his stomach?

    • A.

      After he ingested pathogenic bacteria, the bacteria invaded his duodenal mucosa where a cytotoxin caused an ulcer

    • B.

      Pathogenic bacteria secreted urease and a cytotoxin into his gastric epithelial cells to result in an ulcer

    • C.

      Pathogenic bacteria attached to his antral epithelium and secreted urease; ammonia produced from urea acted to damage his epithelium

    • D.

      Pathogenic bacteria produced urease and damaged the epithelium by secreting acid to result in ulcer formation

    Correct Answer
    C. Pathogenic bacteria attached to his antral epithelium and secreted urease; ammonia produced from urea acted to damage his epithelium
    Explanation
    The correct answer is that pathogenic bacteria attached to his antral epithelium and secreted urease, which resulted in the production of ammonia from urea. This ammonia acted to damage his epithelium, leading to ulcer formation. This explanation suggests that the presence of Helicobacter pylori in the stomach caused the symptoms described by the patient.

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  • 13. 

    A 35-year-old housewife and mother of 3 children with job-related stress complained for 4 months of intermittent epigastric burning pains 1-2 hours after eating and at night. Her doctor diagnosed peptic ulcer disease and a serological test showed Helicobacter antibodies. What is the benefit of antibiotic treatment?

    • A.

      More rapid healing of the ulcer

    • B.

      Prevention of ulcer recurrence

    • C.

      Prevention of gastro-esophageal reflux disease

    • D.

      More rapid resolution of symptoms

    Correct Answer
    B. Prevention of ulcer recurrence
    Explanation
    The benefit of antibiotic treatment in this case is the prevention of ulcer recurrence. Peptic ulcer disease is often caused by the presence of Helicobacter pylori bacteria in the stomach. Antibiotic treatment can effectively eliminate the bacteria, reducing the risk of future ulcers. This can provide long-term relief for the patient and prevent the recurrence of symptoms.

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  • 14. 

    A 36-year-old female develops epigastric pain that occurs about an hour after  eating and is relieved by antacids. She’s under stress due to her job and caring for children at home. Her doctor orders a blood test for Helicobacter pylori antibodies that comes back positive. She is treated with a proton pump inhibitor and antibiotics. Which of the following is true?

    • A.

      Patients with ulcers caused by H. pylori acquire their infections through food or water in the few weeks preceding their symptoms

    • B.

      H. pylori causes ulcers by the actions of urease and cytotoxin

    • C.

      Ulcers caused by H. pylori heal faster when antibiotics are administered

    • D.

      H. pylori infection predisposes persons to both peptic ulcers and esophageal reflux disease

    • E.

      Most persons with H. pylori infection will develop duodenal ulcers or gastric carcinoma

    Correct Answer
    B. H. pylori causes ulcers by the actions of urease and cytotoxin
    Explanation
    H. pylori causes ulcers by the actions of urease and cytotoxin. Urease is an enzyme produced by H. pylori that breaks down urea in the stomach, leading to the production of ammonia. This ammonia can neutralize stomach acid and create an environment favorable for H. pylori to survive and colonize. Cytotoxin, on the other hand, damages the cells lining the stomach and causes inflammation, which can contribute to the development of ulcers. Therefore, the actions of urease and cytotoxin play a role in the pathogenesis of H. pylori-induced ulcers.

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