Block 14 Peptic Ulcer H Pylori Ulcer Cancer

14 Questions | Total Attempts: 830

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Block 14 Peptic Ulcer H Pylori Ulcer Cancer

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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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.

  • 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

  • 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

  • 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

  • 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

  • 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

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