q-1 - natasha15

[ArchivalUser]

A 32-year-old man has an upper endoscopy after an episode of hematemesis. The patient reports intermittent abdominal pain before the episode, which is worse before meals. He regularly takes acetaminophen for headaches, but otherwise has no significant medical history. Endoscopy results reveal a duodenal ulceration with distinct margins, and a visible blood vessel in the base. The lesion is injected with epinephrine, and a small duodenal biopsy is taken. The patient is started on a protein pump inhibitor. Which of the following is the most likely pathophysiology of his underlying condition?
A. Inhibition of cyclooxygenase-dependent prostaglandin production
B. Atriovenous (AV) malformation
C. Carcinomatous invasion of mucosa
D. Direct erosion by gram-negative rods
E. Increased gastrin release caused by gram-negative rod infection

[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

no not a.....

[ArchivalUser]

H Pylori ------------ddddddddddd

[ArchivalUser]

not a or d....Think guys...

[ArchivalUser]

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[ArchivalUser]

The correct answer is E. H. pylori, a gram-negative rod, is associated with 50 to 80% of peptic ulcers, 80% of gastric cancers, and 90% of gastric lymphomas. Colonization results in an alteration of acid secretion physiology, mainly by increased gastrin levels rather than by direct erosion of the mucosa (choice D).

Nonsteroidal antiinflamatory drugs (NSAIDs) cause erosions of the gastric mucosa via nonspecific cyclooxygenase (CO) inhibition (choice A). COX-1 inhibition reduces constitutive prostaglandin production, resulting in reduced protective mucous secretions.

AV malformation (choice B) is a rare cause of duodenal ulcer. A visualized blood vessel in the base of an ulcer is not unusual and does not raise the suspicion of AV malformation.

Gastric ulcers are more likely to represent carcinomatous invasion (choice C) than duodenal ulcers. Further, the gross appearance is more likely to have irregular borders and have elevated, mound-like margins.