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Tufts OpenCourseware
Author: Laurence Scott Bailen, M.D.

1. Question 1

A 45 year-old man comes to the emergency room after passing tarry black stool for 3 days. He has had intermittent epigastric pain with nausea but no vomiting. An upper endoscopy is performed and a large ulcer in the duodenal bulb is seen.

Which of the following would you most likely find in this patient’s stomach?

  1. Basal acid production twice below normal

  2. High acid production in response to a meal

  3. Negative rapid urease test for h.pylori

  4. Reduced sensitivity of parietal cells to gastrin

  5. Very high serum gastrin levels

2. Question 2

An 85 year-old woman is taking aspirin after recently suffering a myocardial infarction. She is admitted to the hospital from the nursing home with coffee ground emesis and several days of black stool. She is found to be hypotensive in the emergency room and severely anemic. She receives intravenous fluid, packed red blood cell transfusions, and pantoprazole intravenously. Once she is stabilized, an upper endoscopy is performed. Multiple small gastric ulcers are seen in the gastric antrum. They are all superficial and not actively bleeding.

Which of the following is the most likely cause for this patient’s ulcers?

  1. h.pylori infection

  2. Lack of gastric mucus

  3. Exuberant blood supply to stomach

  4. Inhibition of cyclooxygenase

  5. Very high gastric acid production

3. Question 3

A 48 year-old man is seen by his primary care physician for evaluation of epigastric abdominal pain and nausea of 3 months duration. There has been no vomiting, hematemesis, or melena (gastrointestinal bleeding). He does not use aspirin or other non-steroidal anti-inflammatory medications. His primary care doctor recommends beginning over the counter prilosec, one tablet in the morning, and she checks H.pylori serology which returns positive.

Which of the following would you most likely expect to see in this patient?

  1. Positive urea breath test

  2. Type A gastritis

  3. Gastrin level greater than 1000

  4. Pernicious anemia

  5. Numerous ulcers in the 3rd and 4th portion of the duodenum