USMLE Forum Archives - USMLE Step 2 CK - GIT
GIT
HIV - 01-09-08 20:36
35. A 42-year-old man has a 6-week history of epigastric pain following meals and at night. The patient does not smoke cigarettes but does drink alcoholic beverages socially. He denies use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin. Physical examination and routine laboratory studies are normal.
A proton pump inhibitor is begun. One week later, upper endoscopy is performed, which shows a small, clean-based ulcer in the duodenal bulb. Rapid urease testing of an endoscopic gastric antral biopsy specimen is negative.
Which of the following is the most likely cause of this patient's ulcer?
A. Zollinger-Ellison syndrome
B. Helicobacter pylori infection
C. Duodenal adenocarcinoma
D. Alcohol consumption
E. NSAID use
HIV - 01-09-08 20:36
35. A 42-year-old man has a 6-week history of epigastric pain following meals and at night. The patient does not smoke cigarettes but does drink alcoholic beverages socially. He denies use of nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin. Physical examination and routine laboratory studies are normal.
A proton pump inhibitor is begun. One week later, upper endoscopy is performed, which shows a small, clean-based ulcer in the duodenal bulb. Rapid urease testing of an endoscopic gastric antral biopsy specimen is negative.
Which of the following is the most likely cause of this patient's ulcer?
A. Zollinger-Ellison syndrome
B. Helicobacter pylori infection
C. Duodenal adenocarcinoma
D. Alcohol consumption
E. NSAID use
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#3
Re: GIT InSitu - 01-09-08 23:38 b. H pylori -Proton-Pump Inhibitors Cause False Negative H. pylori tests but in am not clear if the patient was on PPI before. Is there a false nagtive without PPI?
#5
Re: GIT funtonic - 01-10-08 22:54 I would choose Helicobacter pylori rather than zolinger-illson syndrome.
#6
Re: GIT 8401glacieres - 01-11-08 02:44 B- HP infection.
Given the patient's treatement with proton pump inhibitors for a significsnt time ie 1 week, he is expected to have false negative results. He doesn't have any symptoms suggestive of ZE syndrome except pain abdomen at night(suggestive of duodenal ulcer) and food pain pattern suggestive of gastic ulcer.
Other problems for false-negative results due to infection with coccoid forms of HP that do not produce as much urease or intake of 1)antibiotics,2) bismuth, 3)histamine 2 (H2) blockers, or
4)proton pump inhibitors.
False positivity is seen in patients when HP Serology test is used to diagnose or follow up, as it can't tell if the infection is old or recent.
#7
Re: GIT InSitu - 01-11-08 09:37 
posted by 8401glacieres on 01-11-08 02:44
B- HP infection.
Given the patient's treatement with proton pump inhibitors for a significsnt time ie 1 week, he is expected to have false negative results. He doesn't have any symptoms suggestive of ZE syndrome except pain abdomen at night(suggestive of duodenal ulcer) and food pain pattern suggestive of gastic ulcer.
Other problems for false-negative results due to infection with coccoid forms of HP that do not produce as much urease or intake of 1)antibiotics,2) bismuth, 3)histamine 2 (H2) blockers, or
4)proton pump inhibitors.
False positivity is seen in patients when HP Serology test is used to diagnose or follow up, as it can't tell if the infection is old or recent.
B- HP infection.
Given the patient's treatement with proton pump inhibitors for a significsnt time ie 1 week, he is expected to have false negative results. He doesn't have any symptoms suggestive of ZE syndrome except pain abdomen at night(suggestive of duodenal ulcer) and food pain pattern suggestive of gastic ulcer.
Other problems for false-negative results due to infection with coccoid forms of HP that do not produce as much urease or intake of 1)antibiotics,2) bismuth, 3)histamine 2 (H2) blockers, or
4)proton pump inhibitors.
False positivity is seen in patients when HP Serology test is used to diagnose or follow up, as it can't tell if the infection is old or recent.
Thanks Glacieres!!!
#8
Re: GIT laparotomy - 01-14-08 10:00 A. Not likely, he has only one ulcer, possibility but low on the diff diagnosis list
B. H pylori infection not likely because the urease test is negative
C. Duodenal cancer unliely because the biopsy was negative
D. Alcohol consumption is possible but he is not known to be an alcoholic and alcohol is not proven to be a very likely cause of duodenal ulcer
E. NSAID use not likely because he is not on NSAIDS and it is difficult for a drug to cause an ulcer for you if you are not taking it
F. Duodenal ulcer of unkown origin, a likely cause. We dont really know the cause of a lot of conditions that we have we can only guess based on what is likely.
G. This is not a probable USMLE exam question. Also a correct answer because USMLE usually tests your knowlage based on clinical facts recorded in text books and backed by research. They cant ask you a question just out of the blues which does not have a proper answer.
#10
Re: GIT ammulufy - 06-30-10 21:51 Alcohol consumption is one of d predisposing risk factors.....so I go wid D
#12
Re: GIT babbu5508 - 07-07-10 22:02 D. Alcohol consumption i guess this because the other likely option that striked me was helecobacter which was negative....
#14
Re: GIT bingousmle - 07-09-10 01:16 yeah but given the history that he was treated one week baack with proton pump inhibitors the most likely ettiology could be h pylori.. as the test done was urease.. and most of the organisms change to urease negative once treatment is begun
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