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  #1  
Old 10-02-2012
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Arrow Billy Step 1 Questions #5

A 35-year-old man has had epigastric pain for more than 1 year. The pain tends to occur 2 to 3 hours after a meal and
is relieved if he takes antacids or eats more food. He has noticed a 4-kg weight gain in the past year. He does not smoke
and drinks 1 glass of Johannisberg Riesling daily. The result of a urea breath test is positive, and a gastric biopsy
specimen contains urease. He begins a 2-week course of antibiotics, but on day 4, he feels better and discontinues
treatment. Several weeks later, the epigastric pain recurs. If the patient does not seek further treatment, which of the
following complications is he most likely to develop?


□ (A) Hematemesis
□ (B) Fat malabsorption
□ (C) Hepatic metastases
□ (D) Carcinoid syndrome
□ (E) Vitamin B12 deficiency
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  #2  
Old 10-02-2012
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Default my answer :)

□ (A) Hematemesis
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  #3  
Old 10-02-2012
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I will go with C
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  #4  
Old 10-02-2012
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A

not e, because it takes long to develop B12 Deficiency
isn't H.pylori associated with MALT Lymphoma?
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Old 10-02-2012
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A) hematemesis
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  #6  
Old 10-03-2012
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Correct Answer A is correct

The clinical symptoms in this case suggest peptic ulcer disease. In most cases, peptic ulcers are associated with
Helicobacter pylori infection. These bacteria secrete urease, which can be detected by oral administration of 14C-labeled
urea. After drinking the labeled urea solution, the patient blows into a tube. If H. pylori urease is present in the stomach,
the urea is hydrolyzed, and labeled carbon dioxide is detected in the breath sample. In the biopsy urease test, antral
biopsy specimens are placed in a gel containing urea and an indicator, and if H. pylori is present, the color changes within
minutes. If not properly treated, peptic ulcers can produce many complications, including massive bleeding that can be
fatal. The patient does not have fat malabsorption because fat absorption does not occur in the stomach. Peptic ulcers
rarely progress to gastric carcinoma; metastases are unlikely. Carcinoid tumors can occur in the stomach, but they are
rare and are not related to peptic ulcer disease, which this patient has. Vitamin B12 deficiency can occur with autoimmune
atrophic gastritis because intrinsic factor, which is required for vitamin B12 absorption, is produced in gastric parietal cells.
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