Internal-Medicine

Questions: 66–76 91
(C)
(D)
(E)
(F)
ischemia of the gastric mucosa implicated
in the pathogenesis
associated with Helicobacter pylori infection
unknown mechanism
interruption of prostaglandin synthesis
For each patient with gastritis, select the most likely
mechanism of injury.
72. A 67-year-old man is admitted to the intensive
care unit (ICU) because of respiratory failure
from pneumonia. He requires artificial ventilation
and inotropic support. On the third day in
the ICU, he develops melena and a drop in his
hemoglobin. Urgent upper endoscopy is performed
and it reveals three gastric ulcers in the
fundus and body of the stomach. Appropriate
treatment is started. (SELECT ONE)
73. A 70-year-old man has a long history of heartburn
and dyspepsia. He has tried many medications
but the symptoms always return. His
upper endoscopy is normal with no ulcers.
Routine biopsies of the gastric mucosa report
“gastritis.” (SELECT ONE)
74. A 57-year-old woman experiences frequent
symptoms of heartburn. She reports no weight
loss, diarrhea, or dysphagia symptoms. Past
medical history is significant for B 12
deficiency
treated with monthly injections. She appears
well, and the examination is normal, except for
some patches on her arms where she has lost all
the skin pigmentation. Her upper endoscopy is
normal, except for gastric biopsies commenting
on gastritis. (SELECT ONE)
75. A 54-year-old man is investigated for weight
loss, epigastric pain, nausea, and vomiting. He
appears ill; on examination, there is epigastric
tenderness and marked peripheral edema.
Upper endoscopy reveals large mucosal folds
in the body and fundus of the stomach.
Biopsies are consistent with a diagnosis of
Ménétrier’s disease. (SELECT ONE)
76. A 65-year-old man has developed abdominal
pain, early satiety, nausea, and vomiting. He
reports no weight loss or change in bowel habits.
He had a partial gastrectomy 30 years ago for a
bleeding gastric ulcer. Upper endoscopy finds
erythema of the gastric remnant, and biopsies
report epithelial injury and minimal inflammation
(gastritis). (SELECT ONE)