GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 64-year-old woman presents with epigastric pain worsening postprandially, early satiety, and 3-kg weight loss over two months. She takes ibuprofen daily for osteoarthritis. Vital signs: BP 128/82, HR 88, RR 16, Temp 37°C, SpO2 98%. Laboratory studies show hemoglobin 11.2 g/dL. Upper endoscopy reveals a sharply demarcated ulcer on the gastric lesser curvature with clean base. H. pylori serology is negative. Which mechanism best explains this lesion's pathogenesis?
Answer choices
- AFailure of vagal neural crest migration to the distal colon
- BAutoimmune destruction of the enteric nervous system
- CBreakdown of mucosal protection due to reduced prostaglandin synthesisCorrect answer
- DMutation of ATP7B causing copper accumulation
- EExcess vasoactive intestinal peptide secretion
- FHelicobacter pylori infection
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