GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 52-year-old woman on chronic ibuprofen for rheumatoid arthritis presents with acute epigastric pain and hematemesis. Vital signs show BP 105/68, HR 102, RR 18, temperature 37.2°C, SpO2 98%. Upper endoscopy reveals an active bleeding ulcer in the gastric antrum; hemoglobin is 9.2 g/dL. She denies nausea, vomiting, or melena. H. pylori serology is negative. Which of the following is the most appropriate next step in management?
Answer choices
- ASwitch to acetaminophen and observe without medication
- BPrescribe misoprostol monotherapy and continue NSAIDs
- CPerform antrectomy and vagotomy
- DTest for H. pylori and defer PPI until results return
- EDiscontinue NSAIDs and start high-dose PPI therapyCorrect answer
- FAdminister sucralfate suspension and continue ibuprofen at a reduced dose
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