GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 32-year-old man presents to the clinic with a 3-month history of epigastric pain and chronic diarrhea, along with an 8-pound weight loss. He denies NSAID use, alcohol abuse, or smoking. He has had multiple episodes of duodenal ulcer disease confirmed on previous upper endoscopies despite appropriate acid-suppressive therapy. Vital signs are stable. Laboratory studies show a fasting serum gastrin level of 580 pg/mL (normal <100 pg/mL) and an elevated 24-hour gastric acid output. Repeat upper endoscopy demonstrates multiple duodenal ulcers with severe gastric rugae. Which of the following is the most likely diagnosis?
Answer choices
- AH. pylori-associated peptic ulcer disease
- BNSAID-induced peptic ulcer disease
- CZollinger-Ellison syndromeCorrect answer
- DPrimary hyperparathyroidism with peptic ulcer
- EGastric adenocarcinoma with gastrin-secreting differentiation
- FCrohn disease with duodenal involvement
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