GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 35-year-old woman with rheumatoid arthritis presents with acute epigastric pain, nausea, and hematemesis. She began taking ibuprofen 800 mg three times daily 3 weeks ago for joint pain. Vital signs show BP 108/72 mmHg, HR 102 bpm. Upper endoscopy reveals a 1.5 cm antral gastric ulcer with a visible adherent clot and no arterial spurting. Rapid urease testing is negative. H. pylori serology is negative. Which of the following interventions would most directly reduce the risk of ulcer recurrence in this patient?
Answer choices
- AContinue ibuprofen and initiate famotidine 20 mg twice daily
- BDiscontinue ibuprofen, initiate omeprazole 20 mg daily, and test for H. pylori again in 6 weeks
- CDiscontinue ibuprofen and initiate omeprazole 20 mg twice daily for 8 weeksCorrect answer
- DSwitch to intravenous ketorolac for pain control and add sucralfate monotherapy
- EContinue ibuprofen with concurrent celecoxib to reduce GI side effects
- FPrescribe triple therapy with omeprazole, amoxicillin, and clarithromycin
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