GERD and Peptic Ulcer Disease USMLE Step 1 Practice Question
A 64-year-old man with newly diagnosed stage IIIB non-small cell lung cancer is admitted for chemotherapy. Two weeks into treatment, he develops acute epigastric pain and passes black tarry stools. Vital signs show HR 105 bpm, BP 118/72 mmHg, and he appears uncomfortable. Upper endoscopy reveals a solitary duodenal ulcer with an adherent clot and visible bleeding vessel. He denies NSAID use and reports no prior history of peptic ulcer disease or reflux symptoms. He is currently receiving platinum-based chemotherapy and is on morphine for pain control. Which of the following is the most likely predisposing factor for this acute peptic ulcer with hemorrhage?
Answer choices
- AGastrinoma associated with the underlying malignancy
- BDirect mucosal injury from chemotherapy penetrating the blood-brain barrier
- CAcute stress ulceration secondary to systemic illness and physiologic stressCorrect answer
- DHelicobacter pylori infection acquired nosocominally during hospitalization
- EMedication-induced ulceration from narcotic analgesic use alone
- FSpontaneous peptic ulcer disease unrelated to his underlying condition
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