Histology USMLE Step 1 Practice Question
A 51-year-old woman presents with a 6-month history of postprandial epigastric discomfort and bloating. Over the past 3 months, she has developed progressive paresthesias in her hands and feet, and reports worsening fatigue despite good glycemic control on her insulin pump for type 1 diabetes mellitus. She denies smoking, alcohol use, or recent weight loss. Vital signs are normal. Physical examination reveals mild conjunctival pallor and diminished vibratory sense in the lower extremities bilaterally; the abdomen is soft and non-tender. Laboratory studies show hemoglobin 9.6 g/dL, mean corpuscular volume 111 μm³, normal leukocyte count, and serum B12 level of 180 pg/mL (normal >200). Intrinsic factor antibodies are positive. Esophagogastroduodenoscopy reveals atrophic gastric mucosa with intestinal metaplasia in the body and fundus. Which of the following histologic findings would be expected on gastric biopsy in this patient?
Answer choices
- AChronic inflammation with lymphocytic infiltration of the gastric fundus and loss of parietal cellsCorrect answer
- BAcute erosions with neutrophilic infiltrate and intact parietal cell architecture
- CIntestinal-type adenocarcinoma with signet ring cells replacing the gastric mucosa
- DSpiral gram-negative organisms adherent to gastric antral epithelium with active inflammation
- FVillous atrophy with intraepithelial lymphocytosis in the antral mucosa
- EPreserved gastric glands with gastrin-producing G-cell hyperplasia
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