Neoplasia USMLE Step 1 Practice Question
A 48-year-old male with a 30 pack-year smoking history presents with 8 weeks of progressive epigastric pain unresponsive to omeprazole monotherapy. He reports mild dysphagia but denies weight loss or family history of gastric cancer. Physical examination reveals mild epigastric tenderness. Laboratory studies show hemoglobin 11.2 g/dL and normal liver function tests. Upper endoscopy reveals a 3 cm gastric ulcer with irregular borders on the greater curve. Biopsy demonstrates intestinal-type adenocarcinoma with areas of intestinal metaplasia in adjacent mucosa. Which of the following is the most significant risk factor for the development of this malignancy?
Answer choices
- AHereditary diffuse gastric cancer syndrome due to CDH1 germline mutation
- BLynch syndrome with mismatch repair gene deficiency
- CChronic Helicobacter pylori infection with progression to chronic atrophic gastritis and intestinal metaplasiaCorrect answer
- DFamilial adenomatous polyposis with APC gene mutation
- EChronic Barrett esophagus from gastroesophageal reflux disease
- FHER2 receptor overexpression from gene amplification
See the full explanation
Get the correct-answer rationale, why each distractor is wrong, the underlying mechanism, and high-yield associations — plus adaptive practice that targets your weak areas — with a free MedBoardPRO account.