Current Medical Diagnosis And
Treatment Study Guide Exam
Questions And Detailed Answers
2026/2027(100% Correct)
A 72-year-old woman presents because she "threw up fresh blood" 1 hour ago. She
denies any heartburn or gastric symptoms. Her past medical history includes type 2
diabetes controlled with diet and glyburide and naproxen for severe chronic
osteoarthritis. On initial examination, she appears anxious, but she is ambulatory and
has no noticeable pallor. Family history is unremarkable. Vital signs are as follows: BP
140/80 mm Hg without postural hypotension, HR 104 bpm, and RR 18 bpm. The rest of
the physical examination shows no abnormalities.
Question
The patient is admitted and undergoes upper endoscopy. What finding is most
probable? - ANSWER-Correct answer:
Gastritis
Explanation
Non-steroidal anti-inflammatory agents (NSAIDs) cause ulcer diathesis because they
inhibit prostaglandin synthesis. Virtually all NSAID users develop some degree of
gastritis, and hemorrhagic gastritis is a common cause of upper gastrointestinal
bleeding in these patients. Among common over-the-counter medications, naproxen
and aspirin carry a higher risk than ibuprofen. Patients with gastritis often experience
upper abdominal pain, but many people with gastritis are asymptomatic. Erosions and
ulceration, sometimes with multiple ulcers, are also common. Endoscopic studies have
shown that 15-20% of chronic NSAID users develop ulcers, but most of these lesions
are not associated with serious complications (bleeding, perforation, etc), and screening
is not indicated.
Chronic NSAID users have a 2-4% per year risk of upper gastrointestinal bleeding. It is
estimated that NSAID-associated bleeding causes 2600 deaths annually in the United
States. Its incidence is rising because of population aging, which has led to an
increased number of people with chronic rheumatic conditions.
The following factors are associated with a higher risk of bleeding:
Risk Factor Risk Increase
Age >60 5-6-fold
Anticoagulant use 10-15-fold
Glucocorticoid use 4-5-fold
Prior GI event (e.g., ulcer, bleeding) 4-5-fold
, High NSAID dosage (>2x normal) 10-fold
In patients with several risk factors, the incidence of bleeding can be as high as 9% per
6 months.
Helicobacter pylori colonization is being increasingly recognized as a risk factor for
bleeding in chronic NSAID users. Some studies showed a lower incidence of bleeding
after H. pylori eradication, which has led some investigators to propose testing and
eradication in patients at high risk of bleeding. The role of anti-H. pylori therapy in
chronic NSAID use
Case
A 45-year-old man presents with a 2-day history of burning, left-sided chest pain; he
denies any trauma to the chest. On examination, you note a vesicular rash over the left
T10 dermatome.
Question
What is the most likely cause of his chest pain? - ANSWER-Correct answer:
Herpes zoster
Explanation
Herpes zoster pain is usually described as sharp or burning. On examination, there is
usually a unilateral vesicular rash with a dermatomal distribution. In some cases, the
pain may precede the lesions.
Musculoskeletal chest pain, which can be unilateral or bilateral, is usually described as
an aching pain; it is aggravated by movement. On examination, tenderness may be
elicited upon application of pressure over the affected chest wall.
Spontaneous pneumothorax pain has a sudden onset; patients present within a few
hours of its onset. It is usually pleuritic in nature. On examination, the patient may be
dyspneic, with decreased breath sounds on the affected side.
Angina pain is usually described as tightness or pressure in the chest; it lasts for less
than 10 minutes. It is usually left-sided or retrosternal, and it may radiate to the jaw,
neck, and shoulder. It is precipitated by physical exertion or emotional stress and is
relieved by rest and sublingual nitroglycerin.
Pericarditis pain is usually described as a sharp, retrosternal pain that is often worse
when the patient is supine. It is relieved by sitting upright, and it is aggravated by deep
inspiration and changes in position. It may be episodic and can last for hours or days.
On examination, a pericardial friction rub may be auscultated.
Treatment Study Guide Exam
Questions And Detailed Answers
2026/2027(100% Correct)
A 72-year-old woman presents because she "threw up fresh blood" 1 hour ago. She
denies any heartburn or gastric symptoms. Her past medical history includes type 2
diabetes controlled with diet and glyburide and naproxen for severe chronic
osteoarthritis. On initial examination, she appears anxious, but she is ambulatory and
has no noticeable pallor. Family history is unremarkable. Vital signs are as follows: BP
140/80 mm Hg without postural hypotension, HR 104 bpm, and RR 18 bpm. The rest of
the physical examination shows no abnormalities.
Question
The patient is admitted and undergoes upper endoscopy. What finding is most
probable? - ANSWER-Correct answer:
Gastritis
Explanation
Non-steroidal anti-inflammatory agents (NSAIDs) cause ulcer diathesis because they
inhibit prostaglandin synthesis. Virtually all NSAID users develop some degree of
gastritis, and hemorrhagic gastritis is a common cause of upper gastrointestinal
bleeding in these patients. Among common over-the-counter medications, naproxen
and aspirin carry a higher risk than ibuprofen. Patients with gastritis often experience
upper abdominal pain, but many people with gastritis are asymptomatic. Erosions and
ulceration, sometimes with multiple ulcers, are also common. Endoscopic studies have
shown that 15-20% of chronic NSAID users develop ulcers, but most of these lesions
are not associated with serious complications (bleeding, perforation, etc), and screening
is not indicated.
Chronic NSAID users have a 2-4% per year risk of upper gastrointestinal bleeding. It is
estimated that NSAID-associated bleeding causes 2600 deaths annually in the United
States. Its incidence is rising because of population aging, which has led to an
increased number of people with chronic rheumatic conditions.
The following factors are associated with a higher risk of bleeding:
Risk Factor Risk Increase
Age >60 5-6-fold
Anticoagulant use 10-15-fold
Glucocorticoid use 4-5-fold
Prior GI event (e.g., ulcer, bleeding) 4-5-fold
, High NSAID dosage (>2x normal) 10-fold
In patients with several risk factors, the incidence of bleeding can be as high as 9% per
6 months.
Helicobacter pylori colonization is being increasingly recognized as a risk factor for
bleeding in chronic NSAID users. Some studies showed a lower incidence of bleeding
after H. pylori eradication, which has led some investigators to propose testing and
eradication in patients at high risk of bleeding. The role of anti-H. pylori therapy in
chronic NSAID use
Case
A 45-year-old man presents with a 2-day history of burning, left-sided chest pain; he
denies any trauma to the chest. On examination, you note a vesicular rash over the left
T10 dermatome.
Question
What is the most likely cause of his chest pain? - ANSWER-Correct answer:
Herpes zoster
Explanation
Herpes zoster pain is usually described as sharp or burning. On examination, there is
usually a unilateral vesicular rash with a dermatomal distribution. In some cases, the
pain may precede the lesions.
Musculoskeletal chest pain, which can be unilateral or bilateral, is usually described as
an aching pain; it is aggravated by movement. On examination, tenderness may be
elicited upon application of pressure over the affected chest wall.
Spontaneous pneumothorax pain has a sudden onset; patients present within a few
hours of its onset. It is usually pleuritic in nature. On examination, the patient may be
dyspneic, with decreased breath sounds on the affected side.
Angina pain is usually described as tightness or pressure in the chest; it lasts for less
than 10 minutes. It is usually left-sided or retrosternal, and it may radiate to the jaw,
neck, and shoulder. It is precipitated by physical exertion or emotional stress and is
relieved by rest and sublingual nitroglycerin.
Pericarditis pain is usually described as a sharp, retrosternal pain that is often worse
when the patient is supine. It is relieved by sitting upright, and it is aggravated by deep
inspiration and changes in position. It may be episodic and can last for hours or days.
On examination, a pericardial friction rub may be auscultated.
