A 55-year-old woman presents to her primary care physician with complaints of burning epigastric pain for the past 3 weeks. The pain worsens after meals and is associated with nausea and occasional bloating. She denies vomiting, hematemesis, or melena. She has a history of osteoarthritis and takes ibuprofen daily for pain. She is a non-smoker and denies alcohol or drug use. Upper gastrointestinal endoscopy shows a gastric ulcer, and biopsy tests are negative for Helicobacter pylori. Question: Which of the following is the most appropriate therapy to promote healing of this patient’s gastric ulcer?
A 60-year-old man with a history of peptic ulcers has been successfully treated for H. pylori infection. He now returns with recurrent symptoms despite compliance with PPI therapy and no NSAID use. Which diagnostic test should be considered next to evaluate this patient’s condition?
A 60-year-old male with a history of peptic ulcer disease presents with sudden, severe abdominal pain and generalized tenderness. He appears pale and hypotensive. Upright abdominal X-ray shows free air under the diaphragm. Question: What is the most likely complication this patient is experiencing?
A 58-year-old male presents with a 3-month history of burning epigastric pain occurring 1-2 hours after meals. He has a 30-year smoking history and drinks alcohol regularly. Endoscopy confirms a gastric ulcer. What is the primary mechanism by which NSAIDs contribute to gastric ulcer formation?
Patient Case: A 45-year-old woman presents with a 6-month history of epigastric pain that worsens with meals and is relieved by antacids. She has a history of regular NSAID use for chronic back pain. Physical examination reveals mild epigastric tenderness. Endoscopy reveals an ulcer in the gastric antrum. Question: Which test is most appropriate to confirm the presence of H. pylori in this patient?
An 80-year-old male with a history of Alzheimer’s disease and Parkinson’s disease is admitted to the hospital for nausea and vomiting due to a recent gastrointestinal infection. His caregiver reports worsening confusion and increased difficulty with movement over the past day. His current medications include carbidopa-levodopa and donepezil. A review of his chart shows that he was recently prescribed a new anti-nausea medication. Question: Which of the following anti-nausea medications is most likely responsible for this patient’s worsening symptoms?
A 60-year-old man with a history of Parkinson’s disease presents with nausea. His physician considers prescribing prochlorperazine but hesitates due to potential complications related to the patient’s underlying condition. Question: Why is prochlorperazine contraindicated in this patient?
A 32-year-old woman with severe motion sickness is prescribed prochlorperazine. During her follow-up visit, she reports feeling excessively tired and lightheaded, particularly when standing up quickly. Question: What is the most likely cause of her symptoms?
A 45-year-old man presents with persistent nausea and vomiting after undergoing abdominal surgery. He is started on prochlorperazine to control his symptoms. Within a few hours, he develops stiffness in his neck and difficulty moving his head. Question: Which of the following is the most likely cause of the patient’s new symptoms?
A 70-year-old man presents with sudden epigastric pain, guarding, and rebound tenderness. He has a history of H. pylori-associated peptic ulcer disease and long-term NSAID use. An abdominal X-ray shows free air under the diaphragm. His blood pressure is 85/60 mmHg, and heart rate is 120 bpm. What is the next best step in management?
