A 42-year-old male presents to the clinic with complaints of burning epigastric pain that has been intermittent for the past two months. He describes the pain as gnawing and localized to the upper abdomen. The pain typically occurs 3 to 4 hours after eating and frequently wakes him up at night. He notes that the discomfort is relieved by eating a small meal or taking over-the-counter antacids, though the relief is temporary. He denies significant weight loss, fever, or changes in bowel habits. However, he reports occasional bloating and nausea. The patient works as an office manager and admits to high stress levels. He takes ibuprofen frequently for chronic knee pain and drinks three to four cups of coffee daily. He smokes about 10 cigarettes per day but denies alcohol consumption. There is no personal or family history of gastrointestinal conditions. On physical examination, the patient appears well but slightly uncomfortable. Vital signs are within normal limits. Abdominal examination reveals mild tenderness in the epigastrium without guarding or rebound tenderness. No palpable masses are noted, and bowel sounds are normal. Rectal examination shows no evidence of melena or occult blood. Which of the following is the most common cause of this type of ulcers?

A 67-year-old female presents to the emergency room with a complaint of sudden, severe abdominal pain, described as “all over her belly.” Her medical history includes peptic ulcer disease, hypertension, and vitamin D deficiency. Her temperature is 101 °F (38.3 °C), heart rate is 108 beats/min, blood pressure is 88/68 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 94% on room air. On examination, the patient appears severely distressed, lying quietly with knees drawn up, breathing shallowly. Her abdomen is rigid and quiet with rebound tenderness. After intravenous fluids, the patient reports significant improvement in abdominal pain. Suspecting a perforated peptic ulcer, which of the following tests has the greatest sensitivity to detect the location of the perforation?

A 58-year-old man visits your clinic for evaluation of fatigue and easy bruising over the past few weeks. He has a history of hypertension and atrial fibrillation and is on lisinopril for hypertension and warfarin for anticoagulation. He reports worsening heartburn and mentions using a medication from his wife’s medicine cabinet for relief. On examination, mild jaundice and scattered ecchymoses are noted. Laboratory tests reveal elevated liver enzymes, a high prothrombin time (PT), and an increased international normalized ratio (INR). Which of the following is the most likely medication he has been taking?

Rebecca, a 45-year-old woman, presents to your clinic complaining of heartburn, regurgitation, and a chronic cough. She reports that these symptoms worsen after eating spicy foods or large meals. A physical examination reveals no significant abnormalities. A diagnosis of gastroesophageal reflux disease (GERD) is made based on her symptoms and medical history. You would like to start her on a H2 receptor blocker. Which of the following H2 receptor blockers has the highest risk of drug interactions?

Mr. John, a 45-year-old male, presents to the clinic with complaints of a 3-month history of heartburn and regurgitation, particularly after large meals or lying down. He reports a burning sensation in his chest that worsens after eating spicy or fatty foods. He has been self-medicating with over-the-counter antacids, which provide temporary relief, but his symptoms persist. Medical History Past Medical History: No history of chronic illness. Medications: Occasional use of antacids. Social History: Smokes 1 pack of cigarettes per day; occasional alcohol consumption. Physical Examination Vitals: Blood pressure 130/85 mmHg, heart rate 78 bpm, BMI 28 kg/m². General: Appears well-nourished and in no acute distress. Abdominal Exam: Soft, non-tender abdomen with no organomegaly. Based on clinical presentation, you diagnosed his condition as Gastroesophageal reflux disease (GERD) and started him on famotidine 20 mg twice daily. What is the primary mechanism of action of famotidine

A 15-year-old male presents to the clinic with a six-month history of intermittent abdominal pain and rectal bleeding. The abdominal pain is described as crampy, often severe, and resolves spontaneously after a few hours. He has also experienced bright red blood in his stool, with the bleeding episodes increasing in frequency over time. His mother reports noticing dark spots on his lips and fingers since childhood, though they have never caused him discomfort. Concerned by the worsening symptoms, the family sought medical evaluation. The patient has no significant past medical history. Family history reveals that his mother was diagnosed with colon cancer at the age of 38, and his maternal grandfather underwent abdominal surgery for bowel obstruction, though the exact cause is unknown. The patient is a high school student with no history of smoking, alcohol, or drug use. On physical examination, he appears healthy and in no acute distress. Multiple dark brown macules are noted on his lips, buccal mucosa, and fingertips. Abdominal examination reveals mild tenderness in the lower quadrants, with no palpable masses or organomegaly. Rectal examination is positive for bright red blood. Laboratory tests show microcytic anemia, with a hemoglobin level of 10.5 g/dL. Endoscopy and colonoscopy reveal multiple hamartomatous polyps in the small intestine and colon. Genetic testing confirms the presence of a pathogenic mutation in the STK11 gene. Which of the following cancers is a patient with this syndrome at the highest risk of developing?

A 15-year-old male presents to the clinic with a six-month history of intermittent abdominal pain and rectal bleeding. The abdominal pain is described as crampy, often severe, and resolves spontaneously after a few hours. He has also experienced bright red blood in his stool, with the bleeding episodes increasing in frequency over time. Concerned by the worsening symptoms, the family sought medical evaluation. The patient has no significant past medical history. Family history reveals that his mother was diagnosed with colon cancer at the age of 38, and his maternal grandfather underwent abdominal surgery for bowel obstruction, though the exact cause is unknown. The patient is a high school student with no history of smoking, alcohol, or drug use. On physical examination, he appears healthy and in no acute distress. Abdominal examination reveals mild tenderness in the lower quadrants, with no palpable masses or organomegaly. Rectal examination is positive for bright red blood. Laboratory tests show microcytic anemia, with a hemoglobin level of 10.5 g/dL. Endoscopy and colonoscopy reveal multiple hamartomatous polyps in the small intestine and colon. Genetic testing confirms the presence of a pathogenic mutation in the STK11 gene. Which of the following clinical features is most characteristic of this disease? Peutz-Jeghers syndrome?

A 15-year-old female is brought to the clinic by her parents due to dark spots on her lips and inside her mouth that have been present since childhood. Recently, she has experienced intermittent abdominal pain and rectal bleeding. Physical examination reveals dark brown macules on her lips, buccal mucosa, and fingertips. A colonoscopy identifies multiple polyps in the small intestine and colon. Genetic testing is performed to investigate the underlying cause. What is the most common genetic mutation associated with Peutz-Jeghers syndrome?