A question from GT - could someone help here, please?

[Phloston]

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From GT:

"A patient with a longstanding history of duodenal ulcers undergoes routine follow-up esophagogastroduodenoscopy. The patient currently takes no medications on a regular basis. The gastroenterologist performing the study notes extensive gastritis with no evidence of mucosal barrier erosion and a single, 1 cm ulcer near the ampulla of Vater. Which of the following is a correct diagnosis?

A. Mucosa-associated lymphatic tissue lymphomas
B. Excessive use of nonsteroidal anti-inflammatory medications
C. Gastric ulcer disease
D. Acute nonerosive gastritis
E. Helicobacter pylori erosive gastritis

Answer Explanation

The correct answer is D.

The key to this question is that there are 2 separate diagnoses: the DU (near the ampulla) and the gastritis. While the DU is chronic, we have no information regarding the chronicity of the gastritis. The only answer choice that potentially diagnoses the DU is "excessive use of NSAIDs". However, NSAIDs would cause an erosive gastritis, which the EGD does not show.

An acute nonerosive gastritis from H. pylori fits better with the scenario. The patient is asymptomatic from his gastritis (lack of symptoms is a feature of H. pylori nonerosive gastritis), and the H. pylori also provides a mechanism for chronic DU (70% of DU are associated with H. pylori infection).

An ulcer near the ampulla of Vater is a duodenal ulcer, not a gastric ulcer. There is no evidence at this time for a MALT lymphoma."

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The reason I'm confused is because, based on p. 354 of FA2012, H. pylori is specifically listed under non-erosive chronic gastritis, not acute. In the explanation from GT up above, notice in the second to last paragraph it says "an acute non-erosive gastritis from H. pylori..."

My question would be if the chronic non-erosive gastritis, as specified in FA, is specific to the antrum, because p. 354 of FA says "Type-B (antrum)" under the chronic heading, and in this question's case, the patient has a "long-standing history of duodenal ulcers," yet the gastritis, per this answer, is acute, not chronic.

Any thoughts on this?

Cheers,

 

[JackShephard MD]

I just did some quick calculations, at this rate you will have started ~200 threads on USMLE Q's before you take the exam.🙂

 

[Phloston]

Lol, good one, Jack. I ironically probably won't post much in the month leading up to the exam though, so you better recalculate.

Notice I've been posting a lot from GT. Although I'm glad their explanations are short so I can move through the questions quicker, I'm also annoyed by the literal absence of explanations at times. I've found the GT questions are good if you already pretty much know what's going on and are doing mostly touch-up work. If I had done these questions before Rx (or some other resources), I'd be utterly lost.

 

[JackShephard MD]

Lol, good one, Jack. I ironically probably won't post much in the month leading up to the exam though, so you better recalculate.

Notice I've been posting a lot from GT. Although I'm glad their explanations are short so I can move through the questions quicker, I'm also annoyed by the literal absence of explanations at times. I've found the GT questions are good if you already pretty much know what's going on and are doing mostly touch-up work. If I had done these questions before Rx (or some other resources), I'd be utterly lost.

Yeah, GT's best feature is their long term spaced repetition for the flashcards. I haven't used too much of their qbank but I would think it's below average from some q's I've seen. Uworld >>>> Kaplan/Usmlerx then GT's qbank questions.

 

[Phloston]

Yeah, GT's best feature is their long term spaced repetition for the flashcards. I haven't used too much of their qbank but I would think it's below average from some q's I've seen. Uworld >>>> Kaplan/Usmlerx then GT's qbank questions.

Interestingly, I believe GT's QBank caters to FA more than Rx does. The question stems are super-short, many of them aren't even vignettes, and they tend to be nit-picky regarding some of the minutiae in FA. I'll be able to reasonably evaluate all of the resources relative to one another after I finish my prep, but at least at this point, Rx + GT QBanks are greater for reinforcing FA.

 

[OveractiveBrain]

From GT:

"A patient with a longstanding history of duodenal ulcers undergoes routine follow-up esophagogastroduodenoscopy. The patient currently takes no medications on a regular basis. The gastroenterologist performing the study notes extensive gastritis with no evidence of mucosal barrier erosion and a single, 1 cm ulcer near the ampulla of Vater. Which of the following is a correct diagnosis?

A. Mucosa-associated lymphatic tissue lymphomas
B. Excessive use of nonsteroidal anti-inflammatory medications
C. Gastric ulcer disease
D. Acute nonerosive gastritis
E. Helicobacter pylori erosive gastritis

Answer Explanation

The correct answer is D.

The key to this question is that there are 2 separate diagnoses: the DU (near the ampulla) and the gastritis. While the DU is chronic, we have no information regarding the chronicity of the gastritis. The only answer choice that potentially diagnoses the DU is "excessive use of NSAIDs". However, NSAIDs would cause an erosive gastritis, which the EGD does not show.

An acute nonerosive gastritis from H. pylori fits better with the scenario. The patient is asymptomatic from his gastritis (lack of symptoms is a feature of H. pylori nonerosive gastritis), and the H. pylori also provides a mechanism for chronic DU (70% of DU are associated with H. pylori infection).

An ulcer near the ampulla of Vater is a duodenal ulcer, not a gastric ulcer. There is no evidence at this time for a MALT lymphoma."

-------


The reason I'm confused is because, based on p. 354 of FA2012, H. pylori is specifically listed under non-erosive chronic gastritis, not acute. In the explanation from GT up above, notice in the second to last paragraph it says "an acute non-erosive gastritis from H. pylori..."

My question would be if the chronic non-erosive gastritis, as specified in FA, is specific to the antrum, because p. 354 of FA says "Type-B (antrum)" under the chronic heading, and in this question's case, the patient has a "long-standing history of duodenal ulcers," yet the gastritis, per this answer, is acute, not chronic.

Any thoughts on this?

Cheers,

its just what they've told you. The "duodenal ulcer" is a distractor. They are asking you about the grastritis. Are there erosions or aren't there. No. There are not. So, nonerosive. Its actually H. Pylori Nonerosive Gastritis (probably), but without a CLO or a biopsy, you cant be sure if its H. Pylori or not.

NSAIDs show multiple shallow ulcers
MALTOMA is a cancer, no cancer or mass
The location of teh ulcer is duodenal, so not gastric ulcer
There is no erosion on gross, so, not erosive gastritis.

Pay attention to what the question asks, and the information teh question gives. Your knowledge means nothing if you do not obey the commands of the test!

Another crap question from GT, btw