Item: 1 of 25 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 3442 ..L ar Pre v ious Next Lab~lues Notes Calcula t o r
•1 &
A 34-year-old man is brought to the emergency department after being Involved in a high-speed collision with an oncoming car. H
•2 fractures and contusions. Results of fundoscopy are shown in the image. The patient Is stabilized and transferred to t he intensive
later, there is evidence of gastrointestinal hemorrhage.
•3
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• J'" e. • • f I • • I
a
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Image courtesy of Nicholas Mahoney, MD
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• 12
What Is the most likely mechanism of the gastrointestinal bleeding?
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A . Chronic irritation of the gastroesophagea l junction by caustic acid secretions
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B. Dilated submucosal veins in the esophagus due to portal hypertension
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• 17 c. Increased vagal stimulation secondary to elevated intracranial pressure
• 18 D. Inhibited gastric secretion of mucus secondary to bacterial Infection In the stomach
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E. Overuse of oral analgesics leading to superficial gastric erosions
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a
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,Item: 1 of 25 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 3442 ..L ar Prev ious Next Lab~lues Notes Calculat o r
&
1 The co rrect an sw er i s c . 710/o chose this.
.2 A Cushing ulcer is a type of acute stress ulcer associated with elevated Intracranial pressure in trauma or severe illness. Increase
stimulates the vagus nucleus, causing increased acid secretion in the stomach. A Cushing ulcer tends to occur in the fundus of th
•3 superficial capillary bleeding, but may also involve heavier bleeding if the submucosa is eroded. In this case, the elevated intracr
·4 high-speed collision is markedly demonstrated as papilledema. The image here compares a normal fundus exam (on the left) wit
right), with all the key features labeled. Note that a bulging optic disc Is the prominent feature seen in papilledema through an o
•5 Pap !edema I •tracrama pressure Ophthalmoscopy Optic disc Peptic ulcer Ulce de1 matology "'ajor trauma
•6
.7
·8
.9
• 10
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• 12
• 13
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• 17
. 18 Normal fun dus, right eye Papilledema of the rig ht optic nerve
Image courtesy of Mikael H~ggstrom
• 19 Image courtesy of Nicholas Mahoney, MD
• 20 A i s not correct. 5% chose this•
This answer choice describes the mechanism behind gastroesophageal reflux disease (GERD). Esophageal irritation by acid reflux
• 21 with Intestinal metaplasia of the esophagus and Barrett's esophagus with predisposition to esophageal cancer. GERD is unlikely t
•
a
Lock
, Normal fundus, right eye Papilledema of the right optic nerve
•2
Image courtesy of Mikael Haggstrom Image courtesy of Nicholas Mahoney, MD
•3
A is no t co rrect. 5 % cho se this.
•4
This answer choice describes the mechanism behind gastroesophageal reflux disea se (GERD) . Esophageal irritation by acid reflux
•5 with intestinal met aplasia of the esophagus and Barrett's esophagus with predisposition to esophageal cancer. GERD is unlikely t
bleeding ulcers .
•6 Gastroesophageal reflux disease Esophageal cancer Barrett' s esophagus Esophagus Intestinal metaplasia Metaplasia Ulcer Reflux Peptic
•7
B is no t co rrect. 13 % cho se this.
•8 Esophageal varices are commonly caused by portal hypertension, which is frequently seen in chronic alcoholics or in patients with
hepatic portal pressure can cause the development of lower esophageal varices, which can be a source of massive bleeding. This
•9 history of alcohol use or cirrhosis.
• 10 Esophageal varices Portal hypertension Cirrhosis Hypertension Varices Alcoholism liver Esophagus Esophageal cancer Alcohol
· 11 D is no t co rrect. 4 % cho se this.
Duodenal ulcers are a type of peptic ulcer that is highly associat ed with Helicobacter pylori. The patient with such an ulcer often
• 12 pain that is ameliorat ed by ea ting . The peptic ulcers are chara cteristically more insidious and often linked to H. pylori infection, n
associat ed with trauma or severe illness.
• 13
Peptic ulcer Helicobacter pylori Duodenum Ulcer {dermatology) Abdominal pain Ulcer Helicobacter
• 14
E is no t co rrect. 7% cho se this •
• 15 Oral analgesics such as nonsteroidal anti-inflammatory drugs ( NSAIDs), when used lo ng-term, are associat ed with gastric ulcera
erosions. Given that the patient was just injured 2 days ago, not only is there insufficient exposure to oral NSAIDs, but he is likel
• 16
analgesia. Also, NSAID use is not associat ed with the papilledema shown in the image.
• 17 Nonsteroidal anti-inflammatory drug Papilledema Analgesic Anti-inflammatory Intravenous therapy Mouth ulcer Ulcer {dermatology) Pep
• 18
• 19 Bo tto m Line:
• 20 Cushing ulcer is a type of stress ulcer associat ed with increa sed intracranial pressure from trauma or illness.
Stress ulcer Cushing ulcer Peptic ulcer Intracranial pressure Ulcer {dermatology) Ulcer
• 21
•
6
lock
QIO: 3442 ..L ar Pre v ious Next Lab~lues Notes Calcula t o r
•1 &
A 34-year-old man is brought to the emergency department after being Involved in a high-speed collision with an oncoming car. H
•2 fractures and contusions. Results of fundoscopy are shown in the image. The patient Is stabilized and transferred to t he intensive
later, there is evidence of gastrointestinal hemorrhage.
•3
·4
•5
•6
•7
·8
.9
• 10
• 11
• 12
• 13
• 14
• 15
• 16
• 17
• 18
• 19
• 20
• 21
• J'" e. • • f I • • I
a
Lock
,•2
•3
·4
•5
•6
•7
·8
.9
• 10
Image courtesy of Nicholas Mahoney, MD
• 11
• 12
What Is the most likely mechanism of the gastrointestinal bleeding?
• 13
• 14
A . Chronic irritation of the gastroesophagea l junction by caustic acid secretions
• 15
B. Dilated submucosal veins in the esophagus due to portal hypertension
• 16
• 17 c. Increased vagal stimulation secondary to elevated intracranial pressure
• 18 D. Inhibited gastric secretion of mucus secondary to bacterial Infection In the stomach
• 19
E. Overuse of oral analgesics leading to superficial gastric erosions
• 20
• 21
•
a
Lock
,Item: 1 of 25 ~ 1 • M k -<:J 1>- Jil ~· !:';-~
QIO: 3442 ..L ar Prev ious Next Lab~lues Notes Calculat o r
&
1 The co rrect an sw er i s c . 710/o chose this.
.2 A Cushing ulcer is a type of acute stress ulcer associated with elevated Intracranial pressure in trauma or severe illness. Increase
stimulates the vagus nucleus, causing increased acid secretion in the stomach. A Cushing ulcer tends to occur in the fundus of th
•3 superficial capillary bleeding, but may also involve heavier bleeding if the submucosa is eroded. In this case, the elevated intracr
·4 high-speed collision is markedly demonstrated as papilledema. The image here compares a normal fundus exam (on the left) wit
right), with all the key features labeled. Note that a bulging optic disc Is the prominent feature seen in papilledema through an o
•5 Pap !edema I •tracrama pressure Ophthalmoscopy Optic disc Peptic ulcer Ulce de1 matology "'ajor trauma
•6
.7
·8
.9
• 10
• 11
• 12
• 13
• 14
• 15
• 16
• 17
. 18 Normal fun dus, right eye Papilledema of the rig ht optic nerve
Image courtesy of Mikael H~ggstrom
• 19 Image courtesy of Nicholas Mahoney, MD
• 20 A i s not correct. 5% chose this•
This answer choice describes the mechanism behind gastroesophageal reflux disease (GERD). Esophageal irritation by acid reflux
• 21 with Intestinal metaplasia of the esophagus and Barrett's esophagus with predisposition to esophageal cancer. GERD is unlikely t
•
a
Lock
, Normal fundus, right eye Papilledema of the right optic nerve
•2
Image courtesy of Mikael Haggstrom Image courtesy of Nicholas Mahoney, MD
•3
A is no t co rrect. 5 % cho se this.
•4
This answer choice describes the mechanism behind gastroesophageal reflux disea se (GERD) . Esophageal irritation by acid reflux
•5 with intestinal met aplasia of the esophagus and Barrett's esophagus with predisposition to esophageal cancer. GERD is unlikely t
bleeding ulcers .
•6 Gastroesophageal reflux disease Esophageal cancer Barrett' s esophagus Esophagus Intestinal metaplasia Metaplasia Ulcer Reflux Peptic
•7
B is no t co rrect. 13 % cho se this.
•8 Esophageal varices are commonly caused by portal hypertension, which is frequently seen in chronic alcoholics or in patients with
hepatic portal pressure can cause the development of lower esophageal varices, which can be a source of massive bleeding. This
•9 history of alcohol use or cirrhosis.
• 10 Esophageal varices Portal hypertension Cirrhosis Hypertension Varices Alcoholism liver Esophagus Esophageal cancer Alcohol
· 11 D is no t co rrect. 4 % cho se this.
Duodenal ulcers are a type of peptic ulcer that is highly associat ed with Helicobacter pylori. The patient with such an ulcer often
• 12 pain that is ameliorat ed by ea ting . The peptic ulcers are chara cteristically more insidious and often linked to H. pylori infection, n
associat ed with trauma or severe illness.
• 13
Peptic ulcer Helicobacter pylori Duodenum Ulcer {dermatology) Abdominal pain Ulcer Helicobacter
• 14
E is no t co rrect. 7% cho se this •
• 15 Oral analgesics such as nonsteroidal anti-inflammatory drugs ( NSAIDs), when used lo ng-term, are associat ed with gastric ulcera
erosions. Given that the patient was just injured 2 days ago, not only is there insufficient exposure to oral NSAIDs, but he is likel
• 16
analgesia. Also, NSAID use is not associat ed with the papilledema shown in the image.
• 17 Nonsteroidal anti-inflammatory drug Papilledema Analgesic Anti-inflammatory Intravenous therapy Mouth ulcer Ulcer {dermatology) Pep
• 18
• 19 Bo tto m Line:
• 20 Cushing ulcer is a type of stress ulcer associat ed with increa sed intracranial pressure from trauma or illness.
Stress ulcer Cushing ulcer Peptic ulcer Intracranial pressure Ulcer {dermatology) Ulcer
• 21
•
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