Infectious Esophagitis & Peptic Ulcer Disease Flashcards
A 36-year-old single working mother reported to her physician that she was bothered by epigastric burning pain after meals that was relieved by drinking milk. Her physician wished to determine whether a bacterial infection may have predisposed her to develop ulcer symptoms. Which of the following tests did he most likely carry out?
A) Stool culture for anaerobic bacteria
B) Gastroscopy for biopsy of an ulcer margin
C) Collection of gastric fluid for measurement of pH D) Collection of gastric mucus for bacterial culture
E) Breath test for radioactive ammonia
D
H. pylori can be cultured from gastric mucus. The breath test detects radioactive carbon dioxide. It is not anaerobic.
A 32-year-old man submitted a stool specimen that showed antigen of Helicobacter pylori. If he is not treated with antibiotics for the infection, what is the most likely outcome during the next 20 years?
A) He will remain without symptoms, and his antibodies will clear the infection.
B) He will remain without symptoms, but the infection will persist.
C) He will develop a recurrent peptic ulcer.
D) He will develop adenocarcinoma of the stomach.
E) He will develop odynophagia due to gastroesophageal reflux.
B
Untreated H. pylori most often persists without symptoms. Ulcers or carcinoma can develop occasionally, but GERD is not associated with the infection.
A 39-year-old male stock broker reported to his physician that his life had been stressful recently, and he was bothered by epigastric burning pain after meals that was relieved by Tums tablets. His physician obtained a blood specimen that showed an elevated antibody titer against Helicobacter pylori. Which of the following best describes how this organism predisposes persons to develop peptic ulcers?
A) It causes gastritis, leading to increases in mutations in epithelial cells
B) It injures epithelial cells allowing stomach acid to enter the submucosa
C) It causes ulcers by stimulating secretion of gastrin
D) It alkalinizes the mucus layer of the stomach by its urease producing carbon dioxide
E) It causes atrophic gastritis leading to achlorhydria
B
Cytotoxins and ammonia injure cells, allowing acid to penetrate past the cell lining.
A 45-year-old white male car salesman presents with a one-month history of epigastric burning pain that wakes him up at night and is relieved by drinking milk. A x-ray after a barium meal shows a duodenal ulcer. Biopsy of the ulcer edge shows Gram-negative curved bacilli. He is treated with antibiotics and proton pump inhibitor. What is the principal benefit of antibiotic therapy? A) Prevention of adenocarcinoma B) Faster resolution of ulcer symptoms C) Faster healing of ulcer D) Prevention of recurrent ulcers E) Prevention of gastric B cell lymphoma
D
Antibiotic treatment reduces the incidence of ulcer recurrence.
A 48-year-old man presented with a 2-week history of epigastric pain occurring an hour after eating and waking him up at night. The pain was relieved taking antacid tablets. His physician obtained a blood test result showing antibodies against Helicobacter pylori. How did this patient most likely acquire this bacterium in his stomach?
A) From his own normal flora present since early childhood
B) From another patient during an earlier hospitalization
C) From ingestion of food or water contaminated by an unrecognized human fecal source
D) From unwashed hands of his young son who is in a day care facility
E) From ingestion of food or water during foreign travel in Central America in the previous year
C
H. pylori spreads by the fecal-oral route, but the time and place of acquisition are usually not identifiable.
A 44-year-old man with AIDS and very low CD4+ T cells in the blood developed painful swallowing. His gastroenterologist found white plaques on his esophageal mucosa during esophagoscopy. Which of the following is a laboratory feature of the microbe most likely responsible for his esophageal disease?
A) Hyphae, pseudohyphae, and yeast forms in a KOH mount of a mucosal scraping
B) Requirement of tissue culture cells for intracellular growth
C) Production of cytotoxin and urease for invasion of mucosa
D) Septate and branching hyphae in a KOH mount of a mucosa scraping
E) Failure to grow when placed on blood agar plates
A
Candida appear as hyphae, pseudohyphae, and yeast in a KOH preparation. Hyphae are non- branching. It grows on blood agar. It builds plaques on the mucosal surface.
A 54-year-old man with AIDS and very low CD4+ T cells in the blood developed painful swallowing. His internist ordered a barium swallow, which showed filling defects in the mid-esophagus. Which of the following best describes the microbe most likely responsible for his esophageal disease?
A) An organism in normal human flora
B) A bacterium in the environment acquired by fecal-oral transmission
C) A virus that produces “owls’ eye” inclusions in epithelial cells
D) A fungus acquired from aerosolized soil that had been exposed to bird feces
E) An organism that is ubiquitous in the environment and exists in only hyphal forms in the body
A
Candida is normal flora.
A 35-year-old man with AIDS developed odynophagia. His esophagus was inflamed and showed irregular white plaques. A specimen of an esophageal scraping treated with KOH revealed hyphae, pseudohyphae, and yeast forms. Which of the following features of this fungus allowed it to be an effective pathogen in this patient?
A) Formation of hyphae, pseudohyphae, and yeast forms during growth
B) Overgrowth on the mucosa following antibiotic therapy
C) Overgrowth on the mucosa in patients with deficient cellular immunity
D) Ability to withstand exposure to 10% KOH
E) Ability to produce white plaques on the mucosa during intracellular growth
C
Candida overgrows in persons with defective cell-mediated immunity to cause esophagitis. Oral and vaginal thrush can follow antibiotic use by reducing other competing normal flora.
A 35-year-old man with AIDS developed painful swallowing. His esophagus showed irregular white plaques. Which of the following diagnostic tests would readily show the most likely cause of his esophageal illness?
A) Barium swallow x-ray
B) Fecal antigen test
C) Anaerobic culture of a swab of the esophagus
D) Microscopic examination of a scraping treated with KOH E) Urease breath test
D
Microscopic examination of a KOH mount of mucosal scraping will show fungal forms. Barium swallow is not specific. Other choices are for H. pylori.
A 44-year-old man with advanced cancer on chemotherapy developed painful swallowing. His gastroenterologist found white plaques on his esophageal mucosa. Which of the following would be most likely observed by the diagnostic laboratory personnel examining a microbe, other than Candida, that likely caused his esophageal disease?
A) Branching hyphae in a KOH preparation of the esophageal scraping
B) Encapsulated yeast forms in an India ink preparation of an esophageal sample C) White colonies on a blood agar plate streaked with an esophageal specimen
D) Pseudohyphae and hyphae in a KOH preparation of the esophageal scraping
E) Growth of a DNA-containing virus from an esophageal specimen in tissue culture
E
After Candida in frequency, esophagitis in immunocompromised patients may be caused by CMV and HSV-1.
