QuestionSBA
QuestionChoice
Levothyroxine is used to treat hypothyroidism, and is not associated with gastric ulceration or haematemesis.
10006794
d
Levothyroxine
QuestionChoice
A Mallory-Weiss tear is a tear in the mucosa of the oesophagus which results in severe and prolonged vomiting with haematemesis. Patients may also present with melena. A Mallory-Weiss tear is associated with sudden rises in intra-gastric pressure (e.g. severe vomiting) and binge-drinking, which are absent in this case. It is also likely to cause upper abdominal pain, which is absent in this patient.
10006795
e
Mallory-Weiss tear
QuestionChoice
The patient has suffered from a ruptured stomach ulcer which led to her becoming haemodynamically unstable and necessitating urgent treatment. This was likely caused by the unopposed use of naproxen for the past 14 days. Naproxen is a non-steroidal anti-inflammatory drug (NSAID) which is strongly associated with the development of stomach ulcers and other gastrointestinal side effects. NSAIDs are often prescribed alongside proton pump inhibitors (PPIs) to minimise these potential side effects. However, a PPI has not been prescribed to this patient.
10006791
a
Naproxen
QuestionChoice
Although sertraline has a small risk of gastric ulceration, the recently started NSAID is a much more likely cause in this case.
10006793
c
Sertraline
QuestionChoice
H.pylori is an important differential in a patient presenting with signs of stomach ulcers, and may present similarly to this. However, the negative urea breath test in this case rules it out. H. pylori is a gram-negative urease-producing bacteria which can cause ulceration of the gastric epithelium.
10006792
b
Helicobacter pylori
Concept
Chapter
2693
4543
Side effects of NSAIDs
Topic
146
Rheumatology
13905
A 52-year-old lady presents to the emergency department following two episodes of haematemesis. She also says that she had passed dark and foul-smelling stool earlier today. She denies any abdominal pain. She has a past medical history of hypothyroidism and anxiety, and is currently taking levothyroxine and sertraline. She was prescribed naproxen 500mg BD 14 days ago following an ankle injury.
The patient was seen lying down, with her observations showing: BP 95/38, HR 125bpm.
The only abnormality found on initial blood tests was a Hb of 102 g/L (normal range 115-155 g/L). An endoscopy was carried out which identified a haemorrhaging gastric ulcer which was cauterised, stopping the bleeding. A urea breath test is negative. Which of the following is most likely to have caused the patient's symptoms?
a