1. A 38-year-old man has had upper abdominal pain for 3 months.

For the past week he has had

nausea. On physical examination a stool sample tested for occult blood is positive. An upper GI
endoscopy reveals no esophageal lesions, but there is a solitary 2 cm diameter shallow, sharply
demarcated ulceration of the stomach. Which of the following statements regarding this lesion is
most appropriate?
A. It is probably located in the antrum

B. It is probably malignant (bukan, karena tidak ada tanda2 keganasan seperti penurunan
berat badan yang drastic tnpa planning, dll dan juga tidak punya riwayat family GI
malignant yang memperkecil diagnosis kearah malignant)

C. It is probably associated with increased gastric acid production. (bukan, karena

penyebabnya H.Pylori)

D. Because of its small size, a biopsy is not necessary (perlu, utk liat progresivitas ulcer and
for search H.Pylori infection, kalau H. Pylori bener positive, kita juga bisa sekalian
screening of metaplasic atrophic gastritisa, dll)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580003/

E. A gastrinoma of the pancreas ( bukan, Karena biasanya accompanied by diarrhea,

personal or family history of endocrinopathies, various laboratory findings
(hypercalcemia, hypergastrinemia) kemudian tidak ada tanda2 keganasan seperti
weight loss dan juga tidak ada jaundice)
Answer:
Karena penyebabnya mengarah ke H. Pylori infection dan H. Pylori sangat suka berada di
antrum , karena yg produksi HCL sedikit dsitu.

2. Which of the following is NOT a complication of a gastric ulcer:

A. Hemorrhage
B. Peritonitis
C. Barrett's esophagus
D. Pyloric stenosis
E. Penetration into the omentum
Answer:
Complication of gastric ulcer :
- Hemorrhage
Blood Vessels damage, ulcer erodes into the muscle of the stomach or duodenal walls

- Peritonitis : Peptic ulcer can perforate into peritoneal cavity. Bacteria or digested foods
can spill into the peritoneum = peritonitis

- Pyloric Stenosis: Swelling and scarring can cause obstruction of food leaving the
stomach = repeated vomiting (https://annals.org/aim/article-
abstract/675475/pyloric-obstruction-peptic-ulcer)

- Penetration into the omentum: Ini sebelum terjadinya peritonitis, dia bakal penetrate ke
omental dlu bru nanti omental patch leakage dn bisa peritonitis
 Oleh sebab itu memilih jawaban C, karena barret’s esophagus itu merupakan komplikasi dari
GERD ( regurgitasi asam lambung yang bisa melukai esophagus)

3. Cimetidine and a magnesium-containing antacid preparation administered in an appropriate

dosage regimen for treating peptic ulcer differ in that:
A. The magnesium-containing antacid may increase gastric acid secretion if it is
not formulated in combination with an aluminum salt.
B. Cimetidine is likely to cause an increase in urinary pH.
C. The magnesium-containing antacid is likely to produce a laxative effect if it is
not formulated in combination with an aluminum salt.
D. The antacid is likely to block vagally-mediated increase in gastric acid secretion
E. Cimetidine can prevent the rise in gastric pH after the consumption of a meal
Answer:
Magnesium salts are laxative, while Alumunium are constipating combination May annul
each others. Action and bowel movement may be least affected.

4. A 24-year-old male Brown medical student tests his stool for H. pylori using the stool antigen
test and finds a positive result. All of the following are true about this discovery EXCEPT:?
A. The lifetime chance of developing a peptic ulcer is 10% (true)
B. Most likely he acquired this infection as a baby ( Baby biasanya sering terkena infeksi
dan sembuh namun tidak ada gejala)
C. It is still safe for him to shake hands with his professors
D. He has a 1 in 20 chance of developing gastric cancer ( di ncbi, 1-3% chance utk gastric ca
berarti 1-3/100, jadi jawaban nya juga kemungkinan ini )
E. The causative organism expresses urease, catalase and oxidase enzymes (true)
Answer: Tergantung sih sebenarnya, H. pylori kan fecal-oral, jdi jawaban C bisa saja terjadi
kalau dia memiliki hygiene yg kurang, karena bisa aja mereka habis shake hands si prof ga
cuci tangan dan terjangkit.

5. A 54-year-old man has complained for 5 months of upper abdominal pain accompanied by
nausea. He does not have hematemesis. On physical examination the only finding is a stool sample
positive for occult blood. Upper GI endoscopy is performed and gastric biopsies are taken. On
microscopic examination the biopsies reveal acute and chronic mucosal inflammation along with the
presence of Helicobacter pylori organisms. The presence of these organisms is most likely to be
associated with which of the following?
A. Mucosal invasion with septicemia
B. Duodenal peptic ulceration
C. Development of pernicious anemia
D. Hypochlorhydria with atrophic gastritis
Answer: H. pylori was detected in 38.9% of the subjects with hypochlorhydria.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712537/). H pylori Menyerang
Sel Gaster Inflamasi  Gastric Atrophy Hypochlorhydria

6. Which of the following statements regarding treatment of H. pylori infection are true:
A. Proton pump inhibitors are administered twice daily.
B. Two or three different antimicrobial agents are administered 2 to 4 times daily
C. Bismuth-containing compounds provide some antimicrobial activity.
D. Fourteen days of treatment is superior to 10 days of treatment for eradication of
H. pylori.
E. All of the above
Answer: Sesuai dengan guideline