GI pathology: peptic ulcer: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · GI pathology: peptic ulcer

Sample item

A 58-year-old man has epigastric pain that worsens with food. Endoscopy shows a 2 cm ulcer on the lesser curvature of the stomach. Why should multiple biopsies of the ulcer margin be taken?

ATo exclude duodenal ulcerBTo identify Zollinger-Ellison syndromeCTo exclude ulcerating gastric adenocarcinomaDTo grade the intestinal metaplasia for vitamin deficiency

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. To exclude ulcerating gastric adenocarcinoma

Benign gastric ulcers can look like ulcerating carcinoma, so edge biopsies and healing review are required; malignant ulcers show heaped, irregular, rolled margins, while benign ulcers are sharply punched out with radiating folds. Duodenal ulcers are almost never malignant.

Option by option

A. To exclude duodenal ulcer
A duodenal ulcer is a separate lesion and cannot be diagnosed from a gastric biopsy.
B. To identify Zollinger-Ellison syndrome
Zollinger-Ellison syndrome is diagnosed with gastrin levels, and gastrinomas cause multiple distal ulcers.
C. To exclude ulcerating gastric adenocarcinoma (correct)
Edge biopsies detect gastric cancer masquerading as an ulcer.
D. To grade the intestinal metaplasia for vitamin deficiency
Intestinal metaplasia is graded for gastric cancer risk and is unrelated to vitamin deficiency.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, To exclude ulcerating gastric adenocarcinoma. Benign gastric ulcers can look like ulcerating carcinoma, so edge biopsies and healing review are required; malignant ulcers show heaped, irregular, rolled margins, while benign ulcers are sharply punched out with radiating folds.

Why is "To exclude duodenal ulcer" not the answer?

A duodenal ulcer is a separate lesion and cannot be diagnosed from a gastric biopsy.

Why is "To identify Zollinger-Ellison syndrome" not the answer?

Zollinger-Ellison syndrome is diagnosed with gastrin levels, and gastrinomas cause multiple distal ulcers.

Why is "To grade the intestinal metaplasia for vitamin deficiency" not the answer?

Intestinal metaplasia is graded for gastric cancer risk and is unrelated to vitamin deficiency.

What concept does this question test?

It tests GI pathology: peptic ulcer in Pathology. Duodenal ulcers are almost never malignant.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study GI pathology: peptic ulcer?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.