Peptic ulcer disease: practice question

A General Surgery 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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General Surgery · Peptic ulcer disease

Sample item

A man with a long history of duodenal ulcer has persistent vomiting of food eaten the previous day and a succussion splash. Which acid-base and electrolyte profile is expected, and what should be given first?

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

The answer and the reasoning

B. Hypochloraemic hypokalaemic metabolic alkalosis; intravenous normal saline with potassium

Gastric outlet obstruction causes loss of hydrochloric acid and volume, giving hypochloraemic hypokalaemic metabolic alkalosis. Paradoxical aciduria develops because the kidney conserves sodium at the expense of hydrogen ions. Resuscitation with saline plus potassium replacement precedes decompression and endoscopic dilatation or surgery.

Option by option

  • A. Respiratory alkalosis; rebreathing mask

    Respiratory alkalosis is not the primary disturbance in persistent vomiting.

  • B. Hypochloraemic hypokalaemic metabolic alkalosis; intravenous normal saline with potassium (correct)

    Correct. Chloride and volume repletion with potassium corrects the alkalosis.

  • C. Hyperchloraemic metabolic acidosis; intravenous sodium bicarbonate

    Acidosis is not expected because gastric acid is lost, not bicarbonate.

  • D. High anion gap acidosis; insulin infusion

    A high anion gap acidosis with insulin therapy is relevant in ketoacidosis, not here.

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.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Hypochloraemic hypokalaemic metabolic alkalosis; intravenous normal saline with potassium. Gastric outlet obstruction causes loss of hydrochloric acid and volume, giving hypochloraemic hypokalaemic metabolic alkalosis.

Why is "Respiratory alkalosis; rebreathing mask" not the answer?

Respiratory alkalosis is not the primary disturbance in persistent vomiting.

Why is "Hyperchloraemic metabolic acidosis; intravenous sodium bicarbonate" not the answer?

Acidosis is not expected because gastric acid is lost, not bicarbonate.

Why is "High anion gap acidosis; insulin infusion" not the answer?

A high anion gap acidosis with insulin therapy is relevant in ketoacidosis, not here.

What concept does this question test?

It tests Peptic ulcer disease in General Surgery. Paradoxical aciduria develops because the kidney conserves sodium at the expense of hydrogen ions. Resuscitation with saline plus potassium replacement precedes decompression and endoscopic dilatation or surgery.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Peptic ulcer disease?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.