Gastrointestinal surgery: Cushing ulcer mechanism: 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 · Gastrointestinal surgery: Cushing ulcer mechanism

Sample item

A 28-year-old man on a ventilator after a severe head injury with raised intracranial pressure vomits blood on day 4. Endoscopy shows a deep solitary duodenal ulcer. What is the main mechanism of this ulcer?

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

The answer and the reasoning

B. Vagal overactivity with acid hypersecretion

Cushing ulcers follow intracranial injury or raised intracranial pressure. Stimulation of vagal nuclei causes gastric acid hypersecretion, and the ulcers are often deep and may perforate. Curling ulcers after burns arise from mucosal hypoperfusion instead. Prophylaxis uses a proton pump inhibitor and early enteral feeding.

Option by option

  • A. Mucosal ischaemia from hypovolaemia after extensive burns

    Hypovolaemic mucosal ischaemia describes the Curling ulcer of burns, and this patient has no burns.

  • B. Vagal overactivity with acid hypersecretion (correct)

    Correct. Raised intracranial pressure drives vagal acid hypersecretion, the mechanism of a Cushing ulcer.

  • C. Helicobacter pylori colonisation of the antrum

    H. pylori causes ordinary peptic ulcers and does not explain an ulcer arising within days of cerebral injury.

  • D. Hypergastrinaemia from a gastrin-secreting tumour

    A gastrinoma gives multiple, atypically sited ulcers with diarrhoea and does not follow head injury.

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, Vagal overactivity with acid hypersecretion. Cushing ulcers follow intracranial injury or raised intracranial pressure.

Why is "Mucosal ischaemia from hypovolaemia after extensive burns" not the answer?

Hypovolaemic mucosal ischaemia describes the Curling ulcer of burns, and this patient has no burns.

Why is "Helicobacter pylori colonisation of the antrum" not the answer?

H. pylori causes ordinary peptic ulcers and does not explain an ulcer arising within days of cerebral injury.

Why is "Hypergastrinaemia from a gastrin-secreting tumour" not the answer?

A gastrinoma gives multiple, atypically sited ulcers with diarrhoea and does not follow head injury.

What concept does this question test?

It tests Gastrointestinal surgery: Cushing ulcer mechanism in General Surgery. Stimulation of vagal nuclei causes gastric acid hypersecretion, and the ulcers are often deep and may perforate. Curling ulcers after burns arise from mucosal hypoperfusion instead. Prophylaxis uses a proton pump inhibitor and early enteral feeding.

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 Gastrointestinal surgery: Cushing ulcer mechanism?

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.