Systemic pathology: Zollinger-Ellison syndrome: 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 · Systemic pathology: Zollinger-Ellison syndrome

Sample item

A 45-year-old man has multiple ulcers in the duodenum and proximal jejunum with diarrhoea. Endoscopy shows prominent gastric folds, and fasting serum gastrin is markedly elevated. What explains the ulcers?

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

The answer and the reasoning

D. Gastrin-driven parietal cell hyperplasia causing gastric acid hypersecretion

Gastrinoma produces gastrin that stimulates parietal cell mass and acid output. The acid load overwhelms duodenal defences, producing multiple and unusually located ulcers, and the tumour may be part of MEN1.

Option by option

  • A. Atrophy of parietal cells causing achlorhydria

    Parietal cell atrophy lowers acid, and gastrin is then raised secondarily without ulcers.

  • B. Loss of mucosal prostaglandins from NSAID exposure

    NSAID injury does not produce a high gastrin level or diarrhoea from acid.

  • C. Loss of mucosal bicarbonate from Brunner gland atrophy

    Brunner gland atrophy is not a recognised cause of multiple ulcers with a very high gastrin level.

  • D. Gastrin-driven parietal cell hyperplasia causing gastric acid hypersecretion (correct)

    Correct. Excess gastrin stimulates parietal cells, producing acid hypersecretion and ulcers in unusual sites.

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 Pathology question

What is the answer to this Pathology question?

The best answer is D, Gastrin-driven parietal cell hyperplasia causing gastric acid hypersecretion. Gastrinoma produces gastrin that stimulates parietal cell mass and acid output.

Why is "Atrophy of parietal cells causing achlorhydria" not the answer?

Parietal cell atrophy lowers acid, and gastrin is then raised secondarily without ulcers.

Why is "Loss of mucosal prostaglandins from NSAID exposure" not the answer?

NSAID injury does not produce a high gastrin level or diarrhoea from acid.

Why is "Loss of mucosal bicarbonate from Brunner gland atrophy" not the answer?

Brunner gland atrophy is not a recognised cause of multiple ulcers with a very high gastrin level.

What concept does this question test?

It tests Systemic pathology: Zollinger-Ellison syndrome in Pathology. The acid load overwhelms duodenal defences, producing multiple and unusually located ulcers, and the tumour may be part of MEN1.

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 Systemic pathology: Zollinger-Ellison syndrome?

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.