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Retired NBME 15 Answers

nbme15/Block 2/Question#6 (reveal difficulty score)
A 56-year-old woman comes to the physician ...
Helicobacter pylori ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—prosopagnosia(5)
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GERD --> acid damages mucosa --> knockout of the mucosa leading to decreased stem cells --> ulcers form and heal via fibrosis --> stricture --> dysphagia. Complication of this chronically would be Barrett Esophagus? (I can't tell if those are cells filled with fat or goblet cells that replaced the squamous epithelium). Barrett Esophagus can progress to Adenocarcinoma of the esophagus. Source: Pathoma pg 102

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submitted by โˆ—ergogenic22(401)
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mass in the esophagus with solid/liquid dysphagia. I'm not sure what the histo shows but on the bottom there are more flat cells and the top there are wider spaces within the cells with some fat, so I think it maybe a healing ulcer leading to a stricture.

anways other pathogens are more associated with other infections

A) gallstones and cholangiocarcinoma B) esophagitis c) liver abscess E) i think miliary TB can present in the liver

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submitted by โˆ—ergogenic22(401)
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mass in the esophagus with solid/liquid dysphagia. I'm not sure what the histo shows but on the bottom there are more flat cells and the top there are wider spaces within the cells with some fat, so I think it maybe a healing ulcer leading to a stricture.

anways other pathogens are more associated with other infections

A) gallstones and cholangiocarcinoma B) esophagitis c) liver abscess E) i think miliary TB can present in the liver

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submitted by โˆ—nnasser33(8)
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My understanding is that H. pylori actually decreases the risk for esophageal disorders (ex. adenocarcinoma)

How would a chronic H. pylori infection lead to healing ulcer/ stricture formation or adenocarcinoma?

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bhavika98  Hey , Basiclly since H.pylori leads to excess acidity in the stomach. over time if irritation persists , intestinal metaplasia can occur to neutralize the acidity and eventually convert to an adenocarcinoma. Hope this helps !! +3



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submitted by โˆ—chaosawaits(92)
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How does that picture help at all? Is it just for ruling out or can you rule in H. pylori with it?

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submitted by โˆ—chaosawaits(92)
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I feel like the best strategy for this question is ruling out everything else. The amount of information that definitively says H. pylori, to me, is minimal.

Clonorchis: is a liver fluke, causes problems with gallbladder CMV: usually in immunocompromised patients, no giant cells on histology Entamoeba: liver abscesses TB: no lung involvement, really no indications of TB at all, honestly

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