High -Yield Internal Medicine Board Exam Pearls by Knowmedge - HTML preview

2. Stomach

Given the large number of hospitalizations and deaths from peptic ulcer disease every

year, it is not surprising that this remains a major topic tested on the boards. The most

common causes are Helicobacter pylori infection and NSAIDs.

Remember:

 H. pylori is associated with the development of gastric adenocarcinoma

as well as MALT (mucosa-associated lymphoid tissue) lymphoma

 Treatment for H. pylori consists of triple therapy – PPI, Amoxicillin, and

Clarithromycin (Metronidazole in Clarithromycin resistant areas)

 Urea breath test and fecal antigen test are both sensitive for the detection

of H. pylori

Be able to recognize a patient with a perforated peptic ulcer! Look for a patient who is

hypotensive and tachycardic with absent bowel sounds and severe rebound

tenderness and guarding. Imaging will show free intraperitoneal air. Stat surgical

consultation is required!