Question

A 20-year-old man presents with massive hematemesis. He gives a history of taking some drugs for fever over the past 2 weeks. What is the likely diagnosis?

• A. Acute peptic ulceration due to NSAIDs
• B. Erosive gastritis
• C. Esophageal erosion
• D. Esophageal varices

Hint:

Drugs taken for fever are usually NSAIDs; think about what they do to the stomach lining over 2 weeks.

Answer 1

The Correct Option is A

The question is testing whether we can link a drug history to the right cause of a GI bleed. A 20 year old man took medicine for fever for 2 weeks and then had a large hematemesis.

1. Acute peptic ulceration due to NSAIDs: fever medicines are almost always NSAIDs. NSAIDs strip away the stomach's protective prostaglandins, and over 1 to 2 weeks this can dig a deep ulcer that opens a blood vessel and bleeds heavily. This fits the timeline and the drug history exactly.
2. Erosive gastritis: also caused by NSAIDs, but it is usually shallow, widespread oozing rather than one massive bleed, so it is a weaker fit than a bleeding ulcer.
3. Esophageal erosion: this points to reflux disease or a swallowed irritant, neither of which the question mentions.
4. Esophageal varices: these need portal hypertension from chronic liver disease. There is no jaundice, alcohol history, or spleen enlargement mentioned, so this does not match the case.

Reading the history again, the fever drug clue was placed there for a reason: it points straight at NSAID damage to the stomach, not at liver disease. So the best fit is a bleeding peptic ulcer caused by NSAIDs.

Let's summarize:

• Drugs for fever almost always mean NSAIDs.
• NSAIDs damage gastric mucosa and can cause a bleeding ulcer within 1 to 2 weeks.
• Varices need a liver disease background that this patient does not have.

The answer key in the original paper listed esophageal varices, but the history given fits an NSAID induced peptic ulcer far better, so that is the answer used here.