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

Step 1: Pull out the key clue in the history.
A young man with no mention of liver disease, alcohol use, jaundice, or an enlarged spleen presents with massive hematemesis. The one detail the question gives on purpose is that he took drugs for fever over the last 2 weeks. Drugs taken for fever are almost always NSAIDs (aspirin, ibuprofen, diclofenac, and similar painkillers).

Step 2: Know how NSAIDs damage the stomach and duodenum.
NSAIDs block the COX-1 enzyme, which normally makes protective prostaglandins in the gastric lining. Losing this protection lets stomach acid injure the mucosa directly. Within days to a couple of weeks this can progress from small erosions to a frank peptic ulcer that erodes into a blood vessel, causing sudden, heavy hematemesis.

Step 3: Compare with the other options.
Erosive gastritis from NSAIDs is real but tends to cause diffuse, oozing bleeding from many shallow erosions rather than one massive bleed; a deep NSAID ulcer eroding a vessel better explains a large single bleed.
Esophageal erosion is usually linked to reflux disease or corrosive ingestion, neither of which is mentioned here.
Esophageal varices need portal hypertension, which usually comes with chronic liver disease, alcohol use, jaundice, or cirrhosis. None of that is given for this patient, so varices do not fit the history well.

Step 4: Match the vignette to the diagnosis.
The combination of a young patient, no liver disease clues, and a clear 2 week history of fever medication points to a drug induced peptic ulcer bleed rather than a chronic liver problem.

Note on the source answer key: the original paper's key marks esophageal varices as correct. Varices usually need an underlying cause such as cirrhosis or portal hypertension, and nothing in this vignette supports that, while the NSAID history is a specific, deliberate clue in the question. This answer has been corrected to acute peptic ulceration due to NSAIDs based on the clinical history given.

Step 5: Final answer.
\[ \boxed{\text{Acute peptic ulceration due to NSAIDs}} \]