This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'A peptic ulcer is associated with all except one - \nSelect and explain. \nA. Cirrhosis, B. Zollinger Ellisons syndrome, C. Primary hyperparathyroidism, D. Pernicious anemia', 'role': 'user'}, {'content': "Answer: D \nExplanation: You, don’t expect pernicious anemia to cause peptic ulcer. In pernicious anemia, there is autoimmune destruction of the parietal cells leading to hypochlorhydria which further progresses to achlorhydria\nEtiology. of peptic ulcer\n\n\nAcute Peptic Ulcer\n\n\n\n\nNSAIDS Ingestion\n\n\nStress\n\n\nCushing ulcer after cerebral trauma\nCurling ulcer* after burn injury, any kind of shock\n\n\nSepsis\xa0\xa0— Undrained pus may be responsible for an acute ulcer.\n\n\nSteroids \n\n\n\n\nChronic Gastric Ulcer\n\n\n\n\nNSAIDs Ingestion\n\n\nNSAIDs\xa0disrupt the prostaglandin driven support\xa0of the mucosal barrier.\nProstaglandins are responsible for the prodn. of mucosal gel layer in the stomach, which provide a protective barrier to the gastric and duodenal lining.\nSo disruption of this mucosal barrier allows even minimum amount of acid to cause ulceration.\n\n\nHelicobacter pylori\n\n\nH.Pylori is seen in almost 90% of cases of duodenal ulcer and 70% of cases of gastric ulcer.\n\n\nPyloroduodenal reflux\n\n\nRegurgitate bile & other duodenal juices.\n\n\nMucosal trauma\n\n\nby mechanical effect of food.\n\n\nDiet & smoking\n\n\nIrregular diet, spicy food excessive drinking of tea & coffee, alcohol, Cigarette smoking has a definite relation with both gastric & duodenal ulcers.\n\n\nEmotional factors\n\n\nAnxiety, Stress & strain.\n\n\nLiver\xa0disease\n\n\nUlceration of both stomach and duodenum have co-existed with the disease of the liver, particularly cirrhosis.\nIt may be due to increase in blood supply to the gastric mucosa and overproduction of histamine in the stomach wall to stimulate the parietal cell.\n\n\nChronic Duodenal Ulcer\n\n\n\n\nAcid hypersecretion\n\n\nGenetic factors\n\n\nPersons of blood group 'O'\xa0who do not possess AB antigen are peculiarly apt to develop a duodenal ulcer.\niii.Endocrinal disorders\n\nZollinger Ellison syndrome\nHyperparathyroidism\nMultiple adenoma syndromes (MEN-I)\nCushing. syndrome (b/c of the high level of endogenous steroids)\n\n\n\nChronic liver diseases\n\n\nChronic lung disease\n\n\nChronic pancreatitis\n\n\nEmotional factor\n\n\nDiet & smoking\n\n\nH.pylori\n\n\nThe decrease in bicarbonate production\n\n\n\n\nThe list may be exhaustive but questions have been repeatedly asked on etiology of peptic ulcers.", 'role': 'assistant'}]