Pyloric obstruction from gastric cancer — MCCQE Part 1 MCQ

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ModerateNausea/VomitingPyloric obstruction from gastric cancerMCCQE Part 1

A 70-year-old man has early satiety, non-bilious vomiting of old food, weight loss and iron deficiency anaemia. Which of the following is the most appropriate next step?

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Correct answer: E — Arrange urgent upper endoscopy

Arrange urgent upper endoscopy is the single best answer because the age, timing, examination findings and investigations in the vignette fit Pyloric obstruction from gastric cancer better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian Association of Gastroenterology dyspepsia guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian Association of Gastroenterology dyspepsia guidance