USMLE Forum Archives - USMLE Step 2 CK - tricky one
tricky one
HIV - 02-13-08 00:43
A 49-year-old man has had presistent peptic uclear disease for 7 years. He was originally diagnosed by upper GI series 6 years ago, and was poorly complaint with medical management. For the past 1 year he has also been complaining of watery diarrhea. At this time all tests for H. Pylori are negetive. Upper GI endoscopy at this time confirms the presence of two duodenal uclears and it also shows multiple submucosal gastric tumors, ranging in size from 1 to 2 cm. Biopsies of these masses are read as carcinoid tumors. Determinations of serum levels of which of the following substances would most likely help establish the diagnosis?
A. Epinephrine
B. 5-Hydroxyindoleacetic acid
C. Gastrin
D. Secretin
E. Uric acid
HIV - 02-13-08 00:43
A 49-year-old man has had presistent peptic uclear disease for 7 years. He was originally diagnosed by upper GI series 6 years ago, and was poorly complaint with medical management. For the past 1 year he has also been complaining of watery diarrhea. At this time all tests for H. Pylori are negetive. Upper GI endoscopy at this time confirms the presence of two duodenal uclears and it also shows multiple submucosal gastric tumors, ranging in size from 1 to 2 cm. Biopsies of these masses are read as carcinoid tumors. Determinations of serum levels of which of the following substances would most likely help establish the diagnosis?
A. Epinephrine
B. 5-Hydroxyindoleacetic acid
C. Gastrin
D. Secretin
E. Uric acid
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#4
Re: tricky one laparotomy - 02-28-08 12:06 
posted by HIV on 02-13-08 00:43
A 49-year-old man has had presistent peptic uclear disease for 7 years. He was originally diagnosed by upper GI series 6 years ago, and was poorly complaint with medical management. For the past 1 year he has also been complaining of watery diarrhea. At this time all tests for H. Pylori are negetive. Upper GI endoscopy at this time confirms the presence of two duodenal uclears and it also shows multiple submucosal gastric tumors, ranging in size from 1 to 2 cm. Biopsies of these masses are read as carcinoid tumors. Determinations of serum levels of which of the following substances would most likely help establish the diagnosis?
A. Epinephrine
B. 5-Hydroxyindoleacetic acid
C. Gastrin
D. Secretin
E. Uric acid
A 49-year-old man has had presistent peptic uclear disease for 7 years. He was originally diagnosed by upper GI series 6 years ago, and was poorly complaint with medical management. For the past 1 year he has also been complaining of watery diarrhea. At this time all tests for H. Pylori are negetive. Upper GI endoscopy at this time confirms the presence of two duodenal uclears and it also shows multiple submucosal gastric tumors, ranging in size from 1 to 2 cm. Biopsies of these masses are read as carcinoid tumors. Determinations of serum levels of which of the following substances would most likely help establish the diagnosis?
A. Epinephrine
B. 5-Hydroxyindoleacetic acid
C. Gastrin
D. Secretin
E. Uric acid
The answer is B. But why is that tricky?
#6
Re: tricky one samso - 05-20-08 06:47 C... gastrin , he has a long history of peptic ulcers not poorly responsive to treatment with negative h.pylori and also prolonged watery diarrhea , Zollinger ellison syndrome.
this is not carcinoid syndrome , despite having incidental carcinoid tumors in stomach.
#7
Re: tricky one radhamesramos - 05-20-08 10:06 he has none of the Symptoms of the carcinoid syndrome, but surely he has a Zollinger Ellison, this is not tricky...for step 3 purposes: always go with gastrin first, guys!
#8
Re: tricky one zahoor - 06-09-08 07:29 not sonds tircky the things go more in favour of ZE Syndrome.
#9
Re: tricky one rehaseen - 07-02-08 14:02 Zollinger Ellison, cause of diarrhoea with peptic ulcer so the answer is gastrin
#10
Re: tricky one ammulufy - 06-27-10 20:49 B......even I think its carcinoid dats y I go wid b.......however do require proper explantion for d answer though.
#11
Re: tricky one bingousmle - 06-30-10 17:07 the patient with multiple ulcers has zollinger ellison syndrome where there are multiple ulcers.. but since the biopsy shows carcinoid i will say 5HIAA
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