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NBME 16 Answers

nbme16/Block 4/Question#24 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Gastrin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: GI

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submitted by โˆ—zincy7(29)
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  • Burning Abdominal Pain hours after eating = Gastric ulcer
  • Black stools for 2 days = ???
  • Refractory to OTC Antacids and H2 Blockers
  • Sweating and Low BP
  • Pancreatic Mass = most likely GASTRINOMA

Immunohistochemical labeling uses antibodies as markers for what they want to find. In this case, we're suspecting gastrin given the symptoms

Note: You should revise the function, stimulation, and site of release for each of the hormones mentioned as well

REFERENCE: Zollinger-Ellison Syndrome

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bingcentipede  Black stool because blood in the GI tract? +2
passplease  I was tempted to pick insulin, because of the orthostatics and sweating that could resemble hypoglycemic episodes. Why are those present in a gastrinoma? +3
deberawr  @passplease it's possible that increased gastrin -> peptic ulcers -> perforation -> shock -> sympathetic nervous system overload -> sweating and hypotension +
jsanmiguel415  Black stool = melena = bleeding above the ligament of trietz from ulcers +1
rina  @passplease according to amboss gastrinomas can cause steatorrhea and malabsorption, in addition to anemia from GI bleeding. that might explain the light headedness and low-ish bp. +
jj375  Zollinger Ellison Syndrome --> causes duodenal ulcers that are bleeding causing melena and the low blood volume (symptoms of light headed and low BP). I would guess that sweating is from what @deberawr said of the increased sympathetics from the low blood volume +4
cheesetouch  FA18 347 zollinger ellison +
ley  black stools is caused by blood/bleeding in the upper GI like ulcers(stomach,duodenum) and stools with light red blood y caused by lower bleeding like external hemorroids. +

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