NBME 20 Gastrin (NBME Answers)

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Retired NBME 20 Answers

nbme20/Block 4/Question#18 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Gastrin 🔍 / 📺 / 🌳 / 📖
tags: GI

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submitted by ∗hayayah(1212)

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Zollinger-Ellison syndrome: Gastrin-secreting tumor (gastrinoma) of pancreas or duodenum.

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hello Can you please explain how gastrin relates to the physical exam findings in the patient? +2

amorah I believe the logic behind it is patient has pain and black stool, suggesting peptic ulcer with bleeding. Since pain is not relieved by antiacid and H2 blockers, it suggests ectopic source to stimulate the excessive acid. Among all, gastrin by ZE syndrome fits the most. +12

coconut Also has hypotension and light headedness with blood loss due to a bleeding ulcer. The sweating is likely from sympathetic activation due to hypotension +4

bob_logan I agree with the above, only part I still don't understand is the history of burning abdominal pain 1-2 hours after meals. Zollinger-Ellison created duodenal peptic ulcer presents with epigastric pain that improves with meals. (Pathoma) Gastric peptic ulcers arise due to H. Pylori, NSAIDs, and Bile reflux. Duodenal peptic ulcers arise due to H. Pylori and Zollinger-Ellison. +

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submitted by ∗humble_station(85)

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The question is asking if you did an immunohistochemical labeling of the neoplasm what are you going to target with the use of antibodies. Basically you want the antibodies you have labeled binding to what?

Since this is ZES -- a gastrin secreting tumor -- you want antibodies to gastrin to see where exactly this tumor is coming from

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