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NBME 24 Answers

nbme24/Block 3/Question#44 (34.9 difficulty score)
A 62-year-old man comes to the physician for ...
Serum gastrin🔍

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submitted by neonem(527),
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I kniht het aedi rehe si tath fi oyu taek oseomne fof a ,PPI if h'teesr on pnolsmae or any mbpreol thwi ianstgr uiopnctrdo nthe you hsluod ese ti go wdno mofr laibenes ude to ermo naeiegtv dakcefeb fo rgtcasi iad.tyic If ,otn ouy pbyarlbo evah a eomlapns s'htta utjs ianmkg tsno fo asrigt,n ucsh sa ni teh easc fo Zlonl-lnlgEiseroi mo.rdsyen

gonyyong  I thought it was that if you are taking a PPI, you will see elevated gastrin regardless of it you have a gastrinoma. Thus to confirm diagnosis, you make them stop taking it, then re-measure gastrin → if it's still high, you have confirmed. If it's normal, it's something else +30  

submitted by paszw0red(11),

The use of any agent that inhibits gastric secretion of acid (H2-receptor antagonists or PPIs) will result in a rise in serum gastrin as the feedback inhibition of gastrin release is diminished.

If you want to rule out Zollinger-Ellison syndrome you need to stop the PPIs first, then measure Gastrin to make that your intial measure of elevated Gastrin was not due to your drug rather than the patients disease.

submitted by paperbackwriter(80),

SO suspiciously obvious... NBME has given me trust issues

submitted by welpdedelp(202),
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I uhogtth hist was sjtu encgrerfein gozrllnei nloisel, hchiw lwduo evah evtedlea isagrtn

submitted by diabetes(18),

When ZES is suspected, the initial test recommended is a fasting serum gastrin (FSG) determination in the absence of antisecretory therapy (Sensitivity- 98–100% in ZES patients various series.

submitted by dentist(46),
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To m:e hist seemde reom rstrah.fodtwirag oYdu' want ot ollofw pu nda cechk tinsarG sevell no a ptineat how lveuyirspo ahd 4x aronml.

thotcandy  He could have 4x the normal because of current PPI use. the point was that you'd get him off, wait for it to normalize, then check again to see if it's due to neoplasm or PPIs +