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NBME 24 Answers

nbme24/Block 3/Question#44

A 62-year-old man comes to the physician for a ...

Serum gastrin

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 +6  upvote downvote
submitted by neonem(227),

I think the idea here is that if you take someone off a PPI, if there's no neoplasm or any problem with gastrin production then you should see it go down from baseline due to more negative feedback of gastric acidity. If not, you probably have a neoplasm that's just making tons of gastrin, such as in the case of Zollinger-Ellison syndrome.

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 +5  

 +1  upvote downvote
submitted by welpdedelp(63),

I thought this was just referencing zollinger ellison, which would have elevated gastrin

 +0  upvote downvote
submitted by dentist(1),

To me: this seemed more straightforward. You'd want to follow up and check Gastrin levels on a patient who previously had 4x normal.