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Retired NBME 15 Answers

nbme15/Block 2/Question#47 (reveal difficulty score)
A 30-year-old woman comes to the physician ...
Serotonin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pulm

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submitted by โˆ—cassdawg(1781)
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This woman has a carcinoid tumor, associated with carcinoid syndrome characterized by flushing, wheezing, and diarrhea. (FA2020 p 352) Based on her CXR I'd say she probably has a bronchial carcinoid tumor. Tumor cells would be chromogranin(+).

Carcinoid syndrome is a paraneoplastic syndrome caused by secretion of serotonin (5-HT). It is treated with a somatostatin analog like octreotide and the presence of 5-HIAA in the urine can be a marker (5-HIAA is a serotonin breakdown product).

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fatboyslim  I would just like to add that carcinoid syndrome also causes right-sided heart valve damage (tricuspid regurgitation, pulmonic stenosis). The reason being is that serotonin stimulates fibroblast growth and fibrogensis, which causes deposits of fibrous tissue on the endocardium and disrupts valve architecture. Can result in right-heart failure w/ ascites and the whole shabang. Source: UW#74 +1



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