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Retired NBME 15 Answers

nbme15/Block 4/Question#39 (reveal difficulty score)
A 28-year-old woman is brought to the ...
Determine the C-peptide concentration in the latest blood specimen drawn ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—cassdawg(1781)
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My take is that prior to confronting her or persuing a diagnosis of factitious disorder, you would want to "prove" your suspicions. The best way to do this is to measure C-peptide concentration because if she really was having odd endogenous insulin spikes, C-peptide would be elevated as well (C-peptide is released endogenously when insulin is released, thus elevated endogenous insulin secretion = elevated C-peptide). If it is factitious disorder, her C-peptide would be normal, and you could go from there.

Factitious disorder FA2020 p566

Also interesting to note that C-peptide measurement can be used in determination of the cause of hypoglycemia from medication in a diabetic - glyburide (sulfonylureas) cause increased endogenous insulin and thus C-peptide is increased in hypoglycemia caused by sulfonylurease; hypoglycemia from exogenous insulin overdose has normal C-peptide

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