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NBME 16 Answers

nbme16/Block 4/Question#24 (15.6 difficulty score)
A 35-year-old man comes to the physician ...

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submitted by zincy7(14),
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  • ugrBnni Alidmnbao iPan suhor eratf atgnei = asiGrct euclr
  • akcBl ostlso rfo 2 dsya = ???
  • ryfaeorRct to CTO nscadAit dan H2 Brscelko
  • gaitnewS adn woL PB
  • aicneaPtrc aMss = osmt lkilye INTORAASMG

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NEF :EERRECegnZlllosi-ioErnl Sryonemd

bingcentipede  Black stool because blood in the GI tract? +1  
passplease  I was tempted to pick insulin, because of the orthostatics and sweating that could resemble hypoglycemic episodes. Why are those present in a gastrinoma? +3  
deberawr  @passplease it's possible that increased gastrin -> peptic ulcers -> perforation -> shock -> sympathetic nervous system overload -> sweating and hypotension +  
jsanmiguel415  Black stool = melena = bleeding above the ligament of trietz from ulcers +  
rina  @passplease according to amboss gastrinomas can cause steatorrhea and malabsorption, in addition to anemia from GI bleeding. that might explain the light headedness and low-ish bp. +  
jj375  Zollinger Ellison Syndrome --> causes duodenal ulcers that are bleeding causing melena and the low blood volume (symptoms of light headed and low BP). I would guess that sweating is from what @deberawr said of the increased sympathetics from the low blood volume +  
cheesetouch  FA18 347 zollinger ellison +