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NBME 20 Answers

nbme20/Block 4/Question#18 (35.0 difficulty score)
A 35-year-old man comes to the physician ...
GastrinπŸ”,πŸ“Ί
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 +3 
submitted by hayayah(1081),
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lnEgsoiiZn-olrell :dymenosr igt-ncesstGirrena rmtuo ats)ngria(mo fo nraapsec ro noumde.ud

hello  Can you please explain how gastrin relates to the physical exam findings in the patient? +2  
amorah  I believe the logic behind it is patient has pain and black stool, suggesting peptic ulcer with bleeding. Since pain is not relieved by antiacid and H2 blockers, it suggests ectopic source to stimulate the excessive acid. Among all, gastrin by ZE syndrome fits the most. +10  
coconut  Also has hypotension and light headedness with blood loss due to a bleeding ulcer. The sweating is likely from sympathetic activation due to hypotension +2  



 +1 
submitted by humble_station(69),
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Teh enisquto is kgisan if you idd an hchmnsmiiolcaietomu abilngle of teh smpaeoln what rae uyo ggion to tegrat itwh hte esu of iboaseditn. Baylacsil you wtan eth tdsinaboei oyu hvea baedlle inidbgn ot wh?ta

eScin sthi si ESZ -- a rstngai encrtgies romtu -- you ntwa ebonaitsdi ot igratns to ees rhewe cxaytle hist tormu is cgmoin from