A previously healthy 52-year-old man comes to the physician because of a 4-month history of recurrent abdominal pain, foul-smelling, greasy stools, and a 5-kg (11-lb) weight loss despite no change in appetite. Physical examination shows pain on palpation of the right upper quadrant. His fasting serum glucose concentration is 186 mg/dL. Abdominal ultrasound shows multiple round, echogenic foci within the gallbladder lumen with prominent posterior acoustic shadowing. The serum concentration of which of the following substances is most likely to be increased in this patient?
AGlucagon
BSerotonin
CInsulin
DSomatostatin
EVasoactive intestinal peptide
A 53-year-old patient presents to his primary care provider with a 1-week history of abdominal pain at night and between meals. He has attempted taking antacids, which help briefly, but then the pain returns. The patient has not noticed any changes to the color of his stool but states that he has been having some loose bowel movements. The patient reports that he has had duodenal ulcers in the past and is concerned that this is a recurrence. On exam, his temperature is 98.4°F (36.9°C), blood pressure is 130/84 mmHg, pulse is 64/min, and respirations are 12/min. The abdomen is soft, nontender, and nondistended in clinic today. A fecal occult blood test is positive for blood in the stool. During outpatient workup, H. pylori stool antigen is negative, endoscopy demonstrates duodenal ulcers, and gastrin levels are elevated after a secretin stimulation test. Which of the following should also be examined in this patient?
AParathyroid hormone
BPlasma metanephrines
CVasoactive intestinal peptide
DCalcitonin
EThyroid stimulating hormone
A 42-year-old man presents to his primary care provider for abdominal pain. He reports that for several months he has been experiencing a stabbing pain above the umbilicus during meals. He denies associated symptoms of nausea, vomiting, or diarrhea. The patient’s past medical history is significant for hypertension and hyperlipidemia for which he takes amlodipine and atorvastatin. His family history is significant for lung cancer in his father. The patient is a current smoker with a 20 pack-year smoking history and drinks 3-5 beers per week. Initial laboratory testing is as follows: Serum: Na+: 141 mEq/L K+: 4.6 mEq/L Cl-: 102 mEq/L HCO3-: 25 mEq/L Urea nitrogen: 14 mg/dL Creatinine: 1.1 mg/dL Glucose: 120 mg/dL Calcium: 8.4 mg/dL Alkaline phosphatase: 66 U/L Aspartate aminotransferase (AST): 40 U/L Alanine aminotransferase (ALT): 52 U/L Gastrin: 96 pg/mL (<100 pg/mL) Lipase: 90 U/L (<160 U/L) The patient is started on a proton pump inhibitor without symptomatic improvement after 6 weeks. He is referred for an upper endoscopy, which demonstrates erosive gastritis, three ulcers in the duodenum, and one ulcer in the jejunum. Biopsy of the gastric mucosa is negative for H. pylori. Which of the following is the best next step in management?
ACalcium infusion study
BSerum prolactin level
CSerum chromogranin A level
DEmpiric triple therapy
ESecretin stimulation test
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