Localize the GI lesion? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 10-25-2012
MedicalExaminer's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 826
Threads: 67
Thanked 515 Times in 318 Posts
Reputation: 525
GIT Localize the GI lesion?

A 35-year-old man presents to the physician with a 2-month history of non-bloody, non-mucoid, non-oily watery diarrhea. He has a diastolic murmur that gets louder with inspiration and is best heard over the left lower sternal border. His face is warm and appears to be engorged with blood for several minutes during the examination. Laboratory studies show:

Vanillylmandelic acid: 5 mg/day (normal 07 mg/day)
Metanephrine, urine: 250 μg/g of creatinine (normal 0300 μg/g)
Homovanillic acid, urine: 14 mg/day (normal 015 mg/day)
5-HIAA: 28 mg/day (normal 09 mg/day)

Gastrointestinal endoscopy is most likely to show a lesion located near which of the following?

A Gastroesophageal junction
B Ligament of Treitz
C Pancreaticoduodenal junction
D Rectosigmoid junction
E Splenic flexure
__________________
Everything is possible for him who believes (MARK 9:23)
245/247/passed on 1st attempt/223/2mos Obsie /3 US LORS/visa not needed/2008 grad
Reply With Quote Quick reply to this message
The above post was thanked by:
anoushay khan (10-25-2012)



  #2  
Old 10-25-2012
dr.Irina's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CK
Posts: 230
Threads: 7
Thanked 89 Times in 71 Posts
Reputation: 99
Default

D Rectosigmoid junction
Reply With Quote Quick reply to this message
  #3  
Old 10-25-2012
blade's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS+3
Posts: 358
Threads: 22
Thanked 212 Times in 119 Posts
Reputation: 222
Default BB?

Metastatic Carcinoid syndrome
__________________
with God,nothing is impossible...PREMATCHED!!!
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

Reply With Quote Quick reply to this message
 
  #4  
Old 10-25-2012
venky2600's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,186
Threads: 119
Thanked 894 Times in 469 Posts
Reputation: 904
Send a message via Yahoo to venky2600
Post

diagnosis--carcinoid tumor(mc small bowel tumor)

so, A,D,E can't be

will go with B) ligament of treitz.....thanks
Reply With Quote Quick reply to this message
  #5  
Old 10-25-2012
dr.Irina's Avatar
USMLE Forums Veteran
 
Steps History: 1 + CK
Posts: 230
Threads: 7
Thanked 89 Times in 71 Posts
Reputation: 99
Default

yes B Ligament of Treitz more possible
Reply With Quote Quick reply to this message
  #6  
Old 10-25-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 614 Times in 344 Posts
Reputation: 624
Default my answer :)

Hmm.. nice question

sort of by exclusion: it's not A, C, D, nor E (if at all I think we would find something near the hepatic flexure - liver metas?)

so B Ligament of Treitz but still not sure

thanks for posting! can't wait to see the answer
Reply With Quote Quick reply to this message
  #7  
Old 10-25-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 126
Threads: 6
Thanked 54 Times in 30 Posts
Reputation: 64
Default My answer B

A tumor carcinoid without metastasis to the liver can NOT be clinical evident, so the posible anatomic place is the treitz ligament, spreading through portal vein to the liver
Reply With Quote Quick reply to this message
  #8  
Old 10-25-2012
MedicalExaminer's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 826
Threads: 67
Thanked 515 Times in 318 Posts
Reputation: 525
Default

The correct answer is B. This patient presents with chronic diarrhea, intermittent facial flushing, and a murmur consistent with tricuspid stenosis, a triad of findings classic for carcinoid syndrome. One-third of carcinoid tumors of the gastrointestinal tract occur in the midgut-derived small bowel, which begins at the ligament of Treitz and ends at the mid transverse colon. While adenocarcinoma is the most common type of small bowel tumor, carcinoid tumors are most likely to occur in the small bowel. Carcinoid tumors of the small intestine secrete serotonin, which is usually metabolized by the liver and doesn't cause the symptoms of the carcinoid syndrome. However, when metastases to the liver are present, the bioactive amines can no longer be metabolized and enter the systemic circulation causing diarrhea, abdominal cramps, gastrointestinal bleeding, malabsorption, flushing, bronchospasm, and right heart valvular disease from serotonin-mediated fibroelastosis. Electron microscopy reveals "salt and pepper" granulation of cells, consistent with their neuroendocrine origin. An elevated urinary 5-HIAA level is diagnostic of carcinoid syndrome.

Answer A is incorrect. The gastroesophageal junction is affected by gastroesophageal reflux disease, not carcinoid tumors.

Answer C is incorrect. The pancreaticoduodenal junction is the site where pancreatic endocrine and exocrine secretions empty into the small bowel to aid in digestion. It is part of the foregut-derived intestine, and it is a rare site for carcinoid tumors.

Answer D is incorrect. The rectosigmoid junction is not a common location for carcinoid tumors.

Answer E is incorrect. The splenic flexure is a watershed area that is susceptible to ischemic damage if cardiac output becomes low. It is not, however, a common site for carcinoid tumors.
__________________
Everything is possible for him who believes (MARK 9:23)
245/247/passed on 1st attempt/223/2mos Obsie /3 US LORS/visa not needed/2008 grad
Reply With Quote Quick reply to this message
The above post was thanked by:
anoushay khan (10-25-2012)
  #9  
Old 10-25-2012
rupesh's Avatar
USMLE Forums Guru
 
Steps History: 1 + CS
Posts: 386
Threads: 71
Thanked 202 Times in 117 Posts
Reputation: 212
Send a message via AIM to rupesh
Default

carcinoid syndrome appendix> rectosigmoid junction
Reply With Quote Quick reply to this message



Reply

Tags
Pathology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in


Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Localize this brain lesion! bunny USMLE Step 1 Forum 1 03-21-2012 12:08 AM
skin lesion scopusmount USMLE Step 1 Forum 5 11-03-2011 10:18 AM
Right Arm and Leg Stroke, where is the lesion! ricko335 USMLE Step 1 Forum 12 08-28-2011 07:24 AM
Amilotropic Lateral Sclerosis: Mixed Lesion or Pure Motor Lesion? patelMD USMLE Step 1 Forum 5 08-16-2011 12:29 PM
Can you localize this neurologic lesion? harpreet virk USMLE Step 1 Forum 8 04-27-2011 04:31 AM

Find Us on Facebook
Powered by vBulletin® Version 3.8.8
Copyright ©2000 - 2020, vBulletin Solutions, Inc.
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2020 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2019)