MCQ – 88898

 A 70-year-old man comes to the physician because of episodes of watery stools for the past 6 weeks. During this period, he has also had recurrent episodes of reddening of the face, neck, and chest that last up to 30 minutes, especially following alcohol consumption. He has hypertension. He smoked one pack of cigarettes daily for 20 years but quit 8 years ago. He drinks two glasses of wine daily. Current medications include enalapril. He appears pale. He is 185 cm (6 ft 1 in) tall and weighs 67 kg (147.7 lb); BMI is 19.6 kg/m2. His temperature is 36.7°C (98°F), pulse is 85/min, and blood pressure is 130/85 mm Hg. Scattered expiratory wheezing is heard throughout both lung fields. Cardiac examination shows no abnormalities. The abdomen is soft and mildly tender. The remainder of the physical examination shows no abnormalities. A complete blood count and serum concentrations of urea nitrogen and creatinine are within the reference range. Which of the following is the most likely diagnosis in this patient?

Correct Answer � C Explanation

Answer- C Carcinoid syndrome

The secretory diarrhea, episodic cutaneous flushing, and wheezing that this patient is experiencing is most likely due to carcinoid syndrome. Carcinoid tumors usually occur in the GI tract and are often asymptomatic due to hepatic metabolism of any serotonin that the tumors produce. In the case of extraintestinal carcinoid tumors, or tumors that have metastasized to the liver, the increased serotonin that bypasses hepatic first-pass metabolism and ends up in systemic circulation causes the symptoms of carcinoid syndrome. Episodic flushing is the hallmark of carcinoid syndrome, and may occur spontaneously or be provoked by eating, drinking alcohol, defecation, emotional events, palpation of the liver, or anesthesia. Other effects of carcinoid tumors that this patient does not show signs of include endocardial fibrosis resulting in tricuspid valve insufficiency and/or pulmonary valve abnormality (carcinoid heart disease), as well as pellagra