Luckyall
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Guys, dont forget to enjoy it !!!  )
If you can, explain your answer, if not, just giving it a shot should do it .
47y/o F, c/o mental confusion. FBG= 48 mg/dl, BP= 148/85, P= 92/min.
P/E you notice pt is sweating and small tremor hands. plasma Insulin levels decr. Wich of following most accurately correlates her conditio with a probable etiology?
A) She might have accidentally taken "wrong pill" her condition could result from taking SulfonylUres
B) She might have accidentally taken "wrong pill" her condition could result from taking propranolol
C) Her cond. could result from alcohol intake
D) her cond could result from insulinoma
E) her friend reports these episodes have become more frequent last few months. Her condition could result from Pheochromocytoma
Edited by Luckyall on 05/31/07 - 03:22 PM
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| new_n_lost
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PLZ POST COMPLETE QUESTION SO LESS CONFUSION ARISES and U have forgotten to mention the FBS Value.
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| Luckyall
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NNL, dont get high, it was just an involuntary misstyping ! It is now a very complete Qs though
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| new_n_lost
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oh  Someone's Too Excited !!!!!!!!!!!!!!!!
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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Get High !!!! Not Everyone Does U Know Not Everyone has the Resources Unless u Know Someone.......................................... 
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
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C) Her cond. could result from alcohol intake
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| inkspot
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e
b/w what is FBG?
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| epica
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Lucky pl
What is FBG?
Good Q
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| keepgoing
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pat is hypoglcemic..FBG-fasting blood glucose is low...
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| keepgoing
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sign of hypoglycemia----but in insulinoma/salfunuria--insulin should be high but here given is low....so thats pointing towards either alpha 1 receptor stmulation or alcohol but ketones would have made esaier to make diagnosis i.e so perhaps---->e pheochromocytoma or alcohol but htn also there showing --->adrenal tumor
i guess e
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| tompat
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c
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| silver
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C
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| Luckyall
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sorry, i was assuming you guys know, FBG is fasting blood glucose is standard abbreviation
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| jean robert
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C is the answer.
Why the answer is not E.
In pheocromocytoma ( a catecholamine-secreting tumor that arises from chromaffin cells of the sympathetic nervous system) Polyuria and polydipsia may be found as a result of increased glycolysis and alpha-receptor–mediated inhibition of insulin release.
This insulin inhibition causes an increase in blood sugar levels and glucose intolerance. As a result, patients may present with diabetes mellitus or glucose intolerance, most commonly during paroxysms.
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| Luckyall
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and why not Sulf.Ureas/ propanolol? lets make a good discussion, bc i felt this Qs makes you think !
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| drduck
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nice question...
it cannot be insulinoma....insulin levels are low....
it cannot be bcos of propanolol....it has hypergycemic effects on beta cells of pancreas...but patient has hypoglycemia...
next is....alcohol..aaaa...dont know much about....not clear...was in intoxicating dose??
small doses does decrease blood glucose but not so much....
heavy dose may rather increase...
what remains....sufonylurea and pheochromo...
pheochromocytoma patients cannot have this low BP....thats too low..
also there is headache as chief complaint...and there is no mental confusion in pheochromocytoma....
this confusion is due to deprivation of brain from glucose...
so i feel answer is sulfonylurea....which she is eating as a wrong drug since quite long...
what do u say??
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| new_n_lost
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the tendency to confabulate and mental confusion will be only present in Alcoholics wht the Q is missing is that Plasma Insulin Levels r slightly decreased then Normal it wud have been Sulfonyl ureas if the Insulin levels r markedly increased.
Edited by new_n_lost on 05/31/07 - 03:48 PM
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| drduck
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NNL....i really didnt get u....u mixed up every thing...difficult to understand plz make it clear.
and in the Q...it is given that plasma insulin level decreased..
how come alcohol will cause fall in insulin levels...
theres no evidence of confabulations...
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| drduck
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its time for u luckyall to make things clear.....
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| new_n_lost
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this will help u its the original question
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| drduck
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ok....NNL....u done with that Q...thats why...
anyway i was wrong....sulfos.......must raise insulin level to produce hypoglycemia..........i was no where near
but yes Q wasnt framed properly.....created lot confusions.
thanks NNL
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| silver
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new_n_lost wrote:
PLZ POST COMPLETE QUESTION SO LESS CONFUSION ARISES and U have forgotten to mention the FBS Value.
so this theory has been proven correct!
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| Luckyall
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thanks for saving my time, typing
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| Luckyall
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new_n_lost wrote:
the tendency to confabulate and mental confusion will be only present in Alcoholics wht the Q is missing is that Plasma Insulin Levels r slightly decreased then Normal it wud have been Sulfonyl ureas if the Insulin levels r markedly decreased.
Just adding that Sulf.Ureas --. stimulate excess insulin---> INCR insulin levels
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| new_n_lost
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yup i made a typing mistake
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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