usmlebuzz
Forum Elite
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An 11-year-old girl presents to your office because of a family history of medullary carcinoma of the thyroid. Physical examination is normal. Which of the following tests should you perform?
A. Urine vanillylmandelic acid (VMA) level
B. Serum insulin level
C. Serum gastrin level
D. Serum glucagon level
E. Serum somatostatin level
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| usmleasr
Forum Guru
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Posts: 970
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A.VMA level
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| Idiopathic
Forum Guru
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Posts: 641
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Remember two kinds of medullary CA-familial and sporadic. Sporadic is more common, but familil is ALWAYS associated with MEN syndrome (MEN-II specifically)
MEN-II A = medullary CA of thyroid, pheochromocytoma, hyper-PTH (MP2)
MEN-II B = medullary CA of thyroid, pheochromocytoma, Marfanoid habitus and mucosal neuromas (M3P)
I dont like VMA. 24-h urine for Metanephrines are the gold-standard test, but obviously they want you to know that VMA is a breakdown product of catecholamines.
(I had that exact question on my last path test, only with metanephrines instead of VMA)
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