WBR0261

Author	PageAuthor::Vendhan Ramanujam
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Endocrine, SubCategory::Endocrine, SubCategory::Gastrointestinal
Prompt	[[Prompt::A 58 year old male comes to the office and complains of nausea and early satiety for the past several months. He also complains of anorexia and abdominal bloating. He denies any epigastric pain. He is a known diabetic on insulin for the past 15 years. His home blood glucose readings have ranged between 40 to 400 mg/dL in past few months. The low blood glucose readings occurred after the meals. Which of the following is the most appropriate management of the patients symptoms?]]
Answer A	AnswerA::Omeprazole
Answer A Explanation	AnswerAExp::It is not useful for diabetic gastroparesis
Answer B	AnswerB::Promethazine
Answer B Explanation	AnswerBExp::It is not useful for diabetic gastroparesis
Answer C	AnswerC::Ondansetron
Answer C Explanation	AnswerCExp::It is not useful for diabetic gastroparesis
Answer D	AnswerD::Metoclopramide
Answer D Explanation	[[AnswerDExp::Dopamine antagonist (metoclopramide) is useful in treating gastroparesis. The gastroprokinetic activity of metoclopramide is mediated by its muscarinic activity, D2 receptor and 5-HT4 receptor agonist activity.]]
Answer E	AnswerE::Ranitidine
Answer E Explanation	AnswerEExp::It is not useful for diabetic gastroparesis
Right Answer	RightAnswer::D
Explanation	[[Explanation::Neuropathy is seen among 50% of long standing diabetics. Neuropathy might manifest as polyneuropathy or mononeuropathy or autonomic neuropathy. Any part of the gastrointestinal tract might be affected by autonomic neuropathy. Gastroparesis occurs when stomach is affected. It presents as anorexia, nausea, vomiting, abdominal bloating and early satiety. Due to delayed gastric emptying, glycemic control is hard to achieve. They typically have post meals hypoglycemia after insulin injection. Nuclear scintigraphy is the best study to document delayed gastric emptying. The management includes: 1.Good glycemic control 2.Small and frequent meals 3.Dopamine antagonist (metoclopramide) 4.Bethanechol 5.Erythromycin Educational Objective: References: ]]
Approved	Approved::Yes
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