WBR0502
| Author | [[PageAuthor::Ayokunle Olubaniyi, M.B,B.S [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Behavioral Science/Psychiatry |
| Sub Category | SubCategory::Endocrine |
| Prompt | [[Prompt::A 7-year-old boy is brought to the pediatrics clinic for fever of 39 °C (102.2 °F), cough, and wheezing for the past week. Over the last 24 hours, the child has developed nausea, vomiting, and watery diarrhea. The child's past medical history is significant for neurofibromatosis, asthma, and seizure disorder. He is currently taking daily albuterol and valproic acid. His mother explains that she was diagnosed with insulin-dependent diabetes mellitus at his age and fears he may have developed it too. On physical examination, you note a lethargic and ill-appearing boy. His heart rate is 96/min, blood pressure is 124/84 mm Hg, temperature is 36.8°C (98.2°F), and respiratory rate is 28/min. You decide to admit the child for evaluation and monitoring. Over the next two days, the patient has recurrent episodes of hypoglycemia, with fingerstick glucose levels as low as 33 mg/dL. Both episodes occur at night, with the mother alerting the nurses each time. Further investigation reveals a serum insulin level of 2344 µU/mL (5–25 µU/mL) and a C-peptide level of 0.7 ng/mL (0.8–4.0 ng/mL). What is the most likely diagnosis in this patient?]] |
| Answer A | AnswerA::Insulinoma |
| Answer A Explanation | AnswerAExp:: |
| Answer B | AnswerB::Sulfonylurea intake |
| Answer B Explanation | AnswerBExp:: |
| Answer C | AnswerC::Exogenous insulin administration |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD::Type 1 diabetes mellitus |
| Answer D Explanation | AnswerDExp:: |
| Answer E | AnswerE::Adrenal insufficiency |
| Answer E Explanation | AnswerEExp:: |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation:: Educational Objective: |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Insulin, WBRKeyword::Insulinoma, WBRKeyword::Munchausen's syndrome by proxy, WBRKeyword::Hypoglycemia, WBRKeyword::C-peptide |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |