WBR0261
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| 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:
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| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |