Archive Of Standardized Exam Questions: Carcinoid Syndrome

OVERVIEW

This page is dedicated to organizing various examples of standardized exam questions whose answer is Carcinoid syndrome. While this may seem a odd practice, it is useful to see multiple examples of how Carcinoid syndrome will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.

KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)

When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for Carcinoid syndrome

Chief Complaints:

  • Facial flushing
  • Recurrent diarrhea: often will be watery
  • Wheezing/asthmatic symptoms can be present (may present as shortness of breath

Clinical Workup:

  • Signs of right heart disease: prominent JVP, heart murmur
  • Elevated urinary 5-hydroxyindoleacetic acid (5-HIAA): this is bi-product of serotonin metabolism, and will be increased in the patient’s urine.
  • Valvular fibrous plaques can be detected in the heart histologically (more common on the right side vs. the left)
QUESTION EXAMPLES

Question # 1

A 60 year old woman is being evaluated for recurrent diarrhea. On further questioning she gives a history of episodes of flushing of the face, with expiratory wheezing. A prominent jugular venous pulse is noted on her neck. What condition might this patient have?

Explanation # 1

Recurrent diarrhea + facial flushing + asthmatic symptoms + signs of right heart disease = Carcinoid syndrome

Question # 2

A 48 year old female comes to the clinic because she has noticed reddening of her skin that has become bothersome. She explains that this redness involves her face, and neck, and feels “warm”. These episodes usually last less then 5 minutes, but more recently have been lasting for half an hour. She also complains of persistent watery diarrhea that is associated with abdominal cramping. A physical exam shows the presence of several purple vascular lesions that are surrounding her nose. Abdominal imaging shows a mass present in her small intestine. What is the most likely cause of this patient’s symptoms?

Explanation # 2

Facial flusshing + watery diarrhea + intestinal mass = Carcinoid syndrome

Question # 3

A 60 year old male comes to the office because he has been suffering from watery diarrhea. He also explains that he has been having brief episodes of wheezing and shortness of breath. His son has noticed that at times he appears flushed, and that his face turns “beet red”. The patient denies any symptoms of abdominal pain, vomiting, cough, or a fever. His past medical history is notable for hypertension and he does not smoke cigarettes or drink alcohol. His blood pressure is currently 135/75 mm Hg. His abdominal exam is benign. An abdominal CT scan is ordered and shows the presence of lesions in the right liver lobe, and also a mass in the ileum. What is the likely diagnosis in this patient?

Explanation # 3

Watery diarrhea + wheezing + facial flushing + mass in ileum/mets to the liver = Carcinoid syndrome

Question # 4

A 47 year old woman has a 3 week history of hepatomegaly and also a heart murmur heard by her PCP. She also has a 3 month history of flushing and crampy diarrhea. What is the most likely diagnosis in this patient?

Explanation # 4

Heart murmur + flushing + diarrhea = Carcinoid syndrome

TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)

Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:

Tumor Features:

  • Common location: site of primary neoplasm is the small intestine.
  • Secretion: this tumor will secrete serotonin.
  • Consequence of serotonin: stimulates fibroblast growth and fibrogenesis

Treatment:

  • Medical management of symptoms: octreotide can be used to control symptoms.
  • Definite treatment: surgical excision.

 

 

Page Updated: 03.07.2017