Evaluating Pancreatic Malignancies

In Episode 46 of Med School Question of the Week for USMLE, Alisa Khomutova, MedSchoolCoach expert tutor, answers this medical school question: A 46-year old man comes to the physician for the evaluation of a 6-month history of fatigue and profuse, watery, odorless diarrhea. He reports that he has had a 20-pound weight loss during this time. Physical examination shows conjunctival pallor and mildly delayed capillary refill. Vitals are significant for a HR of 110. Laboratory studies are significant for a fasting glucose of 132 mg/dL, a potassium of 2.3 mEq/L and a calcium of 12.1 mg/dL. On CT, there is well-defined, enhancing mass of about 3x3x3 in the pancreatic tail. Additional evaluation would most likely show which of the following?

• Tricuspid Insufficiency
• Peptic Ulcers
• Hyperinsulinemia
• Cholelithiasis
• Achlorhydria
• Necrolytic Migratory Erythema
• Episodic Hypertension