Potential error in one of the "free 150" questions?

[Tig2575]

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1st block, question 26: A 10-month-old girl is brought to the physician because of a 2-day history of diarrhea. She can sit unassisted and has started to crawl. Her mother is concerned because she babbles most of the time she is awake and she becomes very upset if her mother leaves the room, "even for just a second." Which of the following best describes the girl's development?

Cognitive (delayed/normal) Social (delayed/normal) Motor (delayed/normal)

My answer was Cognitive: delayed, Social: normal, Motor: normal

The "correct" answer was normal across the board


According to BRS behavioral science, infants babble between 4 and 6 months. Between 7 and 11 months, they imitate sounds, use gestures, respond to their own name, and respond to simple instructions. The question specifically said the 10 month old baby was still babbling - how then is its cognitive development not delayed, when its functioning at a 4-6 month old level?

 

[bowlofmushypeas]

I think you're overthinking it and I think BRS is being incorrectly overly specific. Have you ever met a 10 month year old? They spent a LOT of time babbling 🙂 They also do the other stuff mentioned, but babies = babbling so I would've put "normal."

 

[MossPoh]

You are being far too specific with it. Something like babbling has a range. When they give something with a delay, it is rarely a month or two difference....it is more like a year or two.

They'd present a 2 year old who babbles or something else ridiculous. The call is to make those pretty clear cut if you know it.

 

[Tig2575]

You are being far too specific with it. Something like babbling has a range. When they give something with a delay, it is rarely a month or two difference....it is more like a year or two.

They'd present a 2 year old who babbles or something else ridiculous. The call is to make those pretty clear cut if you know it.

That's good to know - thanks

 

[Tig2575]

How about this one? I don't get it:

A 32 year old woman has a 3 week history of dizziness, nausea, and profuse sweating that resolve with eating. She's otherwise healthy and physical exam shows no abnormalities. While in the ER, she becomes dizzy and diaphoretic, and her serum glucose concentration is 45 mg/dL Lab studies show:

Glucose: 35 mg/dL
C peptide 0.5ng/mL (N=0.5-2.5)
Insulin 20uU/mL (N=5-20)
Cortisol 10ug/mL (N=3-15)
Urine sulfonylureas negative

It says the site of the tumor is in her pancreas (and I'm assuming they're calling it an insulinoma), however the labs don't support that at all. C peptide should be through the roof with an insulinoma, shouldn't it? Definitely shouldn't be at the very bottom end of normal...

 

[sgod34]

How about this one? I don't get it:

A 32 year old woman has a 3 week history of dizziness, nausea, and profuse sweating that resolve with eating. She's otherwise healthy and physical exam shows no abnormalities. While in the ER, she becomes dizzy and diaphoretic, and her serum glucose concentration is 45 mg/dL Lab studies show:

Glucose: 35 mg/dL
C peptide 0.5ng/mL (N=0.5-2.5)
Insulin 20uU/mL (N=5-20)
Cortisol 10ug/mL (N=3-15)
Urine sulfonylureas negative

It says the site of the tumor is in her pancreas (and I'm assuming they're calling it an insulinoma), however the labs don't support that at all. C peptide should be through the roof with an insulinoma, shouldn't it? Definitely shouldn't be at the very bottom end of normal...

Look at her insulin, clearly it isn't an insulinoa either. It's a somatostatinoma.

 

[Step1Hash]

Look at her insulin, clearly it isn't an insulinoa either. It's a somatostatinoma.

wouldn't insulin be low then as well? Also I learned that somatostatinomas usually present with hyperglycemia bc they inhibit insulin more than glucagon. In any case this question was poorly written.

 

[sgod34]

wouldn't insulin be low then as well? Also I learned that somatostatinomas usually present with hyperglycemia bc they inhibit insulin more than glucagon. In any case this question was poorly written.

Yah, I heard they can present with either hyper or hypoglycemia. I assumed somatostatinoma was the better answer because she is extremely hypoglycemic but her C-peptide is normal and insulin is with normal limits. And it can't be exogenous insulin, because it isn't a choice apparently.

 

[Tig2575]

Yah, I heard they can present with either hyper or hypoglycemia. I assumed somatostatinoma was the better answer because she is extremely hypoglycemic but her C-peptide is normal and insulin is with normal limits. And it can't be exogenous insulin, because it isn't a choice apparently.

I too heard that somatostatinomas present with hyperglycemia due to the selective inhibition of insulin. I figured it might have been a pheochromocytoma, since catecholamines drive glucose into skeletal mucle...

 

[MintChocolateChip83]

Yah, I heard they can present with either hyper or hypoglycemia. I assumed somatostatinoma was the better answer because she is extremely hypoglycemic but her C-peptide is normal and insulin is with normal limits. And it can't be exogenous insulin, because it isn't a choice apparently.

wouldn't the reason that it couldn't be exogenous insulin be due to the fact that her C-peptide value is normal

 

[septoplasty]

wouldn't the reason that it couldn't be exogenous insulin be due to the fact that her C-peptide value is normal

Yes, exactly, C peptide gives us the picture of endogenous/exogenous insulin..

 

[Vergie]

i'd say the reason its insulinoma is because she continues to secrete enough insulin to lower her glucose even though her serum glucose is well below normal. Since her glucose is 45, you'd expect insulin levels to be pretty low. since they're not, and C-peptide is within normal, its prob insulinoma.

 

[septoplasty]

i'd say the reason its insulinoma is because she continues to secrete enough insulin to lower her glucose even though her serum glucose is well below normal. Since her glucose is 45, you'd expect insulin levels to be pretty low. since they're not, and C-peptide is within normal, its prob insulinoma.

That wouldn't make sense because no matter what your insulin level, your C peptide would have to correspond. Only place where you wouldn't is exogenous insulin. Even in an insulinoma, with the corresponding rise in insulin, you will have an increase in C peptide.

Unless its a somatostatinoma like someone above mentioned, but that would surpress insulin more anyways.. gah its questions like this that make me nervous