A 40-Year-Old Man Is Brought to the Emergency Department for Sudden

question 859

Multiple Choice

A 40-year-old man is brought to the emergency department for sudden onset of headaches, diaphoresis, and loss of consciousness.  His wife states that he was previously in his usual state of health.  His past medical history is unremarkable.  He works as a physician assistant and does not smoke or drink alcohol.  On physical examination, the patient is diaphoretic and comatose.  His fingerstick blood glucose level is 45 mg/dL.  The patient is given 50% dextrose intravenously and then regains consciousness.  He says that he is currently dealing with a great deal of work- and relationship-related stress. Laboratory test results on the blood sample drawn prior to dextrose administration are as follows:
Which of the following is the best next step in management of this patient?

• A)72-hour fasting test
• B)Abdominal CT scan
• C)Examine the patient for needle marks
• D)Mixed-meal challenge test
• E)Oral hypoglycemic agent screen

---

Definitions:

Serendipity

The occurrence of events by chance in a happy or beneficial way, often leading to unexpected and valuable discoveries.

Accidental Discovery

The process of finding something important or useful without actively searching for it, typically resulting in unexpected innovation or knowledge.

Prospective Business Owners

Individuals who are considering starting or purchasing a business.

Social Networking Sites

Online platforms that enable users to create public profiles, share content, and connect with other users for social or professional interaction.