Stomach: Zollinger-Ellison syndrome: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Stomach: Zollinger-Ellison syndrome

Sample item

A patient has recurrent ulcers in the distal duodenum and jejunum with chronic diarrhoea. Fasting gastrin is only mildly raised and the gastric pH is below 2. Which test further supports a gastrinoma?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Secretin stimulation test showing a paradoxical rise in gastrin

Zollinger-Ellison syndrome is caused by a gastrin-secreting tumour, usually in the gastrinoma triangle of the duodenum and pancreas. Marked hypergastrinaemia with acid hypersecretion is diagnostic, and an equivocal case is clarified by secretin, which raises gastrin in gastrinoma but not in other causes. Somatostatin receptor imaging is then used to localise the tumour.

Option by option

  • A. Pentagastrin acid output measurement as the only test

    Acid output studies are not the confirmatory step and are rarely needed.

  • B. Serum amylase

    Amylase is raised in pancreatitis, not gastrinoma.

  • C. Urea breath test

    The breath test detects H. pylori, which does not explain this picture.

  • D. Secretin stimulation test showing a paradoxical rise in gastrin (correct)

    Correct. A gastrin rise of at least 120 pg/mL after secretin confirms gastrinoma.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Secretin stimulation test showing a paradoxical rise in gastrin. Zollinger-Ellison syndrome is caused by a gastrin-secreting tumour, usually in the gastrinoma triangle of the duodenum and pancreas.

Why is "Pentagastrin acid output measurement as the only test" not the answer?

Acid output studies are not the confirmatory step and are rarely needed.

Why is "Serum amylase" not the answer?

Amylase is raised in pancreatitis, not gastrinoma.

Why is "Urea breath test" not the answer?

The breath test detects H. pylori, which does not explain this picture.

What concept does this question test?

It tests Stomach: Zollinger-Ellison syndrome in General Surgery. Marked hypergastrinaemia with acid hypersecretion is diagnostic, and an equivocal case is clarified by secretin, which raises gastrin in gastrinoma but not in other causes. Somatostatin receptor imaging is then used to localise the tumour.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Stomach: Zollinger-Ellison syndrome?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.