{"id":3769,"date":"2021-03-17T19:06:00","date_gmt":"2021-03-17T19:06:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=3769"},"modified":"2025-10-01T11:42:40","modified_gmt":"2025-10-01T19:42:40","slug":"usmle-step-1-question-tea-colored-diarrhea","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea","title":{"rendered":"USMLE\u00ae Step 1 Question: Tea-Colored Diarrhea"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#E_Vasoactive_intestinal_peptide_secretion\" >E. Vasoactive intestinal peptide secretion<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#A_Calcitonin_secretion\" >A. Calcitonin secretion<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#B_Catecholamine_secretion\" >B. Catecholamine secretion<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#C_Gastrin_secretion\" >C. Gastrin secretion<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#D_Somatostatin_secretion\" >D. Somatostatin secretion<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a 34-year-old woman with tea-colored diarrhea for the last 2 months. She experiences muscle cramps and feels weak.&nbsp;<strong><em>Can you figure it out?<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 34-year-old woman comes to the office complaining of consistent diarrhea for the last 2 months. The patient has experienced watery, tea-colored diarrhea that happens even when she has not eaten anything. She denies any associated abdominal pain or difficulty swallowing. The patient feels fatigued and weak with muscle cramps which she attributes to being dehydrated. Medical history includes hyperparathyroidism and nephrolithiasis. The patient\u2019s temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 100\/min, respirations are 20\/min, and blood pressure is 100\/60 mmHg. Physical examination shows dry mucous membranes and decreased skin turgor without abdominal tenderness. Laboratory tests show the following:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Laboratory value<\/strong><\/td><td><strong>Result<\/strong><\/td><\/tr><tr><td>Sodium<\/td><td>144 mEq\/L<\/td><\/tr><tr><td>Potassium<\/td><td>2.5 mEq\/L<\/td><\/tr><tr><td>Chloride<\/td><td>93 mEq\/L<\/td><\/tr><tr><td>Bicarbonate<\/td><td>21 mEq\/L<\/td><\/tr><tr><td>Calcium<\/td><td>12 mg\/dL<\/td><\/tr><tr><td>Glucose<\/td><td>250 mg\/dL<\/td><\/tr><tr><td>Parathyroid hormone<\/td><td>350 pg\/mL<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the most likely mechanism of this patient\u2019s symptoms?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;Calcitonin secretion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.&nbsp;Catecholamine secretion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Gastrin secretion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.&nbsp;Somatostatin secretion<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.&nbsp;Vasoactive intestinal peptide secretion<\/strong>Scroll down to find the answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Everybody loves Osmosis.org\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/kizbJZ9cdLg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><u><em><strong>\u2192 Reinforce your understanding with more self-assessment items on Osmosis.<\/strong>\u00a0<\/em><\/u><\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Vasoactive_intestinal_peptide_secretion\"><\/span>E. Vasoactive intestinal peptide secretion<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s USMLE\u00ae Step 1 Question are&#8230;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Calcitonin_secretion\"><\/span><a href=\"https:\/\/www.osmosis.org\/community\">A. Calcitonin secretion<\/a><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>:&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Calcitonin\" target=\"_blank\" rel=\"noreferrer noopener\">Calcitonin<\/a>&nbsp;is a peptide hormone released by the parafollicular cells (C cells) of the thyroid gland. Its normal function is to reduce serum calcium levels, opposing the actions of parathyroid hormone (PTH). Calcitonin levels can be elevated from medullary thyroid cancer, which is seen in MEN type 2A and MEN type 2B, but it is unlikely to be seen in this patient with MEN type 1.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Catecholamine_secretion\"><\/span>B. Catecholamine secretion<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Tumor secretion of the catecholamines norepinephrine, epinephrine, and dopamine are responsible for the symptoms associated with a&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pheochromocytoma\" target=\"_blank\" rel=\"noreferrer noopener\">pheochromocytoma<\/a>, including hypertension, headache, sweating, and tachycardia. Pheochromocytoma is almost never associated with MEN type 1, from which this patient likely suffers.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Gastrin_secretion\"><\/span>C. Gastrin secretion<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>: Gastrin is a peptide hormone released by the G cells in the pyloric antrum of the stomach, duodenum, and pancreas that stimulates secretion of gastric acid by the parietal cells of the stomach. Gastrinomas, specifically of pancreatic origin, are associated with MEN type 1; however, they typically cause upper gastrointestinal ulcers and&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Gastroesophageal_reflux_disease_(GERD)\" target=\"_blank\" rel=\"noreferrer noopener\">gastroesophageal reflux disease<\/a>&nbsp;(GERD), as opposed to this patient\u2019s persistent diarrhea and electrolyte derangements.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Somatostatin_secretion\"><\/span>D. Somatostatin secretion<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect<\/strong>:&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Growth_hormone_and_somatostatin\" target=\"_blank\" rel=\"noreferrer noopener\">Somatostatin<\/a>&nbsp;is a peptide hormone secreted by delta cells in the pyloric antrum of the stomach, duodenum, and pancreas that acts on G protein-coupled somatostatin receptors to inhibit the release of several secondary hormones, including insulin and glucagon. Somatostatin analogues are used in the treatment of several neuroendocrine tumors.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient\u2019s gastrointestinal symptoms are caused by the effects of excess&nbsp;<strong>vasoactive intestinal peptide (VIP)<\/strong>&nbsp;from a&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Pancreatic_neuroendocrine_neoplasms\" target=\"_blank\" rel=\"noreferrer noopener\">VIPoma<\/a>. VIP is a neuropeptide that functions as a neuromodulator and neurotransmitter, and a VIPoma is a rare endocrine tumor that usually originates from the non-\u03b2 islet cells of the pancreas. VIP\u2019s effects include vasodilation, smooth muscle relaxation, and bicarbonate secretion from bile duct cholangiocytes. In excess, VIP binds to intestinal epithelial cells, increasing cAMP and causing fluid and electrolyte secretion into the lumen, which results in&nbsp;<strong>profuse secretory diarrhea with&nbsp;<\/strong><strong><a href=\"https:\/\/www.osmosis.org\/learn\/Hypokalemia\" target=\"_blank\" rel=\"noreferrer noopener\">hypokalemia<\/a><\/strong>&nbsp;and metabolic acidosis. Electrolyte derangements and dehydration cause symptoms of fatigue, muscle cramps, flushing, and weakness.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">VIPomas are associated with&nbsp;<strong><a href=\"https:\/\/www.osmosis.org\/learn\/Multiple_endocrine_neoplasia\" target=\"_blank\" rel=\"noreferrer noopener\">multiple endocrine neoplasia<\/a>&nbsp;syndrome type 1 (MEN type 1)<\/strong>.&nbsp;<em>MEN1<\/em>&nbsp;is a gene that is found on chromosome 11 and codes for a tumor suppressor protein called menin, which normally stops cells from dividing uncontrollably.&nbsp;<em>MEN1&nbsp;<\/em>mutations cause MEN type 1, which is an&nbsp;<strong>autosomal dominant<\/strong>&nbsp;genetic disorder. There are three types of tumors associated with MEN type 1:&nbsp;<strong>parathyroid, pancreatic, and pituitary<\/strong>. This patient has a history of&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Hyperparathyroidism\" target=\"_blank\" rel=\"noreferrer noopener\">hyperparathyroidism<\/a>&nbsp;from a parathyroid adenoma, as well as symptoms consistent with a pancreatic tumor, the VIPoma, suggesting a diagnosis of MEN type 1.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Multiple endocrine neoplasia - causes, symptoms, diagnosis, treatment, pathology\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/inzv8Qt39rA?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Other pancreatic tumors that can occur in MEN type 1 include gastrinomas (stomach ulcers) and insulinomas (hypoglycemia) or glucagonomas (hyperglycemia). Pituitary adenomas may include&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Prolactinoma\">prolactinomas<\/a>&nbsp;(galactorrhea, gynecomastia) and growth hormone-releasing tumors (gigantism, acromegaly). Although parathyroid tumors can also occur in MEN type 2, pancreatic and pituitary tumors are exclusively found in MEN type 1.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The autosomal dominant,&nbsp;<strong>multiple endocrine neoplasia syndrome type 1<\/strong>&nbsp;(MEN type 1) is caused by a deactivating mutation in the MEN1 tumor suppressor gene on chromosome 11 and is characterized by tumors in the \u201cThree P\u2019s\u201d:&nbsp;<strong>parathyroid, pituitary, and pancreas<\/strong>. The pancreatic tumor \u201cVIPoma\u201d causes profuse secretory diarrhea with resultant hypokalemia, muscle weakness and fatigue, often in the absence of abdominal pain.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/accesspharmacy.mhmedical.com\/content.aspx?bookid=1130&amp;sectionid=79752241\" target=\"_blank\" rel=\"noreferrer noopener\">Multiple Endocrine Neoplasia<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis today! Access your\u00a0<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_f804f2.png\" alt=\"The most powerful platform for learning medicine and the health sciences. Try it now button.\" class=\"wp-image-3771\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_f804f2.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/image_f804f2.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><br><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a 34-year-old woman with tea-colored diarrhea for the last 2 months. She experiences muscle cramps and feels weak.&nbsp;Can you figure it out? A 34-year-old woman comes to the office complaining of consistent diarrhea for the [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":3770,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[27,20,44],"tags":[],"class_list":["post-3769","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question: Tea-Colored Diarrhea - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-tea-colored-diarrhea\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question: Tea-Colored Diarrhea - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Each week, Osmosis shares a USMLE\u00ae Step 1-style practice question to test your knowledge of medical topics. Today&#8217;s case involves a 34-year-old woman with tea-colored diarrhea for the last 2 months. She experiences muscle cramps and feels weak.&nbsp;Can you figure it out? 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