This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'Insulinoma is most commonly located in which part of the pancreas - \nSelect and explain. \nA. Head, B. Body, C. Tail, D. Equally distributed', 'role': 'user'}, {'content': 'Answer: D \nExplanation: “Insulinomas invariably occur only in the pancreas, distributed equally in the pancreatic head, body and tail". — Harrison 17/e\n\nInsulinomas are a β cell endocrinal tumur of the pancreas.\nInsulinomas are the most common pancreatic endocrine neoplasms.\nThe symptoms are produced due to excessive secretion of insulin causing hypoglycemia\nMost of the insulinomas are solitary and benign,\nOnly about 10-15% of insulinomas are malignant. (keep in mind that all other endocrine tumours of pancreas are usually malignant).\n\nSymptoms of insulinoma\n\nThe most common symptom is due to the effect of hypoglycemia on the central nervous system.\nThese symptoms are - confusion, disorientation, visual difficulties, irrational behaviour, coma\nOther symptoms are due to increased secretion of catecholamines which includes sweating, tremor and palpitations.\nClassic diagnostic criteria is - Whipple\'s triad\nSigns and symptoms of hypoglycemia during fasting.\nBlood glucose below 2.8 mmol/L (50mg/dl) during symptomatic episodes.\nRelief of symptoms by intravenous administration of Glucose.\nThe most useful diagnostic test and the only one indicated in almost all patients is demonstration Wasting hypoglycemia in the presence of inappropriately high level of insulin.\nThe patient is fasted for 72 hrs or till the symptoms of hypoglycemia develop.\nWhen hypoglycemia develops, serum level of insulin is measured. A ratio of plasma insulin to glucose > 0.3 is diagnostic.\n\nLocalization of the tumour\n\nOnce the diagnosis has been made, localization of the tumour is must for surgery.\nThe most important examination for localization of tumour is intraoperative ultrasound, which can indentify pancreatic tumour in all cases.\nIt is more sensitive than any other method\n\nOther important methods of localization -\n\nHigh resolution CT and MN.\nEndoscopic ultrasound examination of pancreas.\nSelective arteriography\n\n\nT/T - Surgical excision is the t/t of choice -\nSince most insulinomas are benign simple enucleation is done.', 'role': 'assistant'}]