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Following a large meal, which hormone(s) is downregulated?

Refer to the figure shown.Which panel in the figure shows a voltage-gated channel?

A 12-year-old male presents for evaluation of 8 months of recurrent RLQ pain, loose non-bloody stools, and 5 kg weight loss. His growth chart shows linear growth deceleration from the 45th to the 18th percentile over the past 18 months — before he reported GI symptoms. Perianal examination reveals a draining fistula and multiple skin tags. Fecal calprotectin is 2,100 mcg/g. What is the most appropriate next diagnostic workup?

A 7-year-old with known biliary atresia and cirrhosis presents in hemorrhagic shock with hematemesis and hematochezia. HR 158 bpm, BP 72/40 mmHg. Exam: jaundice, massive hepatosplenomegaly, ascites, and caput medusae. Blood type is sent. PRBCs are being prepared. What pharmacologic intervention should be initiated immediately while endoscopy is arranged?

A 15-year-old transgender male (assigned female at birth) presents for a routine health maintenance visit. He has socially transitioned and uses his affirmed name and he/him pronouns. He is accompanied by his mother, who is supportive. The patient reports increasing anxiety related to being addressed by his birth name during healthcare visits and avoiding medical appointments because of previous negative experiences. He has no acute medical complaints. Which of the following actions best demonstrates gender-affirming, patient-centered care?

A 15-year-old male with no prior GI history presents with severe epigastric pain radiating to the back, nausea, and vomiting after a large meal. Lipase is 1,240 U/L (>3× ULN). Amylase is 890 U/L. Ultrasound shows peripancreatic edema and a 4 mm common bile duct stone. He is hemodynamically stable. What is the most appropriate approach to nutrition in this patient?

A 4-year-old boy is referred to genetics for developmental delay, autism spectrum disorder, and multiple congenital anomalies. Physical examination reveals mild dysmorphic facial features, hypotonia, and a ventricular septal defect. There is no significant family history. The geneticist suspects an underlying chromosomal disorder but is concerned that the abnormality may be too small to be identified on a routine karyotype. Which of the following is the most appropriate first-line genetic test?

A 16-year-old obese adolescent with no prior medical history presents with a 2-week history of polyuria and polydipsia and now has progressive confusion and inability to walk. Glucose is 1,240 mg/dL, Na 158 mEq/L, K 4.1 mEq/L, HCO3 19 mEq/L, pH 7.30, effective osmolality 374 mOsm/kg. There are no Kussmaul respirations and no fruity breath. Which represents the most appropriate initial management priority?

A 10-year-old is referred for weight gain. Review of his growth chart shows he has gained 9 kg over 18 months but his height has dropped from the 52nd to the 12th percentile over the same period. BMI is at the 97th percentile. BP is 148/90 mmHg. Examination reveals wide violaceous abdominal striae, a dorsocervical fat pad, and proximal muscle weakness (he cannot rise from a chair without using his arms). Which diagnosis best explains this constellation of findings?

A 15-year-old with new-onset Type 1 diabetes presents in DKA: glucose 540 mg/dL, pH 7.11, HCO3 5 mEq/L, Na 131 mEq/L, K 3.1 mEq/L, anion gap 31. He has received a 10 mL/kg 0.9% NS bolus over 1 hour. The team is ready to initiate the insulin infusion. What should happen first before starting insulin?