Hi, check this one out:

A 44 year old male presented with history of shortness of breath, diarrhea and flushing attacks, he was admitted to the hospital for further evaluation, general examination is normal except that the patient has non-tender nodular hepatomegaly.
During morning rounds the patient developed an attack of shortness of breath, flushing, nausea and his blood pressure dropped with tachycardia while a student was examining his abdomen.

What do u suspect? and how to confirm it?

Enjoy.

i may say carcinoid tumor metastasied to the liver and can confirm it by urine exam 2 see certain sustance but i cant remember its exact name
i hope i am right

Its urinary 5-HIAA levels
and good job man.

thank u for the case but i am a girl by the way
heba

sorry, and nice to know you Heba.