pancreatitis sample questions based on neet pg , usmle, plab and fmge pattern (mci screening)

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A CT scan of acute pancreatitis will show following features, except:

A: Poor contrast enhancement

B: Dilated main pancreatic duct

C: Enlargement of the pancreas

D: Ill defined outline of the pancreas

Correct Ans:B

Explanation

Dilatation of main pancreatic duct is usually seen in chronic calcific pancreatitis.

Ref: Albert L. Baert, Guy Delorme, L. Van Hoe (1999), Chapter 5 , “Pancreatic Disease inThe Childhood”, In the Book, “Radiology of The Pancreas”, Springer Publications, USA,10 ; Text Book of Radiology and Imaging By Sutton, 7th Edition, Page 7790

Sample Previous Year Question on Pancreatitis based on previous Year Questions ofNEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.orgfor more such Quizzes

Colon cut off sign in plain XRay of abdomen is seen in?

A: Mesenteric ischemia

B: Intussusception

C: Acute pancreatitis



D: Acute cholangitis

Correct Ans:C

Explanation

Abrupt termination of the gas within the colon at the level of the radiological splenicflexure is called colon cut off sign. Inflammatory infiltration of the phrenicocolic ligamentleads to the spasm of the colon and lumen narrowing at the level where colon returns toretroperitoneum.


“Strings of pearls” appearance is seen in?

A: SAIO

B: Gallstone ileus

C: Chronic pancreatitis

D: Duodenal perforation

Correct Ans:C

Explanation

Chronic pancreatitis is characterized by irregularities of of the pancreatic ducts, ductalstrictures, and area of duct dilation. The major as well as the side branch ducts may beinvolved. For unexplained reason, some patients with chronic pancreatitis develop dilatedmain pancreatic ducts (large ductal disease), whereas others retain ducts of normal oreven smaller than normal calibers (small ductal disease). Some patients with chronicpancreatitis can be shown to have major ducts that have the appearance of a “chain oflakes” or a ”strings of pearls” that is the result of segment of dilated duct separated byareas of ductal stricture.

Ref: Sutton’s Radiology 7/e, Volume 1, Page 798




On radiography widened duodenal 'C' loop with irregular mucosal pattern on uppergastrointestinal barium series is most likely due to:

A: Duodenal ileus

B: Chronic pancreatitis

C: Duodenal ulcer

D: Carcinoma head of pancreas

Correct Ans:D

Explanation

Widening of duodenal C loop, inverted 3 sign of Frostburg and rosethorn appearance is seen in carcinoma head of pancreas. Thetreatment is Whipple’s procedure.

Ref: Albert L. Baert, Guy Delorme, L. Van Hoe (1999), Chapter 5, “Pancreatic Disease in The Childhood”, In the Book, “Radiology ofThe Pancreas”, Springer Publications, USA, Page 116


A CT scan of acute pancreatitis will show following features, except:

A: Poor contrast enhancement

B: Dilated main pancreatic duct



C: Enlargement of the pancreas

D: Ill defined outline of the pancreas

Correct Ans:B

Explanation

Dilatation of main pancreatic duct is usually seen in chronic calcific pancreatitis.

Ref: Albert L. Baert, Guy Delorme, L. Van Hoe (1999), Chapter 5 , “Pancreatic Disease inThe Childhood”, In the Book, “Radiology of The Pancreas”, Springer Publications, USA,Page 110 ; Text Book of Radiology and Imaging By Sutton, 7th Edition, Page 7790


The primary imaging technique used in a case of suspected acute pancreatitis is:

A: MRI abdomen

B: CECT abdomen with pancreatic protocol

C: USG abdomen

D: MR enterography

Correct Ans:B

Explanation

MDCT is the primary imaging technique used in evaluating patients suspected of havingacute pancreatitis.

CT useful for:

Morphologic changes in the pancreas that allow confirmation of pancreatitis Assessment of the severity



It is the only imaging study that predicts clinical outcome.

Ref: ACR Appropriateness Criteria, Acute Pancreatitis


The CT severity index in acute pancreatitis is described by:

A: Balthazar

B: Mengini

C: Chapman

D: Napelon

Correct Ans:A

Explanation

The CT severity index (CTSI)described by Balthazar

Balthazar CT Severity Index CT Grade Score

A. Normal 0B. Enlarged gland 1C. Peripancreatic inflammation 2D. One fluid collection 3E. Two or more collections 4

Necrosis Score

<30% (2)30%50% (4)>50% (6)

Ref: ACR Appropriateness Criteria,Acute Pancreatitis.




The potential limitation of CECT in the setting of the acute pancreatitis is:

A: Can not assess the severity

B: May not useful in assessing prognosis

C: Can not clearly diagnose gallstone pancreatitis

D: Can not diagnose peripancreatic fluid collection

Correct Ans:C

Explanation

MDCT is the primary imaging technique used in evaluating patients suspected of havingacute pancreatitis

CT useful for:

Morphologic changes in the pancreas that allow confirmation of pancreatitis Assessment of the severity

It is the only imaging study that predicts clinical outcome.A potential limitation of MDCT in assessing acute pancreatitis is that it has only moderatesensitivity fordetecting gallstones and biliary stones.

Ref: ACR Appropriateness Criteria,Acute Pancreatitis.


A patient with abdominal pain shows "coffee bean" sign in plain abdominal Xray. Heprobably have:



A: Colon carcinoma

B: Duodenal atresia


D: Sigmoid volvulus

Correct Ans:D

Explanation

Sigmoid volvulus is a closedloop colonic obstruction due to twisting along the mesentericor long axis of the bowel. Although colonic volvulus is not common, about 90% of casesoccur in the sigmoid colon. On plain abdominal films, the sigmoid volvulus forms aninverted Ushaped structure with the twisted sigmoid loops lying adjacent and having anoval appearance called the "coffee bean" sign. On barium enema examination, taperedobstruction of the sigmoid colon is found. Ref: Ott D.J. (2011). Chapter 10. Gastrointestinal Tract. In M.Y. Chen, T.L. Pope, D.J. Ott(Eds), Basic Radiology, 2e.


Doublebubble sign on abdominal Xray is seen in :

A: Colon carcinoma

B: Duodenal atresia


D: Perforation



Correct Ans:B

ExplanationDouble bubble sign is the characteristic abdominal Xray sign associated with duodenalatresia. In tis, the stomach and first part of the duodenum are the only parts of theintestine filled with gas giving the characteristic appearance. Duodenal atresia typically presents in the first hour of life. Children presents with biliousvomiting and epigastric distention within a few hours of birth. Meconium may be passednormally. It is often associated with other conditions such as esophageal atresia, intestinal atresia,cardiac and renal anomalies. Ref: Oski's Pediatric Certification and Recertification Board Review By Carmen Coombs,page 404. Sundaram S.S., Hoffenberg E.J., Kramer R.E., Sondheimer J.M., Furuta G.T.(2012). Chapter 21. Gastrointestinal Tract. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding,J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.


Erythema nodosum is seen in all of the following, EXCEPT:

A: Pregnancy

B: Tuberculosis

C: SLE

D: Chronic Pancreatitis

Correct Ans:D

Explanation

Pregnancy, SLE and Tuberculosis are all associated with Erythema Nodosum. Erythema Nodosum arepainfully red nodular lesions, occuring bilaterally on the shins. This lesion occur predominantly inwoman in the fall and winter months. It is associated with SLE, Leprosy, TB, etc.

Ref: Immunology, Immunopathology and Immunity, by Stewart Sell, Edward E. Max, Page518; Chronic Pancreatitis, by Markus Buchler, Helmutt Friess, Page 29, 30, 37.




Pancreatitis occurs with:

A: Abacavir

B: Zidovudine

C: Lamivudine

D: Didanosine

Correct Ans:D

ExplanationThe most prominent dose related toxicity associated with the use of didanosine arepancreatitis and peripheral neuropathy.

Ref: Essentials of Medical Pharmacology By KD Tripathi, 5th Edition, Page 728 30;Pharmacogenomic Testing in Current Clinical Practice : Implementation in the ClinicalLaboratory By Alan H. B. Wu, KiangTeck J. Yeo, Page 203.


All of the following drugs cause pancreatitis as side effect, EXCEPT:

A: Captopril

B: Furosemide

C: Valproic acid



D: Didanosine

Correct Ans:A

Explanation

Adverse effects of captopril are hypotension, acute renal failure in patients with bilateralrenal artery stenosis, hyperkalemia , dry cough and angioedema.

Drugs associated with highest incidence of pancreatitis aredidanosine, sodium valproate, 5 aminosalicylates and oestrogens.

Drugs causing pancreatitis:

DidanosineFurosemide and thiazide diureticsMesalazineMetronidazoleOestrogensPentamidineSodium valproateSulfasalazineSulfonamidesTetracycline

Ref: Adverse Drug Reactions edited by Anne Lee page 183.Benowitz N.L. (2012). Chapter 11. Antihypertensive Agents. In B.G.Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & ClinicalPharmacology, 12e.


The MOST important risk factor for pancreatic cancer among the following is:

A: Cigarette smoking

B: Chronic pancreatitis

C: Diabetes



D: Alcohol

Correct Ans:A

Explanation

All are risk factors of pancreatic malignancy except alcohol.

Cigarette smoking is the most common environmental risk factor for pancreaticmalignancy. Other risk factors are chronic pancreatitis and diabetes.

ALSO NOTE:Alcohol does not appear to be a risk factor.

Ref: Harrison, Edition 18, Page787


A 25 year old plumber comes to the clinic with complaints of abdominal colic,constipation, weakness of hand and anemia since 2 years. What would be the mostprobable diagnosis in this patient?

A: Lead poisoning

B: Gastric carcinoma

C: Chronic pancreatitis

D: Hookworm infestation

Correct Ans:A

Explanation

The occupational history and clinical features of this patient suggest that he is sufferingfrom chronic lead poisoning.

Characteristic features of chronic lead poisoning includes:



Facial pallor: Particularly of the mouth is the earliest and most consistent sign.Anemia: Anemia associated with polychromasia, punctate basophilia,reticulocytosis, poikolocytosis, anisocytosis and sideroblastosis. Basophilic stipplingrefers to the presence of dark blue pin head sized spots in the cytoplasm of redblood cells. Lead line or Burtonian line: seen on gums in 70% cases.Colic and constipation seen in 85% cases.Lead palsy: Radial nerve is most commonly involved resuling in wrist drop. Encephalopathy: It is seen in every case of plumbism. Lead encephalopathy isirreversible and 85% have permanent brain damage.


Round worm causes all, except :

A: Obstructive jaundice

B: Pancreatitis

C: Intestinal obstruction

D: Intestinal perforation

Correct Ans:D

ExplanationA large Round worm burden can lead to malnutrition and weakness, and a mass of wormsmay lead to bowel obstruction. Wandering ascaris also traverse internal organs rarelyleading to biliary obstruction, hepatic abscess, acute pancreatitis, acute appendicitis, orhypersensitivity pneumonitis. It does not cause intestinal perforation. Ref :VanRooyen M.J., Venugopal R. (2011). Chapter 156. World Travelers. In R.K.Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive StudyGuide, 7e.




Which of the following condition is associated with migratory thrombophlebitis?

A: Pancreatitis

B: Pancreatic Ca

C: Varicose veins

D: Buerger's disease

Correct Ans:C

ExplanationSuperficial vein thrombophlebitis (SVT) most commonly occurs in varicose veins but canoccur in normal veins. When SVT recurs at variable sites in normal superficial veins, itmay signify a hidden visceral malignancy or a systemic disease such as a blood dyscrasiaand/or a collagen vascular disease. This condition is known as thrombophlebitis migrans.Clinical signs of SVT include redness, warmth, and tenderness along the distribution of theaffected veins, often associated with a palpable cord. Ref: Liem T.K., Moneta G.L. (2010). Chapter 24. Venous and Lymphatic Disease. In F.C.Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock(Eds), Schwartz's Principles of Surgery, 9e.


All of the following statements about Pancreatic Carcinoma are true, EXCEPT:

A: Mutation in P53 gene is associated in 75% of cases

B: Hereditary Pancreatitis significantly increases the risk

C: Median survival in locally advanced (stage III) disease is 36 months



D: Five year survival after curative pancreaticoduodenectomy is 15 20%

Correct Ans:C

Explanation

Median survival for stage III pancreatic cancer is 610 months and for patients withmetastatic disease such as stage IV it is 36 months.

Staging of pancreatic cancer:Stage I disease includes T1 (size <2cm diameter) and T2 tumors (>2cm, limited topancreas) with no lymph node involvement. Stage II disease includes T3 ( lesions extend beyond the pancreas but do not involve theceliac axis or superior mesenteric artery). Stage III includes T4 (lesions involve the celiac axis or superior mesenteric artery andare not resectable) without metastatic disease. Stage IV includes T4 with metastases to distant sites such as the liver or lungs are stageIV.

Ref: Schwartz's Principles of Surgery, 9th Edition, Chapter 33; Pancreatic Cancer ByDaniel D. Von Hoff, Page 447; Lecture Notes: General Surgery By Harold Ellis, Page 288


A patient presents in the causality with history of abdominal pain. On examination theperson is in shock, with severe abdominal tenderness and guarding. There was also oneepisode of bloody diarrhoea. He gives a history of recurrent abdominal pain soon aftertaking food which persists for about 3 hours after food. He also has a history of MI about 5years back. What is your diagnosis?

A: Acute thrombotic mesenteric vascular occlusion

B: Acute pancreatitis

C: Acute duodenal ulcer perforation

D: Acute appendicitis



Correct Ans:A

Explanation

The person has had recurrent episodes of abdominal angina as shown by the pain afterfood intake. He also has a history of MI which also suggests that he has atherosclerosis.The bloody diarrhoea is again suggestive of mesenteric vascular occlusion in this patient.

Ref: Manipal Millennium Edition, Page 429; S.Das, Edition 5, Page 354


Which of the following type of pancreatitis is associated with better prognosis ?

A: Alcoholic pancreatitis

B: Gall stone pancreatitis

C: Post operative pancreatitis

D: Idiopathic pancreatitis

Correct Ans:B

Explanation

Pancreatitis caused by a remediable cause such as cholilithiasis is associated with best prognosis. Eradication of gallsones can prevent further attacks of pancreatitis.

Gall stone pancreatitis accounts for about 90% of cases of acute pancreatitis. Women are more affected than men. In this, gallstone is typically located in the distal common bile duct, which shares its pathway with the main pancreatic duct. Gallstones are recoverable in the feces of over 90% of patients within 10days of an attack of acute pancreatitis.

Treatment involves supportive care till amylase and lipase levels returns to normal. ERCP with sphincterectomy and stone retrieval is done in patients who do not pass the stone spontaneously. After the resolution of of an episode of gallstone pancreatitis, patient should be treated with a laparoscopic hysterectomy with a cholangiogram.

Ref: Oxford Textbook of Surgery, 2nd Edition, Page 1766; Clinical Review of Surgery: ABSITE



Preparation By Surgisphere Corporation, Page 2378


A patient undergoes a prolonged and complicated pancreatic surgery for chronicpancreatitis. Most preferred route for supplementary nutrition in this patient would be:

A: Total Parental Nutrition

B: Feeding Gastrostomy

C: Feeding Jejunostomy

D: Oral feeding

Correct Ans:C

Explanation

When a patient has undergone a prolonged and complicated pancreatic surgery, therecovery of the patient will require a form of nutrition that gives rest to the pancreas andprotect the pancreatic anastomosis. A feeding jejunostomy in such a case can providesupplementary nutrition and also gives protection to the pancreatic anastomosis andcause minimal stimulation of pancreatic secretion thereby giving rest to the pancreas.

Ref: Clinical Nutrition in Gastrointestinal Disease By Buchman, 2006, Pages 25657;Artificial Nutrition Support in Clinical Practice By Jason Payne, 2nd Edition, Page 273;Essentials of General Surgery By Lawrence, 4th Edition, Page 80


All of the following statements about Pancreatic Carcinoma are true, EXCEPT:



A: Mutation in P53 gene is associated in 75% of cases

B: Hereditary Pancreatitis significantly increases the risk

C: Median survival in locally advanced (stage III) disease is 36 months

D: Five year survival after curative pancreaticoduodenectomy is 15 20%

Correct Ans:C

Explanation

Median survival for stage III pancreatic cancer is 610 months and for patients withmetastatic disease such as stage IV it is 36 months.

Staging of pancreatic cancer:

Stage I disease includes T1 (size <2cm diameter) and T2 tumors (>2cm, limited topancreas) with no lymph node involvement. Stage II disease includes T3 ( lesions extend beyond the pancreas but do not involve theceliac axis or superior mesenteric artery). Stage III includes T4 (lesions involve the celiac axis or superior mesenteric artery andare not resectable) without metastatic disease. Stage IV includes T4 with metastases to distant sites such as the liver or lungs are stageIV.

Ref: Schwartz's Principles of Surgery, 9th Edition, Chapter 33; Pancreatic Cancer ByDaniel D. Von Hoff, Page 447; Lecture Notes: General Surgery By Harold Ellis, Page 288


A lady with a history of epigastric pain radiating to back for three days with normal Serumamylase levels and abdomen ultrasonogram (USG) revealed cholelithiasis and anenlarged pancreas. CT scan confirmed the underlying pathology. Which of the following isthe most likely diagnosis.

A: Acute Cholecystitis

B: Acute Pancreatitis



C: Acute Appendicitis

D: Acute Peritonitis

Correct Ans:B

ExplanationHistory of epigastric pain radiating to back along with an enlarged (edematous) pancreason ultrasonography suggests a diagnosis of Acute Pancreatitis. Serum amylase levels maybe normal during an attack of acute pancreatitis. Ref: Bailey and Love Short Practice of Surgery 24th Edition, Page11231125; Harrison's17th Edition, Page 2003, 2004, 2007; Current Diagnosis & Treatment in Gastroenterology(Wiley Blackwell) 4th Edition, Page 516; Basic skills in Interpreting Laboratory Data byMary Lee 4th Edition, Page 7251.


Which of the following can be used in the management of acute pancreatitis?

A: Octreotide

B: Aprotinin

C: Glucagone

D: All the above

Correct Ans:D

Explanation

Antibiotic, corticosteroids, H2 blockers and NSAIDS also have a role.




Which of the following is not a cause for Acute pancreatitis?

A: Gall stones

B: Hemochromatosis

C: Alcohol intake

D: Anti retroviral drug

Correct Ans:B

Explanation

Common causes of acute pancreatitis are gallstones, alcohol, ERCP, trauma, post surgery, dysfunction of sphincter of Oddi and by drugs such as antiretroviral drugs, azathioprine, tetracycline, valproic acid, 6 mercaptopurine, sulfonamides and estrogen. Hemochromatosis is not a cause of acute pancreatitis.

Reference:Harrison's Principles of Internal Medicine 18e, chapter 313.


All of the following are used in the treatment of acute pancreatitis EXCEPT:

A: Analgesics

B: IV fluids

C: Antibiotics

D: Nasojejunal feeds



Correct Ans:C

Explanation

In most patients (8590%) with acute pancreatitis, the disease is selflimited and subsides spontaneously, usually within three to seven days after treatment is instituted. Conventional measures includes

•Analgesics for pain•IV fluids and colloids to maintain normal intravascular volume•No oral alimentation.

Once it is clear that a patient will not be able to tolerate oral feeding (a determination that can usually be made within 4872 hours), enteral nutrition should be considered [rather than total parenteral nutrition (TPN)] since it maintains gut barrier integrity, thereby preventing bacterial translocation, is less expensive, and has fewer complications than TPN. The route through which enteral feeding is administered is under debate. Nasogastric access is easier to establish and may be as safe as nasojejunal enteral nutrition. However, enteral nutrition that bypasses the stomach and duodenum stimulates pancreatic secretions less and this rationale theoretically supports the use of the nasojejunal route. It has not been demonstrated whether either route is superior in altering morbidity and mortality. When patients with necrotizing pancreatitis begin oral intake of food, consideration should also be given to the addition of pancreatic enzymesupplementation and proton pump inhibitor therapy to assist with fat digestion and reduce gastric acid.

About oral antibiotics harrisson states that:

"There is currently no role for prophylactic antibiotics in either interstitial or necrotizing pancreatitis. Although several early studies suggested a role for prophylactic antibiotics in patients with necrotizing pancreatitis, two recent doubleblind, randomized controlled trials failed to demonstrate a reduction in pancreatic infection with use of antibiotic prophylaxis". Percutaneous aspiration of necrosis with Gram stain and culture should generally not be performed until at least 710 days after establishing a diagnosis of necrotizing pancreatitis and only if there are ongoing signs of possible pancreatic infection such as sustained leukocytosis, fever, or organ failure. Once a diagnosis of infected necrosis is established, appropriate antibiotics should be instituted and surgical debridement should be undertaken


Which of the following statement regarding pancreatitis is true ?

A: Acute pancreatitis has reversible changes



B: Alcohol causes only acute pancreatitis

C: Chronic pancreatitis shows no signs of inflammation

D: Acute pancreatitis affects mainly younger population

Correct Ans:A

Explanation

Chronic pancreatitis is a disease process characterized by irreversible damage to the pancreas as distinct from the reversible changes noted in acute pancreatitis. The condition is best defined by the presence of histologic abnormalities, including chronic inflammation, fibrosis, and progressive destruction of both exocrine and eventually endocrine tissue.

Alcohol is implicated in both acute and chronic pancreatitis and both can occur in young adults.


Scenario: A 40 year old immunocompromised lady presents with rapid onset of severeaddominal symptoms. Assertion: “Sentinel loop” is a Xray finding in acute pancreatitis. Reason: The finding is due to patient's posture of leaning forward like a loop, because of pain.

A: Both Assertion and Reason are true, and Reason is the correct explanation forAssertion

B: Both Assertion and Reason are true, and Reason is not the correct explanationfor Assertion

C: Assertion is true, but Reason is false

D: Assertion is false, but Reason is true



Correct Ans:C

Explanation

It is an Xray finding of acute pancreatitis. Sentinel loop is a single dilated atonic loop ofsmall bowel in straight Xray which is a diagnostic feature of acute pancreatitis.

Ref: A Manual of Clinical Surgery by S. Das, 6th Edition, Page 352


The 'beading' appearance is seen in the condition:

A: Chronic pancreatitis

B: Acute pancreatitis

C: Gall stone ileus

D: Subacute intestinal obstruction

Correct Ans:A

Explanation

In chronic pancreatitis, the pancreatic duct may show beading or a chainoflakes orstringofpearls appearance because of alternating stenosis and dilatation of thepancreatic duct. Other features of chronic pancreatitis include strictures, cysts and ductalcalculi.


Pancreatitis may be produced by which of the following drugs?



A: Colchicine

B: L asparagine

C: Ciprofloxacin

D: Nalidixic acid

Correct Ans:B

Explanation

Exposure to certain drugs is the third most common frequent cause of pancreatitis aftergallstones and alcohol.

Drugs associated with pancreatitis:

Definitive cause

5 Aminosalicylate6 MercaptopurineAzathioprineCytosine arabinosideDideoxyinosineDiureticsEstrogensFurosemideMetronidazolePentamidineTetracyclineThiazideTrimethoprim sulphamethoxazoleValproic acid

Probable cause

Acetaminophena Methyl DOPAIsoniazidL asparaginePhenforminProcainamideSulindac

Ref: Sabiston 18/e, Page 1595




Which of the following is NOT a bad prognostic sign for pancreatitis?

A: TLC > 16000

B: Calcium < 8 mmol/L

C: Glucose > 200 mg%

D: Prothrombin > 2 time the control

Correct Ans:D

Explanation

Ranson’s Prognostic signs of Acute Pancreatitis (Caused by causes other than gallstones)

At Admission During the initial 48 hrs

Age > 55 years WBC > 16,000/mm^3 Blood glucose > 200 mg/dl Serum LDH > 350 IU/dl Serum AST > 250 U/dl

Hematocrit fall > 10 points BUN elevation > 5 mg/dL Serum calcium < 8 mg/dL Arterial PO2 < 60 mmHg Base deficit > 4 mEq/dL Estimated fluid sequestration > 6L

Also know Prognosis criteria for gallstone pancreatitis

At Admission During the initial 48 hrs

Age > 70 years WBC > 18,000/mm^3 Blood glucose > 220 mg/dl Serum LDH > 400 IU/dl Serum AST > 250 U/dl

Hematocrit fall > 10 points BUN elevation > 2 mg/dL Serum calcium < 8 mg/dL Arterial PO2 < 60 mmHg Base deficit > 5 mEq/dL Estimated fluid sequestration > 4L

Ref: Sabiston 18/e, Page 1600; Schwartz 9/e, Page 1183; Washington Manual of Surgery4/e, Page 282v.




Poor prognostic factors for acute pancreatitis are all, EXCEPT:

A: Hyperglycemia

B: Hypocalcemia

C: Raised LDH levels in blood

D: Hyperamylasemia

Correct Ans:D

Explanation

Hyperamylasemia is not mentioned as the poor prognostic factor. Increased blood glucose,Increased LDH, and decreased serum calcium, all are included in the ranson’s criteria ofsevere pancreatitis.

Ref: Sabiston 18/e, Page 1600; Schwartz 9/e, Page 1183; Washington Manual of Surgery4/e, Page 282.


All of the following can be used to predict severe acute pancreatitis, EXCEPT:

A: Glasgow score 3



B: Apache II score 9

C: CT severity score 6

D: C reactive protein < 100

Correct Ans:D

Explanation

On account of difference in the outcome between patients with mild and severe disease, itis important to define that group of patients who will develop severe pancreatitis.

Criteria used to determine the severity of acute pancreatitis: Criteria used Score at which severity is indicated

Apache score 8

Glasgow score 3

Ranson criteria 3

CT severity index 6

C reactive protein > 150 mg L

Ref: Harrison 17/e, Page 2008; Bailey & Love 1140.


Persistent organ failure in the setting of acute pancreatitis is defined, when the organfailure lasts for more than:

A: 12 hours

B: 24 hours



C: 48 hours

D: 72 hours

Correct Ans:C

Explanation

The determinant of the severity of acute pancreatitis during the early phase is thepresence and duration of organ failure, if organ failure persists for >48 h.

Ref: Gut 2013;62:102–111. doi:10.1136/gutjnl2012302779.


Areas of peripancreatic fluid seen within the first 4 weeks after onset of interstitialoedematous pancreatitis is called:

A: Acute Peripancreatic fluid collection

B: Pseudocyst

C: WOPN

D: Abscess

Correct Ans:A

Explanation

APFC (acute peripancreatic fluid collection)

This term applies only to areas of peripancreatic fluid seen within the first 4 weeksafter onset of interstitial oedematous pancreatitis

CECT criteria of peripancreatic fluid collection

In the setting of interstitial oedematous pancreatitis



Homogeneous collection Confined by normal peripancreatic planesNo definable wall encapsulating the collection

Ref: Gut 2013; 62:102–111. doi:10.1136/gutjnl2012302779.


Ranson’s score is associated with:

A: Volvulus

B: Pancreatitis

C: Appendicitis

D: None of the above

Correct Ans:B

ExplanationPancreatitis can be classified as severe based on predictors such as APACHEII scores andRanson's signs, and any evidence that the condition is severe mandates care of thepatient in the intensive care unit. Such evidence may take various forms, such as theonset of encephalopathy, a hematocrit >50%, urine output <50 mL/h, hypotension, fever,or peritonitis.

Elderly patients with three or more Ranson's criteria should also be monitored carefullydespite the absence of severe pain. Ref: Schwartz’s principle of surgery 9th edition, chapter 33.




Surgical intervention in acute pancreatitis is indicated in all, EXCEPT:

A: Infected necrosis

B: Infected collection

C: Impacted gallstone in ampulla

D: None of the above

Correct Ans:D

ExplanationSurgical intervention in acute pancreatitis is reserved for patients with infected collectionsor infected necrosis only, or to relieve an impacted gallstone in the ampulla if endoscopicor radiologic treatments are unavailable or unsuccessful. Ref: Schwartz’s principle of surgery 9th edition, chapter 33.


A 58 year old male alcoholic with chronic pancreatitis develops a palpable abdominalmass. Ultrasound reveals a 9 cm cystic lesion adjacent to the pancreas. An importantcomplication that might occur if this cyst ruptured would be?

A: Anaphylactic shock

B: Carcinomatosis

C: Disseminated infection

D: Intestinal hemorrhage



Correct Ans:D

ExplanationThe patient most likely has a pancreatic pseudocyst, which is a complication ofpancreatitis. Pancreatic pseudocyst is not a true cyst; it is lined by granulation tissue andcollagen. It contains pancreatic juices and lysed blood, so rupture would spill the activedigestive enzymes onto the adjacent viscera, particularly the stomach, small intestine,and transverse colon. Digestive action produces potentially severe gastrointestinalhemorrhage. Anaphylactic shock results from massive activation of the IgEmediated branch of theimmune system. Pancreatic secretions do not elicit an IgE response. The classicabdominal cyst that ruptures, producing anaphylactic shock, is a hydatid cyst. Carcinomatosis is widespread serosal spread of a carcinoma, typically due to tumorspillage into a body cavity. Although this may occur with pancreatic mucinouscystadenocarcinoma, this disease is far less likely to occur than is pancreatic pseudocystin a patient with chronic pancreatitis. Pancreatic pseudocyst is not an infective disease. Although septic abscesses do occur inthe abdomen, and may even complicate a pancreatic pseudocyst, the danger of rupture ismore associated with tissue destruction by pancreatic enzymes than with infection. Ref: Fisher W.E., Anderson D.K., Bell R.H., Saluja A.K., Brunicardi F.C. (2010). Chapter 33.Pancreas. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B.Matthews, R.E. Pollock (Eds), Schwartz's Principles of Surgery, 9e.


A 23 year old female presented with symptoms of severe pancreatitis. All of the followingare the bad prognostic signs in this patient, EXCEPT:

A: TLC> 16000

B: Calcium less than 8 mmol/L

C: Glucose > 200 mg%



D: Prothrombin > 2 times the control

Correct Ans:D

Explanation

Ranson criteria differentiates mild and severe pancreatitis. It includes five parametersdetermined at the time of admission and six parameters determined during thesubsequent 48 hours.

Ranson Criteria:

On admission Within Next 48 h

Age >55 y (>70 y) Decrease in hematocrit by >10% (same)

White blood cell count >16,000/mm3 (>18,000/mm3)

Estimated fluid sequestration >6 L (>4 L)

Blood glucose level >200 milligrams/dL (>220 milligrams/dL)

Serum calcium level <8.0 milligrams/dL (same)

Serum lactate dehydrogenase level >350 IU/L (>400 IU/L)

Partial pressure of arterial oxygen <60 mm Hg (omitted)

Serum aspartate aminotransferase level >250

IU/L (same)

Increase in blood urea nitrogen level >5 milligrams/dL after IV fluid hydration (>2

milligrams/dL)

Base deficit of >4 mmol/L (>6 mmol)

Patients with three or more Ranson criteria have more severe disease and an increasedrisk of complications and death.

Ref: Atilla R., Oktay C. (2011). Chapter 82. Pancreatitis and Cholecystitis. In J.E. Tintinalli,J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli'sEmergency Medicine: A Comprehensive Study Guide, 7e.


Which of the following is NOT a prognostic factor for acute pancreatitis?



A: Hypocalcemia

B: Hyperglycemia

C: AST elevation

D: Increased serum amylase

Correct Ans:D

Explanation

The prognostic factors considered for predicting the severity of acute pancreatitis are :

Arterial PaO2 less than 60 mmHgLDH more than 600 IU/LAST more than 200 IU/LWBC more than 15,000/mm3Serum albumin less than 3.2gm/dlSerum calcium less than 8 mg/dlBlood glucose more than 180 mg/dlBlood urea more than 45 mg/dl

Ref: Grading and Staging in Gastroenterology By Guido N. J.Tytgat, page 300.


Child's ChildTurcottePugh is used in :

A: Pancreatitis

B: Cirrhosis

C: Multiple myeloma

D: AIDS



Correct Ans:B

ExplanationThe ChildTurcottePugh (CTP) score was originally developed to evaluate the risk ofportacaval shunt procedures secondary to portal hypertension and subsequently has beenshown to be useful in predicting surgical risks of other intraabdominal operationsperformed on cirrhotic patients. Numerous studies have demonstrated overall surgicalmortality rates of 10% for patients with class A cirrhosis, 30% for those with class Bcirrhosis, and 75 to 80% for those with class C cirrhosis. Ref : Tsung A. (2010). Chapter 31. Liver. In T.R. Billiar, D.L. Dunn (Eds), Schwartz'sPrinciples of Surgery, 9e.


Gallstones may be complicated by which of the following?

1. Pancreatitis2. Choledocholithisasis3. Acute cholecystitis4. Carcinoma stomach5. Carcinoma pancreas

A: 1,2 & 3

B: 2,3 & 4

C: 1,3 & 5

D: 2,3 & 5

Correct Ans:A

Explanation

Effects and complications of gallbladder stones are:

In Gallbladder In Bile ducts In the intestine

Silent stoneObstructive jaundice

Acute intestinal obstruction



Acute cholecystitisChronic cholecystitisMucoceleEmpyemaPerforationGangreneCarcinoma

CholangitisAcute pancreatitis

(Gallstone ileus)

Ref: Bailey & Love 25/e, Page 1120.


The Reynold's pentad of fever, jaundice, right upper quadrant pain, septic shock andmental status change in typical of:

A: Cholangitis

B: Hepatitis

C: Cholecystitis

D: Pancreatitis

Correct Ans:A

Explanation

Cholangitis is one of the two main complications of choledochal stones, the other beinggallstone pancreatitis. The most common presentation is fever, epigastric or right upperquadrant pain, and jaundice. These classic symptoms, well known as Charcot's triad, arepresent in about two thirds of patients.

The illness may progress rapidly with septicemia and disorientation, known as Reynoldspentad (e.g., fever, jaundice, right upper quadrant pain, septic shock, and mental statuschanges). Ref: Oddsdottir M., Pham T.H., Hunter J.G. (2010). Chapter 32. Gallbladder and the



Extrahepatic Biliary System. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G.Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwartz's Principles of Surgery, 9e.


In case of choledochal cyst, sidetoside choledochoduodenostomy is NOT recommendedbecause of the risk of:

A: Malignancy

B: Pancreatitis

C: Recurrent Cholangitis

D: Gall stones

Correct Ans:C

Explanation

The treatment for choledochal cyst is complete excision with RouxenYhepaticojejunostomy. The duodenal end of the bile duct should be oversewn withoutinjury to the anomalous entry of the pancreatic duct, limiting the amount of residualbiliary tissue at risk for malignancy. Sidetoside choledochoduodenostomy is notrecommended because it is followed by a high incidence of stricture of the anastomosisand recurrent cholangitis. Cholecystectomy is always performed.

Ref: Albanese C.T., Sylvester K.G. (2010). Chapter 43. Pediatric Surgery. In G.M. Doherty(Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.


What will be the likely diagnosis in a thirty year old male presenting with epigastric painradiating to back that wakes him up at night and is relieved by consuming food. He has apast history of surgery for a perforated duodenal ulcer, treated with omental patch andproton pump inhibitors and analgesics:



A: Atrophic Gastritis

B: Duodenal Ulcer

C: Gastric Ulcer

D: Chronic Pancreatitis

Correct Ans:B

Explanation Epigastric pain relieved by food that awakens the patient of night (when stomach isempty) suggests a diagnosis of duodenal ulcer. Gastric ulcer pain is exacerbated by foodand usually does not awaken the patient at night. Pancreatic pain is not relieved by food &is typically relieved by bending forwards & worsened on lying down. Ref: Bailey and Love Short Practice of Surgery 24th Edition, Page 10389; CurrentDiagnosis & Treatment in Surgery (CSDT) 13th Edition, Page85.


Ten days after a splenectomy for blunt abdominal trauma, a 23yearold man complains ofupper abdominal and lower chest pain exacerbated by deep breathing. He is anorectic butambulatory and otherwise making satisfactory progress. On physical examination, histemperature is 38.2°C (108°C) rectally, and he has decreased breath sounds at the leftlung base. His abdominal wound appears to be healing well, bowel sound are active andthere are no peritoneal signs. Rectal examination is negative. The W.B.C. count is 12,500mm3 with a shift to left. Chest Xrays show platelike atelectasis of the left lung field.Abdominal Xrays show a nonspecific gas pattern in the bowel and an airfluid level in theleft upper quadrant. Serum amylase is 150 Somogyi units dl (normal 60 to 80). The mostlikely diagnosis is:

A: Subphrenic abscess

B:

C: Pancreatitis



D: Pulmonary embolism

Correct Ans:A

Explanation

Patient is showing features of subphrenic abcess. Patient presents with local or subcostal pain and tenderness, unexplained fever and tachycardia.

Investigation: CBC shows leucocytosis.

Xray chest shows elevated hemidiaphragm, blunting of the costophrenic angle, pleural effusion and pulmonary infiltrates or atelectasis.

CT scan of abdomen is used to confirm the diagnosis. Scanning techniques such as gallium technetium subtraction or following injection of gallium labeled leucocytes is also useful in the localization of subphrenic abscess.

Treatment includes surgical drainage and appropriate antibiotic therapy.

Ref: Crofton and Douglas's Respiratory Diseases: 2 Volume Set, 5th Edition By Anthony Seaton, Page 1239; Common Surgical Emergencies By S. K. Kochar, Page 139; SRB's Manual of Surgery By Bhat, 3rd Edition, Page 508


In which of the following condition is Alvarado's score indicated?

A: Pancreatitis

B: Appendicitis

C: Cholecystitis

D: Cholangitis

Correct Ans:B

Explanation



Alvarado’s score is a 10 point clinical scoring system designed to predict appendicitisbased on clinical parameters.

Alvarado’s clinical scoring for appendicitis:

Clinical parameter Score

Migration of pain 1

Anorexia 1

Nausea or Vomiting 1

Right iliac fossa tenderness 2

Rebound tenderness 1

Temperature more than 37.3 degree celsius 1

WBC more than 10,000 2

Left shift more than 75% PMNs 1

Total 10

An Alvarado score of 8 or greater is about 96% sensitive for appendicitis, while a scoreless than 5 rules out the diagnosis.

Ref: Case Studies in Emergency Medicine edited by Rebecca Jeanmonod, page 27


Child with hyperammonemia, later develops pancreatitis and basal ganglia stroke. He mayhave:

A: Homocystinuria

B: Maple syrup urine disorder

C: Methylmalonic acidemia



D: Tyrosinemia

Correct Ans:C

ExplanationChildren with severe methylmalonic acidemia present with acute, lifethreateningmetabolic acidosis, hyperammonemia, and bone marrow depression in early infancy orwith metabolic acidosis, vomiting, and failure to thrive during the first few months of life.Most patients with severe disease have mild or moderate mental retardation. Latecomplications include pancreatitis, cardiomyopathy, and basal ganglia stroke, and inmethylmalonic aciduria, interstitial nephritis. Ref: Thomas J.A., Van Hove J.L. (2012). Chapter 36. Inborn Errors of Metabolism. In W.W.Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis& Treatment: Pediatrics, 21e.


A patient undergoes a prolonged and complicated pancreatic surgery for chronicpancreatitis. Most preferred route for supplementary nutrition in this patient would be:

A: Total Parental Nutrition

B: Feeding Gastrostomy

C: Feeding Jejunostomy

D: Oral feeding

Correct Ans:C

Explanation

When a patient has undergone a prolonged and complicated pancreatic surgery, therecovery of the patient will require a form of nutrition that gives rest to the pancreas andprotect the pancreatic anastomosis. A feeding jejunostomy in such a case can providesupplementary nutrition and also gives protection to the pancreatic anastomosis andcause minimal stimulation of pancreatic secretion thereby giving rest to the pancreas.



Ref: Clinical Nutrition in Gastrointestinal Disease By Buchman, 2006, Pages 25657;Artificial Nutrition Support in Clinical Practice By Jason Payne, 2nd Edition, Page 273;Essentials of General Surgery By Lawrence, 4th Edition, Page 80


Which of the following is the most common cause of pancreatic pseudocyst?

A: Ca pancreas

B: Pancreatitis

C: Trauma

D: ERCP

Correct Ans:B

Explanation

Pancreatic pseudocysts mostly occur as a complication of acute and chronic pancreatitis. In children, abdominal trauma is the most common cause.


The immunoglobulin level, which is specifically elevated in autoimmune pancreatitis is which of the following?

A: IgM

B: IgE



C: IgG4

D: IgG2

Correct Ans:C

Explanation

Serum IgG4 is elevated at least twofold higher than 135 mg/dL in those with autoimmune pancreatitis.

Reference:Harrisons Principles of Internal Medicine, 18th Edition, Page 2644


Cobalamin absorption may be abnormal in all, EXCEPT:


B: Achlorhydria

C: Bacterial overgrowth syndromes

D: Diverticular disease of colon

Correct Ans:D

Explanation

Cobalamin absorption may be abnormal in:

Pernicious anemia: Due to absence of both gastric acid and intrinsic factor secretion.Chronic pancreatitis as a result of deficiency of pancreatic proteases to split thecobalamin–R binder complex.



Achlorhydria or absence of another factor secreted with acid that is responsible forsplitting cobalamin away from the proteins in food to which it is boundBacterial overgrowth syndromes: leading to bacterial utilization of cobalamin (oftenreferred to as stagnant bowel syndrome).Ileal dysfunction: due to impaired function of the mechanism of cobalamin–intrinsicfactor uptake by ileal intestinal epithelial cells.

Ref: Harrison, Edition18, e371, e371t.


Pancreatitis, pituitary tumor and phaeochromocytoma may be associated with which ofthe following type of thyroid cancer?

A: Anaplastic carcinoma of thyroid

B: Medullary carinoma of thyroid

C: Papillary carcinoma of thyroid

D: Follicular carcinoma of thyroid

Correct Ans:B

ExplanationA MEN 1, or Wermer’s syndrome, is inherited as an autosomal dominant trait. Thissyndrome is characterized by neoplasia of the parathyroid glands, enteropancreatictumors, anterior pituitary adenomas, and other neuroendocrine tumors with variablepenetrance. Among the types of thyroid cancer given in the question stem, medullarycarcinoma of the thyroid is associated with multiple endocrine neoplasia syndrome. Ref: Harrison’s Internal Medicine, 18th Edition, Chapter 351


Which is the commonest complication of Mumps in adults ?



A: Encephalitis

B: Orchitis

C: Pancreatitis

D: Carditis

Correct Ans:B

Explanation

Meningoencephalitis is common in children. Unilateral deafness and thyroiditis are also known complication.


A 25 year old woman presents with bloody diarrhea and is diagnosed as a case ofUlcerative colitis. Which of the following condition is not associated with ulcerative colitis?

A: Iritis

B: Pancreatitis

C: Sclerosing cholangitis

D: Ankylosing spondylitis

Correct Ans:B

Explanation

Pancreatitis is not an associated extraintestinal manifestation of ulcerative colitis.

Ulcerative Colitis is associated with:



? Dermatologic:? ? ? Erythema nodosum? ? ? Pyoderma gangrenosum

? Rheumatologic:? ? ? Peripheral arthritis? ? ? Ankylosing spondylitis? ? ? Sacroiliitis

? Ocular:? ? ? Conjunctivitis? ? ? Anterior uveitis/iritis? ? ? Episcleritis

? Hepatobiliary:? ? ? Hepatic steatosis? ? ? Fatty liver? ? ? Cholelithiasis? ? ? Primary sclerosing cholangitis

? Urologic:? ? ? Calculi? ? ? Ileal bladder fistulas

? Metabolic bone disorders

? Thromboembolic disorders

Ref: Harrisons Internal Medicine, 18th Edition, Chapter 295, Pages 24872489


Maldigestion of protein and fat is manifested in chronic pancreatitis only if the damage of pancreatic tissue exceeds?

A: 30 %

B: 50 %

C: 90 %



D: 75 %

Correct Ans:C

Explanation

There is a very large reservoir of pancreatic exocrine function. > 90% of the pancreas must be damaged before maldigestion of fat and protein is manifested.



Elevated serum amylase usually returns to normal after 7 days of acute pancreatitis. If it remains elevated after 7 days, the possible causes include all except:

A: Pancreatic ductal disruption

B: Pancreatic ductal obstruction

C: Pseudocyst formation

D: Chronic calcific pancreatitis

Correct Ans:D

Explanation

In acute pancreatitis, the serum amylase and lipase are elevated within 24 hours of onset and remains for 3–7 days. Levels return to normal within 7 days unless there is pancreatic ductal disruption, ductal obstruction, or pseudocyst formation.





Risk factors for post ERCP pancreatitis include all, except

A: Minor papilla sphincterotomy

B: Sphincter of Oddi dysfunction

C: Age <60 years

D: Age > 60 years

Correct Ans:D

Explanation

Risk factors for postERCP pancreatitis are minor papilla sphincterotomy, sphincter of Oddi dysfunction, prior history of postERCP pancreatitis, age <60 years, >2 contrast injections into the pancreatic duct.



The genetic factors that can increase the susceptibility and modify the severity of pancreatic injury in acute pancreatitis are all, except:



A: Cationic trypsinogen mutations

B: Pancreatic secretory trypsin inhibitor

C: CFTR

D: ATP7a gene mutation

Correct Ans:D

Explanation

There are some genetic factors that can increase the susceptibility and/or modify the severity of pancreatic injury in acute pancreatitis. They are,

(1) Cationic trypsinogen mutations(2) Pancreatic secretory trypsin inhibitor (SPINK1)(3) CFTR, and(4) Monocyte chemotactic protein (MCP1)

Menkes syndrome is caused by mutations in the ATP7A gene.



A 30 year old patient is investigated for acute pancreatitis. Which scoring system is used for early prediction of mortality?

A: BISAP



B: Balthazar scoring system

C: Ranson’s

D: APACHE II

Correct Ans:A

Explanation

Early predictors of severity at 48 hours included 3 Ranson's signsand APACHE II score 8. A recent scoring system for the earlyprediction of mortality was developed in acute pancreatitis. Thisscoring system known as the Bedside Index of Severity in AcutePancreatitis (BISAP), incorporates five clinical and laboratoryparameters obtained within the first 24 hours of hospitalization.BUN >25, Impaired mental status, SIRS, Age >60 years, Pleuraleffusion on radiography. Presence of three or more of these factorswas associated with increased risk for inhospital mortality.



All are indications of elective ERCP with sphincterotomy in acute pancreatitis, except:

A: Incipient biliary obstruction

B: Those who are poor candidates for cholecystectomy in biliary pancreatitis

C: Bile duct stones after cholecystectomy



D: Walled off pancreatic necrosis

Correct Ans:D

Explanation

Elective ERCP with sphincterotomy is considered in patients with persistent / incipient biliary obstruction, those who are poor candidates for cholecystectomy, and for those in whom there is strong suspicion for bile duct stones after cholecystectomy. ERCP with stent placement is indicated for pancreatic ductal disruptions.



Which of the following is an indication of urgent ERCP in pancreatitis?

A: Acute alcoholic pancreatitis

B: Acute necrotising pancreatitis

C: Acute biliary pancreatitis with cholangitis

D: Chronic calcific pancreatitis with pseudocyst

Correct Ans:C

Explanation

Urgent ERCP is indicated in patients who have severe acute biliary pancreatitis with cholangitis.





Which of the following is the usual presenting symptom of pseudocyst in pancreatitis?

A: Abdominal swelling

B: Abdominal pain

C: Persistent vomiting

D: Early satiety and postprandial fullness

Correct Ans:B

Explanation

Pseudocysts are caused by pancreatitis in 90% of cases and by trauma in 10%. Approximately 85% are located in the body or tail of the pancreas. Some patients have two or more pseudocysts. Abdominal pain is the usual presenting complaint.



Which is the most frequently involved artery in acute pancreatitis leading to pseudoaneurysm?



A: Splenic artery

B: Superior pancreatico duodenal artery

C: Inferior pancreaticoduodenal artery

D: Gastroduodenal artery

Correct Ans:A

Explanation

Pseudoaneurysms develop in up to 10% of patients with acute pancreatitis. The splenic artery is most frequently involved.



Purtscher’s retinopathy in acute pancreatitis is due to which of the following?

A: Occlusion of the posterior retinal artery with aggregated granulocytes

B: Occlusion of ciliary artery with exudation

C: Central retinal artery occlusion with cotton wool spots and hemorrhage

D: Inflammatory exudates in the retinal vein

Correct Ans:A



Explanation

Purtscher's retinopathy a sudden and severe loss of vision in a patient with acute pancreatitis. It is due to occlusion of the posterior retinal artery with aggregated granulocytes.



The immunoglobulin level, which is specifically elevated in autoimmune pancreatitis is which of the following?

A: IgM

B: IgE

C: IgG4

D: IgG2

Correct Ans:C

Explanation

Serum IgG4 is elevated at least twofold higher than 135 mg/dL in those with autoimmune pancreatitis.


Sample Previous Year Question on Pancreatitis based on previous Year Questions of



NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.orgfor more such Quizzes

Medical therapy can be tried in gallstone patients with:

A: Contracted and small non functioning gallbladder

B: Radiolucent gallstones

C: Gallstones of size < 30 mm in diameter

D: Gallstone pancreatitis

Correct Ans:B

Explanation

Ursodeoxycholic acid (UDCA) decreases cholesterol saturation of bile. In carefullyselected patients with functioning gallbladder and with radiolucent stones <10 mm indiameter, complete dissolution with UDCA can be achieved in 50% of patients within 6months to 2 years.

Reference: Harrisons Principles of Internal Medicine, 18th Edition, Page 2621


A 14 year old male was presented to the casualty on a saturday night with left sided upperabdominal pain. Clinical examination revealed massive splenomegaly. He has history ofmassive hematemesis 2 year back, and was diagnosed to have Extrahepatic Portal VenousObstruction (EHPVO) and bleeding was controlled by ligation of the esophageal varices.What is the likely diagnosis?



A: Acute pancreatitis

B: Aortic dissection

C: Splenic infarction

D: Intussusception

Correct Ans:C

Explanation

EHPVO is a common cause of portal hypertension in children. It commonly presents withstable massive variceal bleeding during childhood. Patients have massive splenomegaly.Splenic infarction and mesenteric vein thrombosis are the two possibilities if EHPVOdevelops sudden onset of abdominal pain. Here we have splenic infarction as the answer.


A 30 year old male presented with insidious onset of diarrhea, steatorrhea, abdominalpain, weight loss, migratory large joint arthropathy, fever and dementia. The mostprobable diagnosis is:

A: Chronic calcific pancreatitis

B: Whipple's disease

C: Tropical sprue

D: Celiac sprue

Correct Ans:B

Explanation

Whipple’s disease is a chronic multisystem disease caused by tropheryma whippleibacteria. Dementia is a late symptom. Diagnosed by PAS positive macrophages in small



intestinal biopsy. DOC is double strength trimethoprim / sulfamethoxazole.

Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2479


About autoimmune pancreatitis:

a) It is associated with other autoimmune disordersb) Obstructive jaundice is a featurec) Elevated serum IGM 4 is a markerd) Distinct enlargement of the head of pancreas in CT abdomen

e) Glucocorticoids are effective in alleviating symptoms

A: b,c,d,e True & aFalse

B: c,d,eTrue & a,bFalse

C: a,eTrue & b,c,dFalse

D: a,b,d, eTrue & cFalse

Correct Ans:D

Explanation

Elevated IgG4 is a marker of autoimmune pancreatitis. 5075 patients presents withobstructive jaundice. Steroids are effective in treatment. CT showed diffuse enlargement,focal enlargement and distinct enlargement of the head of the pancreas. MRCP revealsstrictures in the bile duct.

Ref: Harrisons , Edition 18 , Page 2644


All are important hypersensitivity related side effects of high dose sulfasalazine therapy,



EXCEPT:

A: Hepatitis

B: Agranulocytosis

C: Pancreatitis

D: Thrombocytopenia

Correct Ans:D

Explanation

Although sulfasalazine is more effective at higher doses, up to 30% of patients experienceallergic reactions or intolerable side effects such as headache, anorexia, nausea, andvomiting that are attributable to the sulfapyridine moiety.

ALSO KNOW:Hypersensitivity reactions, independent of sulfapyridine levels, include rash, fever,hepatitis, agranulocytosis, hypersensitivity pneumonitis, pancreatitis, worsening of colitis,and reversible sperm abnormalities. Sulfasalazine can also impair folate absorption, and patients should be given folic acidsupplements.

Ref: Harrison, Edition18, Page2489.


Cobalamin absorption may be abnormal in all, EXCEPT:


B: Achlorhydria



C: Bacterial overgrowth syndromes

D: Diverticular disease of colon

Correct Ans:D

Explanation

Cobalamin absorption may be abnormal in:

Pernicious anemia: Due to absence of both gastric acid and intrinsic factor secretion.Chronic pancreatitis as a result of deficiency of pancreatic proteases to split thecobalamin–R binder complex.Achlorhydria or absence of another factor secreted with acid that is responsible forsplitting cobalamin away from the proteins in food to which it is boundBacterial overgrowth syndromes: leading to bacterial utilization of cobalamin (oftenreferred to as stagnant bowel syndrome).Ileal dysfunction: due to impaired function of the mechanism of cobalamin–intrinsicfactor uptake by ileal intestinal epithelial cells.

Ref: Harrison, Edition18, e371, e371t.


The modified Mayo score used in clinical trials to assess the severity of:

A: Ulcerative colitis

B: Crohn's disease

C: Diverticulosis

D: Pancreatitis

Correct Ans:A

Explanation



Modifications of the original Truelove and Witts' criteria are used in daily practice, the modified Mayoscore is used in current clinical trials.The mayo score uses:

Stool frequency Rectal bleeding Mucosal appearance in endoscopyPhysician's global assessment

Ref: Journal of Crohn's and Colitis (2012) 6, 965–990


Which of the following is the most rare complication of acute pancreatitis?

A: Hypotension

B: Jaundice

C: Retinopathy

D: Hypertriglyceridemia

Correct Ans:C

Explanation

Due to blockage of the posterior retinal artery by aggregated granulocytes, hemorrhageand cottonwool spots are seen in the optic disk and macula in a patient with acutepancreatitis. Such an unusual complication of acute pancreatitis is known as Purtscher'sretinopathy, which is characterized by sudden and severe loss of vision.Hypertriglyceridemia is seen in 15% of the patients with acute pancreatitis.

Ref: Friedman L.S. (2013). Chapter 16. Liver, Biliary Tract, & Pancreas Disorders. In M.A.Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment2013.




What does HbA1c level in the blood indicate?

A: Acute rise of sugar

B: Long terms status of blood sugar

C: Hepatorenal syndrome

D: Chronic pancreatitis

Correct Ans:B

ExplanationGlycosylated Hemoglobin (HbA1C) is the standard method for assessing longtermglycemic control. When plasma glucose is excessively elevated, it enters the erythrocytes,and glycates the amino group of lysine residues and the amino terminals of hemoglobin.This results in the formation of glycosylated hemoglobin. Since the halflife of anerythrocyte is typically 120 days, the level of glycated hemoglobin (HbA1c) reflects themean blood glucose concentration over the preceding 23 months. Measurement of HbA1ctherefore provides valuable information for management of diabetes mellitus. Ref: Harrison’s Internal Medicine, 18th Edition, Page 2992 ; Harper's IllustratedBiochemistry, 28th Edition, Chapter 6 ; Tintinalli's Emergency Medicine : A ComprehensiveStudy Guide, 7th Edition, Chapter 218.


Pancreatitis, pituitary tumor and phaeochromocytoma may be associated with which ofthe following type of thyroid cancer?



A: Anaplastic carcinoma of thyroid

B: Medullary carinoma of thyroid

C: Papillary carcinoma of thyroid

D: Follicular carcinoma of thyroid

Correct Ans:B

ExplanationA MEN 1, or Wermer’s syndrome, is inherited as an autosomal dominant trait. Thissyndrome is characterized by neoplasia of the parathyroid glands, enteropancreatictumors, anterior pituitary adenomas, and other neuroendocrine tumors with variablepenetrance. Among the types of thyroid cancer given in the question stem, medullarycarcinoma of the thyroid is associated with multiple endocrine neoplasia syndrome. Ref: Harrison’s Internal Medicine, 18th Edition, Chapter 351


The clinical situations in which intestinal absorption is increased among the following?

A: Wilson disease

B: Pernicious disease

C: Chronic calcific pancreatitis

D: Cystic fibrosis

Correct Ans:A

Explanation

Almost all clinical problems are associated with diminished intestinal absorption of one or



more dietary nutrients. The only clinical situations in which absorption is increasedis Wilson disease, in which absorption of copper is increased.

ALSO NOTE:Another example is hemochromatosis in which iron absorption is increased.

Ref: Harrison, E18, P2460.


pancreatitis sample questions based on neet pg , usmle, plab and fmge pattern (mci screening)

Health & Medicine

chronicpancreatitis

chronicpancreatitis

dilatedmainpancreaticduct

gallstoneileus c

intussusception c

enlargementofthepancreas

duodenalulcer d

duodenalileus b