Disorders of pancreas Flashcards
Which enzyme gene mutation causes hereditary pancreatitis?
A) carbonic anhydrase
B) cationic trypsin
C) phospholipase
D) kallikrein
E) hexokinase
B) cationic trypsin
The main functions of pancreatic ductal cells, except:
A) to guarantee a shell for th acinic cells
B) to excrete a liquid rich in bicarbonate
C) to bring the enzymes produced by the acini into the duodenum
D) to neutralize the protons produced by acini through bicarbonate secretion
E) to excrete a liquid rich in sodium and chloride ions
E) to excrete a liquid rich in sodium and chloride ions
It is true for the enzymes produced by pancreas:
A) Three different enzymes are produced by acini: amylase, trypsin and lipase
B) The enzymes are activated under physiological conditions in the pancreatic duct.
C) Lipase is activated by the enzyme enterokinase in the duodenum.
D) Enzymes are produced in inactive state in acini and under physiological conditions they only become activ in duodenum.
E) Most of the enzymes are produced by pancreatic ductal cells.
D) Enzymes are produced in inactive state in acini and under physiological conditions they only become activ in duodenum.
It is true for acute pancreatitis, except:
A) Antibiotic therapy should always be used due to the risk of infection.
B) The lipase level increases in the blood.
C) Usually it is induced by gallstone or excessive alcohol consumption.
D) It leads to abdominal pain.
E) The amylase level increases in the blood.
F) The inflammation can also spread to other organs in severe cases.
A) Antibiotic therapy should always be used due to the risk of infection.
In case of acute pancreatitis, the first thing to do is:
A) performing a CT scan
B) performing an ERCP test
C) starting fluid replacement
D) surgical console
E) performing an MRCP test
C) starting fluid replacement
It is true for the distant complications of acute pancreatitis, except:
A) Lungs, kidneys and liver are the most common affected.
B) They are not related to the severity of the disease.
C) Migratory leukocytes, cytokines and free radicals are primarily responsible for their development.
D) The inflammation of organs may also lead to dysfunction and may cause multiple organ failure (MOF).
E) In severe cases, intensive therapy may be also needed.
B) They are not related to the severity of the disease.
It refer to the severity of the acute necrotizing pancreatitits, except:
A) Ranson’s prognostic criteria
B) Glasgow prognostic criteria
C) Apache II. prognostic criteria
D) amylase elevation
E) markers of the inflammatory reaction (TNF-α, IL-6, CRP etc.)
F) CT findings (Balthazar-score) with contrast agent enhancement
G) clinical picture
H) infected necrosis
D) amylase elevation
It is characteristic for the SPINK1 gene:
A) It is located on chromosome 8.
B) It encodes a protein called pancreatic secretory trypsin inhibitor.
C) The production of the protein that it encodes is essential for the activation of trypsin.
D) Its mutation leads in all cases to pancreatitis.
E) It often occurs in pancreatitis with hereditary or familial accumulation.
B) It encodes a protein called pancreatic secretory trypsin inhibitor.
The most sensitive and specific imaging method is for the diagnosis of chronic pancreatitis:
A) transabdominal ultrasound
B) abdominal CT
C) endoscopic ultrasound
D) ERCP
E) native abdominal X-ray
F) irrigoscopy
D) ERCP
In the case of chronic pseudocysts, primarily selectable procedures are, excluded:
A) percutaneous drainage
B) endoscopic cystogastrostomy or cystoduodenostomy
C) transpapillar drainage of the pseudocyst
D) surgical cystogastrostomy posterior or cystoduodenostomy
E) surgical cystowirsungogastrostomy or cystowirsungo-jejunostomy
A) percutaneous drainage
Mutations in the CFTR molecule in the pancreas can cause the following diseases or increase their risks, except:
A) cystic fibrosis
B) chronic pancreatitis
C) acute pancreatitis
D) pancreatic carcinoma
E) pancreatic division
E) pancreatic division
In case of cystic fibrosis, the most endangering for the patient’s life is:
A) pancreatic insufficiency
B) gallstones
C) colonic stricture
D) pulmonary complications
E) meconium ileus
F) complications of diabetes mellitus
G) biliary cirrhosis
D) pulmonary complications
It is valid for the endoscopic retrograde cholangiopancreatography (ERCP):
1) It is an unlimited repeatable, uncomplicated procedure.
2) The obstruction of the choledochus and the pancreas line can be solved by an additional intervention.
3) It is always diagnostic in mild chronic pancreatitis as well.
4) It has a high sensitivity and specificity in case of pancreatic head tumors.
A) the 1., 2. and 3. answers are correct
B) the 1. and 3. answers are correct
C) the 2. and 4. answers are correct
D) only the 4. answer is correct
E) all of the answers are correct
C) the 2. and 4. answers are correct
It is characteristic of cystic fibrosis:
1) CFTR gene mutations with autosomal recessive inheritance cause cystic fibrosis disease
2) CFTR protein is a cationic channel located on pancreatic acinic cells
3) mutations reduce the amount or inhibit the function of CFTR protein
4) Cystic fibrosis is the rarest anomaly with recessive inheritance in the Caucasian population
A) the 1., 2. and 3. answers are correct
B) the 1. and 3. answers are correct
C) the 2. and 4. answers are correct
D) only the 4. answer is correct
E) all of the answers are correct
B) the 1. and 3. answers are correct
It is valid for transabdominal pancreatic ultrasound diagnostics:
1) unlimited repeatable, relatively cheap
2) suitable for detecting fluid collections and pseudocysts
3) meteorism is not an obstacle
4) the accompanying bile disease can be well proven
5) edema is well separated from necrosis
6) obesity is not an obstacle
7) ductal diatation can be well recognized
A) the 1., 2. and 3. answers are correct
B) the 4., 5., 6. and 7. answers are correct
C) the 1., 2., 3. and 4. answers are correct
D) the 1., 2., 4. and 7. answers are correct
E) all of the answers are correct
D) the 1., 2., 4. and 7. answers are correct
It is valid for pancreatic computer tomography (CT):
1) unlimited repeatable, relatively cheap
2) suitable for detecting fluid collections and pseudocysts
3) obesity and meteorism are not obstacles
4) it also detects small parapapillary tumors
5) edema is well separated from necrosis
6) calcification and ductal diatation can be well recognized
A) the 1., 2., 3. and 6. answers are correct
B) the 3., 4. and 5. answers are correct
C) the 2., 3., 5. and 6. answers are correct
D) all of the answers are correct
C) the 2., 3., 5. and 6. answers are correct
It is characteristic of pancreatic tumors:
1) the five-year survival rate is below 5%
2) it usually begins with jaundice and severe spastic abdominal pain
3) it mainly origins from acinic cells
4) it never causes pancreatitis
5) it responds well to cytostatics
A) the 1., 2. and 3. answers are correct
B) the 1., 2. and 4. answers are correct
C) the 1., 2. and 5. answers are correct
D) only the 1. answer is correct
E) the 3. and 4. answers are correct
D) only the 1. answer is correct
Pair them.
A) acute pancreatitis
B) chronic pancreatitis
C) pancreatic tumor
D) cystic fibrosis
INT - 9.18 - I can heal Restitutio ad integrum, plenty of fluid replacement, gallstone.
INT - 9.19 - Weight loss, painless icterus.
INT - 9.20 - Alcohol, fatty stool discharge, maldigestion.
INT - 9.21 - Autosomal recessive inheritance, involvement of the lung.
18- A
19- C
20- B
21- D
Pair them!
A) cationic trypsin (PRSS1)
B) chymotrypsin C (CTRC)
C) cystic fibrosis transregulator (CFTR)
D) pancreatic secretory trypsin inhibitor (SPINK1)
INT - 9.26 - Apical Cl- channel, thickening of the glandular secretion, ∆F508-mutation.
INT - 9.27 - p.N34S mutation, mainly idiopathic pancreatitis.
INT - 9.28 - Control of trypsin breakdown, 4-5x risk increase in idiopathic and alcoholic patients.
INT - 9.29 - Recurrent acute pancreatitis attacks, hereditary pancreatitis, 40-50x risk for the developement of pancreatic carcinoma, p.R122H-mutation.
26- C
27- D
28- B
29- A
Tactile, dilated, tight, painless gall bladder (Courvoisier-symptom) and icterus are characteristic of pancreatic tail tumors, because the tumors near the ducus choledochus are able to slowly compress the duct, blocking hereby the flow of the bile.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
D) the first is wrong, the second is correct in itself
It can occur in case of gallstone disease, that the gallstone impact into the hepatic duct, therefore, acute haemorrhagic pancreatic necrosis can occur as a complication of gallstone disease.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
B) both are correct, but there is no causal relationship between them
Necrotizing pancreatitis usually requires prolonged, energy-intensive therapy, therefore, in these cases, jejunial nutrition should be chosen instead of parenteral therapy.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
A) both are correct, there is a causal relationship between them
In acute pancreatitis, a decrease in energy (ATP) levels can be observed in both the acini and ductal cells, resulting an increased enzyme and bicarbonate secretion.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
C) the first is correct in itself, but the second is wrong
Amylase elevation is a specific symptom of acute pancreatitis, because serum amylase originate only from the pancreas.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
E) both are wrong
ERCP and EST are required in all cases of acute pancreatitis, because opening the papilla may be necessary in some cases to the racovery of the pancreatitis.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
D) the first is wrong, the second is correct in itself
In case of chronic pancreatitis with pain, a pancreatic preparation with high lipase activity should be given, to put pancreas rest through the pancreatoduodenal feedback system, and to reduce secretion pressure.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
D) the first is wrong, the second is correct in itself
Combined adjuvant chemotherapy and radiotherapy of resecabile pancreatic cancers prolong the survival time, therefore, the five-year survival rate is improving worldwide.
A) both are correct, there is a causal relationship between them
B) both are correct, but there is no causal relationship between them
C) the first is correct in itself, but the second is wrong
D) the first is wrong, the second is correct in itself
E) both are wrong
C) the first is correct in itself, but the second is wrong
In the diagnosis of this case, which laboratory tests will provide a valuable help directly at the time of the enrollment of the patient?
A 35-year-old man complains of increased epigastric pain radiating under the left rib and to the back from early morning hours, after abundant food and alcohol consumption last night. He feels nausea, has vomited several times, but there is no relief. Blood pressure is 105/70 Hgmm, pulse is 120/min and easy to suppress. The abdomen of the patient is meteoristic, difficult to touch, but there is no pronounced defense, and in the epigastrium undetermined resistance can be detected.
1) white blood cell count
2) hematocrit
3) LDH
4) urea nitrogen
5) blood sugar
6) calcium
7) SGOT
8) arterial pO2
9) bicarbonate
10) albumin
11) C-reactive protein
12) serum amylase, lipase
A) 2., 4., 6., 8. and 9. answers are correct
B) 1., 3., 5. and 7. answers are correct
C) 2., 4., 6., 8., 9., 10. and 11. answers are correct
D) 1., 3., 5., 7. and 12. answers are correct
D) 1., 3., 5., 7. and 12. answers are correct
Which laboratory tests will provide a valuable help in evaluation of the prognosis of this case at the 48. hour of the observation?
A 35-year-old man complains of increased epigastric pain radiating under the left rib and to the back from early morning hours, after abundant food and alcohol consumption last night. He feels nausea, has vomited several times, but there is no relief. Blood pressure is 105/70 Hgmm, pulse is 120/min and easy to suppress. The abdomen of the patient is meteoristic, difficult to touch, but there is no pronounced defense, and in the epigastrium undetermined resistance can be detected.
1) white blood cell count
2) hematocrit
3) LDH
4) urea nitrogen
5) blood sugar
6) calcium
7) SGOT
8) arterial pO2
9) bicarbonate
10) albumin
11) C-reactive protein
12) serum amylase,-lipase
A) 2., 4., 6., 8. and 9. answers are correct
B) 1., 3., 5. and 7. answers are correct
C) 2., 4., 6., 8., 9., 10. and 11. answers are correct
D) 1., 3., 5., 7. and 12. answers are correct
C) 2., 4., 6., 8., 9., 10. and 11. answers are correct
Which imaging procedures would you use to clarify the diagnosis of this case?
A 35-year-old man complains of increased epigastric pain radiating under the left rib and to the back from early morning hours, after abundant food and alcohol consumption last night. He feels nausea, has vomited several times, but there is no relief. Blood pressure is 105/70 Hgmm, pulse is 120/min and easy to suppress. The abdomen of the patient is meteoristic, difficult to touch, but there is no pronounced defense, and in the epigastrium undetermined resistance can be detected.
1) native abdominal X-ray
2) transabdominal ultrasound
3) irrigoscopy
4) abdominal CT
5) a. coeliaca angiography
A) 1., 2., 3. and 5. answers are correct
B) 1., 2. and 4. answers are correct
C) 3., 4. and 5. answers are correct
D) 3. and 5. answers are correct
E) all of the answers are correct
B) 1., 2. and 4. answers are correct
What can be the diagnosis?
A 35-year-old man complains of increased epigastric pain radiating under the left rib and to the back from early morning hours, after abundant food and alcohol consumption last night. He feels nausea, has vomited several times, but there is no relief. Blood pressure is 105/70 Hgmm, pulse is 120/min and easy to suppress. The abdomen of the patient is meteoristic, difficult to touch, but there is no pronounced defense, and in the epigastrium undetermined resistance can be detected.
A) perforated duodenal ulcus
B) mesenterial thrombosis
C) esophageal perforation
D) alcoholic acute pancreatitis
E) diabetic ketoacidosis
D) alcoholic acute pancreatitis
Which therapy would you use based on the correct diagnosis?
A 35-year-old man complains of increased epigastric pain radiating under the left rib and to the back from early morning hours, after abundant food and alcohol consumption last night. He feels nausea, has vomited several times, but there is no relief. Blood pressure is 105/70 Hgmm, pulse is 120/min and easy to suppress. The abdomen of the patient is meteoristic, difficult to touch, but there is no pronounced defense, and in the epigastrium undetermined resistance can be detected.
1) low calorie containing total parenteral nutrition with fractional insulin
2) jejunial nutrition
3) immediately surgery
4) fluid replacement, ion replacement, cardiorespiratoric assistance as occasion requires
5) analgesia, reduction of inflammation
A) 1., 3., 4. and 5. answers are correct
B) 1. and 4. answers are correct
C) 2., 4. and 5. answers are correct
D) all of the answers are correct
C) 2., 4. and 5. answers are correct
Which tests will help to find the diagnosis of this case most quickly?
A 38-year-old obese woman is brought to the hospital with a pain under the right rib radiating to the shoulder. She used to eat a scrambled eggs made with bacon previous day. Her abdomen is meteoristic, diffuse sensitive, bowel movements are reduced, tachycardia can be detected (120/min).
1) blood tests (WBC, platelet counts, blood sinking)
2) liver function (bilirubin, AP, γGT, SGOT, prothrombin)
3) serum amylase
4) EKG, chest X-ray
5) transabdominal ultrasound
6) echocardiography
A) 1., 2., 3. and 5. answers are correct
B) 1., 4. and 6. answers are correct
C) 4. and 6. answers are correct
D) all of the answers are correct
A) 1., 2., 3. and 5. answers are correct
What can be the diagnosis?
A 38-year-old obese woman is brought to the hospital with a pain under the right rib radiating to the shoulder. She used to eat a scrambled eggs made with bacon previous day. Her abdomen is meteoristic, diffuse sensitive, bowel movements are reduced, tachycardia can be detected (120/min).
A) myocardial infarction
B) pleuropneumonia
C) pulmonary embolism
D) biliary acute pancreatitis
E) lung tuberculosis
D) biliary acute pancreatitis
Which therapy should be used after the quick diagnosis?
A 38-year-old obese woman is brought to the hospital with a pain under the right rib radiating to the shoulder. She used to eat a scrambled eggs made with bacon previous day. Her abdomen is meteoristic, diffuse sensitive, bowel movements are reduced, tachycardia can be detected (120/min).
A) antibiotic therapy + analgesia
B) anticoagulant treatment + bed rest
C) ERCP + papillotomy
D) antituberculotic therapy
C) ERCP + papillotomy
What is your diagnosis?
A 56-year-old man turned to the family doctor due to an insecure, deep epigastric pain. The pain occurs before 15-20 minutes after meal, but recently, it occurs regardless of meals. The patient has been drinking 4-5 bottles of beer a day for 20 years. His body weight has been gradually decreasing in the recent years, because he does not dare to eat due to the pain. Recently, she reports about loose stools. Diarrhea occurs after fatty meals. His urine is normal.
A) functional dyspepsia
B) spondylosis
C) dyskinesia of the major duodenal papilla
D) chronic pancreatitis
E) gastric ulcer
D) chronic pancreatitis
Which test methods would you use to certify the suspected diagnosis?
A 56-year-old man turned to the family doctor due to an insecure, deep epigastric pain. The pain occurs before 15-20 minutes after meal, but recently, it occurs regardless of meals. The patient has been drinking 4-5 bottles of beer a day for 20 years. His body weight has been gradually decreasing in the recent years, because he does not dare to eat due to the pain. Recently, she reports about loose stools. Diarrhea occurs after fatty meals. His urine is normal.
1) gastroscopy
2) irrigiscopy
3) ERCP
4) abdominal ultrasound
5) abdominal MR
6) starch load
A) 1., 2. and 3. answers are correct
B) 3., 4. and 6. answers are correct
C) 1., 5. and 6. answers are correct
D) all of the answers are correct
B) 3., 4. and 6. answers are correct
Which treatment is recommended primarily?
A 56-year-old man turned to the family doctor due to an insecure, deep epigastric pain. The pain occurs before 15-20 minutes after meal, but recently, it occurs regardless of meals. The patient has been drinking 4-5 bottles of beer a day for 20 years. His body weight has been gradually decreasing in the recent years, because he does not dare to eat due to the pain. Recently, she reports about loose stools. Diarrhea occurs after fatty meals. His urine is normal.
1) low fat diet
2) total alcohol abstinence
3) proton pump inhibitor
4) physiotherapy
5) spasmolytics, painkillers
6) pancreatic enzyme replacement
A) 1., 2., 3. and 4. answers are correct
B) 2., 3. and 6. answers are correct
C) 1., 2., 5. and 6. answers are correct
D) all of the answers are correct
C) 1., 2., 5. and 6. answers are correct
The complaints of the patient do not disappear after 3 to 4 months of treatment. What would you suggest, except:
A 56-year-old man turned to the family doctor due to an insecure, deep epigastric pain. The pain occurs before 15-20 minutes after meal, but recently, it occurs regardless of meals. The patient has been drinking 4-5 bottles of beer a day for 20 years. His body weight has been gradually decreasing in the recent years, because he does not dare to eat due to the pain. Recently, she reports about loose stools. Diarrhea occurs after fatty meals. His urine is normal.
A) increase the enzyme replacement dose
B) ERCP with intervention as needed
C) pancreatic resection surgery
D) angiography
D) angiography
