Disorders of pancreas

Question 1

Which enzyme gene mutation causes hereditary pancreatitis?
A) carbonic anhydrase
B) cationic trypsin
C) phospholipase
D) kallikrein
E) hexokinase

Answer 1

B) cationic trypsin

Question 2

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

Answer 2

E) to excrete a liquid rich in sodium and chloride ions

Question 3

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.

Answer 3

D) Enzymes are produced in inactive state in acini and under physiological conditions they only become activ in duodenum.

Question 4

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.

Answer 4

A) Antibiotic therapy should always be used due to the risk of infection.

Question 5

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

Answer 5

C) starting fluid replacement

Question 6

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.

Answer 6

B) They are not related to the severity of the disease.

Question 7

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

Answer 7

D) amylase elevation

Question 8

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.

Answer 8

B) It encodes a protein called pancreatic secretory trypsin inhibitor.

Question 9

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

Answer 9

D) ERCP

Question 10

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

Answer 10

A) percutaneous drainage

Question 11

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

Answer 11

E) pancreatic division

Question 12

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

Answer 12

D) pulmonary complications

Question 13

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

Answer 13

C) the 2. and 4. answers are correct

Question 14

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

Answer 14

B) the 1. and 3. answers are correct

Question 15

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

Answer 15

D) the 1., 2., 4. and 7. answers are correct

Question 16

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

Answer 16

C) the 2., 3., 5. and 6. answers are correct

Question 17

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

Answer 17

D) only the 1. answer is correct

Question 18

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.

Answer 18

18- A
19- C
20- B
21- D

Question 19

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.

Answer 19

26- C
27- D
28- B
29- A

Question 20

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

Answer 20

D) the first is wrong, the second is correct in itself

Question 21

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

Answer 21

B) both are correct, but there is no causal relationship between them

Question 22

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

Answer 22

A) both are correct, there is a causal relationship between them

Question 23

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

Answer 23

C) the first is correct in itself, but the second is wrong

Question 24

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

Answer 24

E) both are wrong

Question 25

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

Answer 25

D) the first is wrong, the second is correct in itself

Question 26

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

Answer 26

D) the first is wrong, the second is correct in itself

Question 27

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

Answer 27

C) the first is correct in itself, but the second is wrong

Question 28

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

Answer 28

D) 1., 3., 5., 7. and 12. answers are correct

Question 29

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

Answer 29

C) 2., 4., 6., 8., 9., 10. and 11. answers are correct

Question 30

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

Answer 30

B) 1., 2. and 4. answers are correct

Question 31

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

Answer 31

D) alcoholic acute pancreatitis

Question 32

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

Answer 32

C) 2., 4. and 5. answers are correct

Question 33

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

Answer 33

A) 1., 2., 3. and 5. answers are correct

Question 34

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

Answer 34

D) biliary acute pancreatitis

Question 35

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

Answer 35

C) ERCP + papillotomy

Question 36

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

Answer 36

D) chronic pancreatitis

Question 37

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

Answer 37

B) 3., 4. and 6. answers are correct

Question 38

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

Answer 38

C) 1., 2., 5. and 6. answers are correct

Question 39

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

Answer 39

D) angiography