PANCREAS

Question 1

Cytology of this cyst shows pigmented histocytes

Answer 1

pseudocyst

Question 2

cytology of this cyst shows bland periodic-acid Schiff +

Answer 2

serous cystic neoplasm

Question 3

Viscosity is increased or high in which two cystic neoplasms?

Answer 3

MCN and IPMN

Question 4

Amylase is high in which two cystic neoplasms

Answer 4

pseudocyst or IPMN

Question 5

CEA is <200 in which neoplasms

Answer 5

Pseudocyst

<0.5 in SCN

Question 6

CEA is >200 in what two cystic neoplasms

Answer 6

MCN and IPMN

Question 7

Amylase is low but CEA is high

Answer 7

MCN

Question 8

Amylase is high and CEA is high

Answer 8

IPMN

Question 9

KRAS mutations are positive in which cystic neoplasms

Answer 9

MCN and IPMN

Question 10

MCN are most commonly found in what location

Answer 10

tail of pancreas

Question 11

Steatorrhea, diabetes, gallstones

Answer 11

Somatostatinoma

Question 12

Where are somatostatinomas typically found

Answer 12

67% in the head

Question 13

How often are somatostatinomas malignant

Answer 13

> 70%

Question 14

Whipple’s triad

Answer 14

fasting hypoglycemia, neuroglycopenic symptoms, relief with glucose

Question 15

How often are insulinomas malingnat?

Answer 15

Actually 90% are benign

Question 16

Biology of gastrinoma

Answer 16

50% malignant 50% multiple

Question 17

Glucagonoma are typically found

Answer 17

distal pancreas

Question 18

VIPoma are typically found

Answer 18

distal pancreas

Question 19

Enucleation can be considered in insulinomas of what size

Answer 19

<2 cm

Question 20

Frey procedure

Answer 20

Lateral pancreaticojejunostomy with localized pancreatic head resection

Question 21

Where do the short gastric arteries arise from?

Answer 21

both splenic artery and left gastroepiploic artery

Question 22

Where does the right gastroepiploic artery arise from

Answer 22

gastroduodenal artery

Question 23

Where does the left gastric artery arise fro,m

Answer 23

celiac trunk - supplies lesser curve

Question 24

Where does the right gastric artery arise from

Answer 24

common hepatic artery

Question 25

Sx of autoimmune pancreatitis

Answer 25

Elevated IgG4 (specific but not sensitive), xerostomia, xeropthalmia, mild renal insufficiency

Question 26

Which type of autoimmune pancreatitis is more common

Answer 26

type 1

Question 27

Which type of autoimmune pancreatitis is associated with acute pancreatitis

Answer 27

Type 2 (seen in young)

Question 28

Associations with type 1 AIP

Answer 28

Sjogren syndrome, PSC

Question 29

Associations with AIP type II

Answer 29

IBD

Question 30

Low density, capsule like rim with focal mass ERCP shows segmental or diffuse irregular narrowing of main duct usually accompanied by extrinsic stricture of distal bile duct

Answer 30

AIP

Question 31

In distal pancreatectomy and splenectomy, the IMV should be ligated if?

Answer 31

It enters the splenic vein lateral to the target lesion

Question 32

Splenic artery or splenic vein ligate dfirst?

Answer 32

Artery first, near its point of origin. THEN IMV if enters splenic vein to the left of the lesion and finally the splenic vein should be ligaated near the point of where it joins with SMV to form the portal vein

Question 33

A mutation in what is diagnostic for hereditary pancreatitis

Answer 33

PRSS1 gene (serine protease inherited via AD pattern, high penetrance)

Question 34

Insulin is secreted from?

Answer 34

B cells

Question 35

Glucagon is secreted from?

Answer 35

Alpha cells of pancreas

Question 36

Somatostatin is secreted from

Answer 36

D cells

Question 37

Elevated serum LDH or beta-2 microglobulin level and palpable abdominal mass

Answer 37

Pancreatic lymphoma

Question 38

Pancreatic adenoCA in distal pancreas - tx

Answer 38

distal panc with splenectomy

Question 39

Most appropriate tx for pancreatic divisum

Answer 39

ERCP with sphincterotomy

Question 40

70% of the pancreas is drained by which duct?

Answer 40

Ventral duct

Question 41

High risk stigmata assoc with IPMN

Answer 41

Enhancing mural nodule >5 mm, main duct dilation >10 mm, jaundice

Question 42

Worrisome stigmata of IPMN

Answer 42

``` Growth >5 mm/2 years Cyst size >3 cm Enhancing mural nodule <5 mm Enhancing thickened cyst wall Main duct dfilation 5-9 mm; panc duct caliber change Elevated serum CA 19-9 Pancreatitis ```

Question 43

Which pancreatic neoplasm has central calicification

Answer 43

serous cystic neoplasm

Question 44

Which two pancreatic neoplasms have capsules

Answer 44

SCN or MCN

Question 45

Where are pseudopapillary neoplasms found?

Answer 45

throughout pancreas

Question 46

In pancreatic divisum, the major drainage of the pancreas is done by?

Answer 46

the dorsal duct which opens up into the MINOR papilla

Question 47

Whcih hormone causes increased intestinal secretion but inhibits gastrin release

Answer 47

Vasoactive peptide

Question 48

Which hormone stimulates pancreatic duct cells to secrete pancreatic fluid and bicarbonate

Answer 48

Secretin

Question 49

Most potent stimulator of pancreatic enzyme secretion

Answer 49

Cholecystokinin

Question 50

Which imaging modality is best for evaluation of pancreatic cystic lesions

Answer 50

MRCP

Question 51

Most consistently observed environmental risk for development of pancreatic CA

Answer 51

cigarette smoking

Question 52

MC chemo regimen for pancreatic lymphoma

Answer 52

cyclophosphamide, doxorubicin, vincristine,m prednisone

Question 53

which enzyme cleared fastest in course of pancreatitis

Answer 53

Amylase, <48 hours. Lipase and elastase remain elevated for >96 hours

Question 54

Peustow procedure

Answer 54

creation of retrocolic roux limb, opening of duct from head of pancreas to the tail, 1 or 2 layer side to side pancreaticojejunostomy

Question 55

Beger procedure

Answer 55

local resectio nfo pancreatic head with duodenal preservation, cfreation of retrocolic Roux limb, end to end pancreaticojejunostomy with pancreaticojejunostomy to the pancreatic head remnant Key is preservation of posterior branch of GDA to maintain viability of duodenum and distal CBD

Question 56

Pancreatic leak defined as

Answer 56

drain amylase >3 times serum amylase on POD # 3

Question 57

Primary genetic abnormality believed to play a role in apncreatic cancer

Answer 57

KRAS2 oncogene Activated by point mutation which causes constitutive activation and loss of regulation of mitogen-activated protein kinase cell signal transduction

Question 58

Which pancreatic enzyme is secereted into the pancreatic duct in its active form

Answer 58

Lipase

Question 59

what enzyme converts proelastase into elastase? where does it occur

Answer 59

trypsinogen i nthe duodenal lumen

Question 60

what 3 hormones inhibit pancreatic exocrine function

Answer 60

pancreatic polypeptide, somatostatin, and glucagon

Question 61

pancreatic secretion is stimulated. y what hormones

Answer 61

secretin and CCK and by parasympathetic vagal discharge

Question 62

Trypsin is secreted as tryspinogen by what cells

Answer 62

acinar cells

Question 63

What converts trypsinogen into trypsin

Answer 63

enterokinase (duodenum)

Question 64

borderline resectable pancreatic CA have NO involvement of

Answer 64

celiac axis or hepatic artery bifurcation