Pancreas

Question 1

Pancreatic cyst, pigmented histiocytes, low viscosity, high amylase, low CEA, KRAS neg; dx and distribution

Answer 1

Pseudocyst, evenly

Question 2

Pancreatic cyst, acid Schiff+, low viscosity, low amylase, low CEA, KRAS neg; dx and distribution

Answer 2

Serous Cystadenoma, evenly

Question 3

Pancreatic cyst, mucinous, increased viscosity, low amylase, high CEA, KRAS positive; dx and distribution

Answer 3

Mucinous Cyst Neoplasm, Tail

Question 4

Pancreatic cyst, mucinous, high viscosity, high amylase, high CEA, KRAS pos; dx and distribution

Answer 4

IPMN, Head

Question 5

Palpable abdominal mass, 6cm pancreatic head, , weight loss, fevers, elevated LDH, normal CA 19-9; dx and tx

Answer 5

Primary pancreatic lymphoma, CHOP or R-CHOP

Question 6

Indication for IMV ligation during pancreatectomy

Answer 6

If it enters the splenic vein to the right of the lesion

Question 7

Pancreatic duct ≥ 7 mm (normal diameter 3.5 mm) without enlarged pancreatic head; surgical tx and describe

Answer 7

Longitudinal pancreatojejunostomy (Puestow procedure)

Question 8

Pancreatic head/ampullary mass; surgical tx and description

Answer 8

Pancreaticoduodenectomy (Whipple procedure)

Question 9

Enlarged pancreatic head with normal caliber pancreatic duct; surgical tx and description

Answer 9

Duodenal sparing pancreatic head resection (Beger procedure)

Question 10

Dilated pancreatic duct due to obstruction from enlarged pancreatic head; surgical tx and description

Answer 10

Lateral pancreatojejunostomy with local pancreatic head resection (Frey procedure)

Question 11

Approach to infected pancreatic necrosis

Answer 11

Step Up

Question 12

Step Up approach

Answer 12

1 - FNA for gram stain/culture + Carbapenem
2 - Perc drainage with upsizing PRN
3 - VARD (video assist retroperitoneal debride)
4 - Necrosectomy (endo vs lap vs open)

Question 13

Persistent pancreatic pseudocyst not amenable to endo or perc tx

Answer 13

Lap or open cystojejunostomy

Question 14

Infiltrate vascular, lymphatic and perineural space and account for more than 75% of non-endocrine pancreatic cancers

Answer 14

Ductal adenocarcinoma

Question 15

Sudden hematemesis or bloody drain output s/p pancreatic debridement; next step

Answer 15

CT angio

Question 16

Most common functional neuroendocrine tumor and distribution

Answer 16

Insulinoma, even

Question 17

Symptomatic annular pancreas, tx

Answer 17

Surgical bypass (duo-duo, duo-je, gastro-je)

Question 18

Diameter of pancreatic duct along pancreas

Answer 18

4-3-2 rule, 4mm head, 3mm body, 2mm tail

Question 19

Location of splenic artery and vein in respect to pancreas

Answer 19

Superiorly and posteriorly to the body/tail

Question 20

Superior modality for staging pancreatic ampullary malignancy

Answer 20

EUS

Question 21

Ranson Criteria components

Answer 21

Admission:
Age >55, WBC>16, Glucose>200, LDH>350, AST>250
48hrs:
Hct >10%, BUN incr >5, Base deficit >4, Fluid req >6L, PaO2 <60, Ca <8

Question 22

Pancreatic fistula; tx

Answer 22

NPO, nasojejunal feeding, correct electrolytes, skincare and close in 4-6wks

Question 23

Definition of high output pancreatic fistula

Answer 23

> 200mL/day

Question 24

Pancreas divisum with recurrent pain or pancreatitis, tx

Answer 24

Sphincterotomy and tenting of minor papilla

Question 25

Concerned for autoimmune pancreatitis; next step

Answer 25

Bx to rule out pancreatic adenocarcinoma

Question 26

Most common PNET, where do they arise

Answer 26

Non-functional from islets of Langerhans

Question 27

Unresectable pancreatic cancer definition

Answer 27

Mets, extension into hepatoduodenal lig, involvement of major arterial structures or neural structures

Question 28

Ligated in the gastrosplenic ligament during pancreatectomy

Answer 28

Short gastrics from the splenic artery

Question 29

Homogenous well-circumscribed fluid collection with hyperdense capsule 4wks after pancreatitis

Answer 29

Pancreatic pseudocyst

Question 30

Gallstone pancreatitis with high suspicion for choledocholithiasis; next step

Answer 30

ERCP prior to cholecystectomy

Question 31

Best imaging for dx of acute pancreatitis

Answer 31

MRCP

Question 32

Subtypes of acute pancreatitis based on Atlanta Classification

Answer 32

Interstitial edematous pancreatitis and Necrotizing pancreatitis

Question 33

Severity of acute pancreatitis based upon Atlanta Classification

Answer 33

Mild - no organ failure Moderate - <48hrs organ failure Severe - >48hrs organ failure

Question 34

Young with unexplained recurrent acute pancreatitis; dx and tx

Answer 34

Pancreatic divisum, ERCP