Pancreasđź‘˝ Flashcards
The percentage ofpatients who will have an occurrence of a replaced right hepatic artery is
A. 1-2%
B. 5-10%
c. 15-20%
D. 20-25%
C
The most common complication ofchronic pancreatitis is
A. Pseudocysts
B. Duct strictures and/or stones
C. Pancreatic necrosis
D. Duodenal obstruction
A pseudocyst
Insulinomas assc with multiple endocrine neoplasia syndrome
A. Do not usually require resection
B. Sporadic in nature
C. Lower rate of recurrence
D. More likely to be malignant
B sporadic in nature
A pancreatic cystic neoplasms that is <3 em, has atypical cells present, and has a solid component
A. Requires a repeat CTscanin3to6months
B. RequiresarepeatCTscanin1year
C. Requirescontinuedobservation
D. Requires resection
D. Requires resection read compre abscite pancreas question 4 diagram
According to Ranson criteria a 67-year-old female patient suspected of acute pancreatitis presenting to the OR with sudden onset of severe abdominal pain, a serum aspartate transaminase (AST) >250 U/dL, a white blood cell (WBC) >16,000/mm3, and a blood glucose >200 mg/dL would receive a disease classification of
A. Predicted severe
B. Predicted mild, uncomplicated
C. Predicted moderate
D. Amortalityof10%
A. Predicted severe. Read compre absite q5
Which of the following is the most common presenting symptom in patients with a somatostatinoma?
A. Cholelithiasis
B. Constipation
C. Hypoglycemia
D. Hypocalcemia
A. Cholelithiasis
The etiology associated with chronic calcific pancreatitis is
A. Hyperparathyroidism
B. Hyperlipidemia
C. Alcoholabuse
D. All ofthe above
D
patients undergoing endoscopic retrograde cholangio pancreatography (ERCP) for diagnosis and staging of chronic pancreatitis, the population most at risk of devel oping procedure- induced pancreatitis is
A. One with calculus disease
B. Onewithintraductallesions
C. Onewithsphincterof Oddi dysfunction
D. One with a high percentage of parenchymal calcification
C. One with sphincter of oddi dysfunction
And a history of post op ercp pancreatitis
Treatment of a 1 cm GASTRINOMA in the wall of the duodenum is best accomplished by
A. Enucleation
B. Full-thickness resection
C. Duodenectomy
D. Whippleprocedure
B full thickness resection
50% metastasizes to lymph nodes and are therefore malignant
The ERCP finding that is virtually diagnostic of intra ductal papillary mucinous neoplasms (IPMNs) is
A. A fish-eye lesion
B. Calcification
C. Beaded or chain-of lakes appearanceoftheduct
D. Cysts that resemble serous cystadenomas
A fish eye lesion
Pain from chronic pancreatitis can be caused by
A. Ductal hypertension
B. Parenchymal disease
C. Obstructive pancreatopathy
D. Allow the above
D. AOTA
A px undergoing Frey procedure to relieve pain from obstructive pancreatopathy is found to have 85% parenchymal fibrosis. The percentage of pain relief the patient is likely to experience is
A. 50%
B. 10%
c. 100%
D. 60%
C 100%
The only therapy shown to prevent the progression chronic pancreatitis is
A.Pancreatic duct decompression
B. Major resection
C. Transduodenal sphincteroplasty
D. Roux-en-Y pancreaticojejunostomy
A. Pancreatic duct decompression
The part of the pancreas re cessful resolution of PAIN
chronic pancreatitis is
A. The head
B. The body
C. The neck
D. The tail
A. The head
Especially the central portion= long term relief
- In pylorus-preserving resections of the pancreas, the technique with the lowest rate of pancreatic leakage is
A. Stent
B. Glue
C. Octreoride
D. AOTA
D. Aota
The prognosis factor that does NOT decrease survival rates in patients with gastrinomas is
A. Liver metastases
B. Absence of MEN 1
C. Lymph node metastases
D. Primary tumor located Outside Of Passaro triangle
C. Lymph node metastes. Remember! Presence of gastrinoma=50% metastasizes to the lymph nodes= resect all as it is malignant
The origin of the inferior pancreaticoduodenal artery is the
A. Gastroduodenal artery
B. Superior mesenteric artery
C. Superior pancreaticoduodenal artery
D. Common hepatic artery
B. Superior mesenteric a
The A
of PP (pancreatic polypeptide) cells is found in the
A. Head of the pancreas
C. Tail of the pancreas
B. Body of the pancreas
D. None of the above—they are equally distributed across the pancreas
A head of the pancreas
Head and uncinate process (ventral)—->High PP, LOW ALPHA cells
Tail (dorsal) and body—-> HIGH ALPHA, LOW PP CELLS
Insulin secretion is stimulated by
A. Lysine
B. Somatostatin
C. Amylin
D. Alpha adrenergic stimulation
A. Lysine
Others: mnemonics: FALL”
FFA
Arginine
Leucine
Lysine
Which of the following pancreatic enzymes is secreted in an active form? A. Amylase
B. Chymotrypsinogen
C. Tyrpsinogen
D. Pepsin
A. Amylase
Only 1
Sympathetic stimulation of the pancreas results in
A. Stimulation of endocrine and exocrine secretion
B. Inhibition of endocrine and exocrine secretion
C. Stimulation of endocrine and inhibition of exocrine secretion
D. Inhibition of endocrine and stimulation of exocrine secretion
B. inhibit both!
Somatostatin-28, one of the two active forms of somatostatin present in the human body, selectively binds to
A. SSTR1
B. SSTR3
C. SSTR5
D. None of the above
C. SSTR5
The most common gene mutation found in pancreatic cancer is
A. HER2/neu
B. K-ras
C. p53
D. Smad 4
B. KRAS -90%
Pancreatic delta cells produce
A. Somatostatin
B. Ghrelin
C. PP
D. Glucagon
A. SOmatostatin
Insulin- beta
Glucagon- alpha
Somatostatin- D cells
PP- PP cell
Amylin- beta
Pancreastatin- beta
A. Lipases
B. Amylase
C. Proteases
D. All of the above
D.AOTA
Which of the following is the primary stimulus for secretion of bicarbonate by the pancreas?
A. CCK
B. Gastrin
C. Acetylcholine
D. Secretin
D. Secretin
Major.
CCK, GHRELIN, ACH- lesser extent
The veins of the HEAD of the pancreas drain into the
A. Ant. Surface of the portal vein
B. Posterolateral surface portal vein
C. Right renal vein
D. Inferior vena cava
B. Posterolateral surface lf the portal vein
Which of the following is NOT a cause of elevated gastrin ?
A. Proton pump inhibitors
B. Gastric outlet obstruction
C. Chronic pancreatitis
D. Pernicious anemia
C. Chronic pancreatitis
Whichof the ff should be ordered in a px with gastrinoma
A serum vit d
B. Serum calcium
C. Serum B12 level
D. Stool occult
B. Serum calcium
To rule out MEN1
Men 1 rarely normalizes serum gastin or even improve survival with resection of gastrinoma
Preservation of the pylorus during the Whipple procedure may
A. Increase the incidence of marginal ulcers
C. Impair gastric emptying
B. Maintain normal gastric hormone release
D. Improve quality of life
B. Maintain normal gastric hormone release
Which of the following drugs has been shown to improve outcome in patients with mild
pancreatitis?
A. H2 blockers
B. Somatostatin
C. Glucagon
D. None of the above
D nota
Supportive thru restriction of food and fluids only
Which of the following procedures is the best treatment for a01.5-cm insulinoma located in the mid pancreas
A enucleation
B. Wedge resection
C distal pancreatomy
D. Duodenal sparing total pancreatectomy
A Enucleation
If >2 cm, letter C with pancreaticoduodenectomy
The most common type of pancreatic cancer is
A. Ductal AdenoCa
B Adenosquamous CA
C ACINAR cell carcinoma
D. SCCA
A. Ductal adenoCA
Pancreas divisum occurs as a result of
A. Pancreatitis
B. Carcinoma of the pancreas
C.Trauma
D. Abnormal fusion of the pancreatic ducts
D. Abnormal fusion of the p ducts
Which of the ff is the initial med used to treat pain in px w chronic pancreatitis
A. Enteric coated pancreatic enzyme prep
B N o n – e n t e r i c - c o a t e d -p a n c r e a t i c e n z y m e p r e p a r a t i o n s
C. Octreotide
D. Somatostatin
B. Non enteric coated pancreatic enzyme prep
The median survival following pancreaticoduodenectomy (Whipple procedure) for pancreatic cancer is approximately
A 9 mo
B 2 yrs
C 4 yrs
D 8 yrs
B. 2 yrs
Which of the following is the most commonly used initial treatment for pancreatic ascites?
A. Octreotide, bowel rest, TPN
B. Endoscopic stenting of the pancreatic duct
C. Roux-en-Y pancreaticojejunostomy
D. Distal pancreatectomy
A. Octreotide, bowel rest tpn
The most common cause of chronic pancreatitis is A.Alcoholconsumption
B. Hypertriglyceridemia
C. Autoimmune pancreatitis
D. Hereditary pancreatitis
A. ALAQ
What percentage of patients who consume 100 to 150 g (7-10 drinks) of alcohol per day will develop pancreatitis?
A. 1-3%
B. 10-15%
C. 20-30%
D. 50-65%
B 10-15%
Patients with gallstone pancreatitis should undergo cholecystectomy A. Emergently (within the first 12-24 hours of admission)
B. Within 48-72 hours of admission
C. Following ERCP
D. 4-6 weeks after resolution of symptoms
B w/i 48-72 hrs
At the time of laparotomy, which of the following is a contraindication to proceeding with a whipple resection
A duodenal invasion
B pyloric invasion
C clinically positive hilar lymph nodes
D clinically positive peripancreatic nodes
C. Clinically positive hilar lymph npdes
Which of the following is the most sensitive diagnostic test for chronic pancreatitis?
A. Serum amylase
B. Serum lipase Pancreatitis
C. Postprandial pancreatic polypeptide hormone
D. Oral glucose tolerance test
C. PPPP
Which of the following is one of ransons criteria determined during the initial assessment of a potential pancreatitis
A serum calcium 8 mg/dl
B. Serum ldh >350 iu/dl
C. Blood glucose >120mg/dL
D serum AST >150 U/dL
B. Serum LDH >350
The most common endocrine tumor of the pancreas is
A. Gastrinoma
B. Glucagonoma
C. Insulinoma
D. Somatostatinoma
C insulinoma
Most daghan cells i guess
Which of the following techniques decreases the risk of pancreatic anastomotic leak in the Whipple
procedure?
A. End-to-side anastomosis glue
B. Side-to-side anastomosis
C. Duct to mucosa sutures
D. None of the above
D nota
Which of the ff is often adjacent to the inferior border of a pancreatic pseudocyst
A. Psoterior wall of thestomach
B splenic vein
C transverse mesocolon
D left kidney
C. Transv mesocolon
- Which of the following is the most sensitive imaging study to indentify and localize a gastrinoma
A. CT scan
B. MRI
C. PET scan
D. Octreotide scintigraphy
D. Octreotide scintigraphy
Bc if may gastrinoma= need whole body imaging
Wh i c h o f t h e f o l l o w i n g i s s u g g e s t i v e o f m a l i g n a n cI y i n a c y s t i c l e s i o n o f t h e p a n c r e a s ?
A. Elevated LDH in the cyst fluid
B. Cyst wall >3 mm in thickness
C. Thick, mucinous fluid in the cyst cavity mucinous
D. Hemorrhagic fluid in the cyst cavity
C thick mucinous fluid in the cyst cavity
FLUID CYST= malignancy
The most common location for a VIPoma is
A. Head of the pancreas
B. Tail of the pancreas
C. Passaro’s triangle
D. Duodenal wall
B. Tail of the pancreas
V for Vuntot
Failure to inhibit activation of which of the following enzymes can cause familial pancreatitis?
A. Trypsinogen
B. Pepsinogen
C. Chymotrypsinogen
D. Elastase
A. Trypsinogen
Which of the following is NOT a recognized cause of pancreatitis?
A. Pancreas divisum
B. Hypermagnesemia
C.Venom
D. Hypercalcemia
B. Hypermagnesemia
Compre absite q 13 p 202
Which of the following CT findings is NOT considered a sign that a pancreatic tumor is unresectable?
A. Enlarged lymph nodes outside the boundary of resection
A. Ascites
C. Invasion of the superior mesenteric vein ,
D. Invasion of the superior mesenteric artery
C. Invasion of the SMV
Invasion of the SMV and portal vein IS NOT A CONTRAINDICATION as long as theyre patent then ok
Serum amylase rises at the onset of pancreatitis and remains elevated for
A. 24 hours
B. 43 hrs
C 3-5 days
D. 7-10 days
C. 3-5 days
A/my/lase= 3 syllables
Which of the following is NOT a risk factor for pancreatic cancer?
A. Age >60
D. Female gender
B. African American race
C. Smoking
-
D. Female gender
The or mucin extruding from the ampulla of Vater during ERCP, is virtually pathog
A. Cystadenoma of the pancreas
B. Mucinous cystadenoma
C. Intraductal papillary mucinous neoplasm
D. Mucinous adenocarcinoma of the pancreas
C. Intraductal papillary mucinous neoplasm
Which of the following analgesic drugs should NOT be used in a patient with pancreatitis?
A. Meperidine
B. Morphine
C. Buprenorphine
D. Pentazocine
B. Morphine
Causes spasms to Sphincter of Oddi =morph!
Thee most common complication of chronic pancreatitis is
A. Hemorrhage
B. Necrotizing infection C.Pseudocyst
D.Duodenal obstruction
C, pseudocyst
Appropriate management of a patient with an asymptomatic 3-cm cystadenoma of the tail of the pancreas is
A. Observation and serial CT scans
B. Percutaneous cyst aspiration and sclerosis
C.Enucleation
D. Distal pancreatectomy
A. Observation and serial ct scans
very benign!
Which of the following is NOT an indication for diagnostic laparoscopy to determine respectability in a patient with pancreatic cancer?
A. CT demonstrates respectable disease
B. CA19-9 is high
C.Tumorsize2cm
D. Ascites
C. Tumor size 2 cm
Which of the following is the preferred treatment for a persistent pseudocyst after traumatic injury to the pan@creas?
A. External drainage
B. Endoscopic stenting of the pancreatic duct C. Cystgastrostomy
D. Cystjejunostomy
B. Endoscopic stenting of the pancrearic duct
A variant of chronic pancreatitis, a non obstructive, diffusely infiltrative disease associated with fibrosis and mononuclear infiltrate.
a. autoimmune pancreatitis
b. SPINK1
c. tropical Pancreatitis
d. CFTR
e. Idiopathic Pancreatitis
A autoimmune pancreatitis
Pain from chronic pancreatitis can be caused by which of the following ?
a. Obstructive pancreatopathy
b. All of the above
c. Parenchymal disease
d. Ductal hypertension
AOTA
In Pancreas Divisum the ventral anlage becomes/contains which of the following
a. Tail of the pancreas
b. Duct of Wirsung
c. Duct of Santorini
d. Body of the pancreas
B duct of wirsung
Which of the following is a malignant primary tumor of the exocrine pancreas?
a. None of the choices is correct
b. intraductal mucinous papillary tumor
c. All of the choices are correct
d. solid pseudo papillary tumor
e. mature cystic teratoma
B. Intraductal mucinous papillary TUMOR
BENIGN IS IPMA
A 46 year old male presented with severe pancreatitis. Upon diagnostic imaging, gallstones were noted. Which of the following is the best option in the management of this patient?
a. ERCP and extraction of the obstructing stone
b. MRCP
c. Laparoscopic cholecystectomy
d. ERCP and extraction of stone and
laparoscopic cholecystectomy
e. Antibiotic therapy
D. Ercp and extraction of stone and lap. Cholecystectomy
A 40 year old patient is diagnosed to have a pancreatic head mass, the surgeon decided to do a pancreaticoduodenectomy. Intra-op , the surgeon decided to do a palliative operation instead. Which of the following could prompt the change in the operative plan?
a. Invasion of the distal stomach
b. Liver metastasis
c. Peritoneal implants
d. 190 degrees involvement of the
superior mesenteric artery
Pwede B and C but number one sa list is B, metastases
The superior and inferior pancreaticoduodenal arteries join together within the parenchyma of the anterior and posterior sides of the head of the pancreas along the medial aspect of the C- loop of the duodenum to form arcades that give off numerous branches to the duodenum and head of the pancreas. therefore, it is possible to resect the head of the pancreas without devascularization the duodenum
a. FALSE
b. TRUE
FALSE unless a rim of pancreas containing the arcade is preserved
Which statement is correct about the exocrine function of the pancreas?
a. All of the choices are correct
b. Greater concentrations of bicarbonate are secreted at higher secretory rates.
c. None of the choices is correct
d. Chloride secretion varies inversely with
bicarbonate secretion.
e. Sodium and potassium concentrations
are independent of the secret
AOTA
This is the collection of pancreatic juice enclosed within a perimeter of early granulation tissue, usually as a consequence of acute pancreatitis that has occurred within the preceding 3-4 weeks
a. peri pancreatic fluid collection
b. late pancreatic necrosis
c. Acute pseudocyst
d. pancreatic abscess
e. chronic pseudocyst
Acute pseudocyst
Peripancreatic- enzyme rich that occurs early in the course
Early pancreatic necrosis- sterile, focal/diffused with liquefied debris
Late pancreatic necrosis- organized steril debris and fluid
Acute pseudocyst- pancreatic juice that occured 3-4 wks prior
Chronic pseudocyst- pancreatic fluid with normal wall >6 wks
Pancreatic abscess- any of the above w pus
Intra pancreatic complications of pseudocyst , except
a. visceral artery erosion
b. splenic vein thrombosis
c. bile duct stenosis
d. portal vein thrombosis
e. duodenal obstruction
AOTA are true
A 30 year old male patient , diagnosed with chronic pancreatitis, was readmitted because of abdominal pain and palpable mass. CT scan revealed pancreatic pseudocyst, which statement is not correct?
a. pseudocysts > 6cm resolve less frequently than smaller ones but may regress over a period of weeks to months
b. pseudocysts may become abscesses and can cause pseudoaneurysms
c. None of the choices is correct
d. pancreatic duct leak with extravasation of pancreatic juice results in peripancreatic fluid collection, over a period of 4 weeks, is sealed by an inflammatory reaction that leads to development of wall of acute granulation tissue without much fibrosis referred as acute pseudocyst
e. acute pseudocysts may resolve spontaneously in up to 50% of cases, over a course of 6weeks or longer
C none r korique
A pancreatic adenocarcinoma >2cm in size but does not extend beyond the pancreas and has no lymph node invasion and metastasis is staged as?
a. Stage Ia b. Stage IIa c. Stage IIb d. Stage Ib
D 1b
Which of the following subset of patients could have the most severe form of pancreatitis
using the Ranson’s Criteria?
A. 50 year old female with gallstone pancreatitis and an initial blood glucose of 200 mg/dL
b. A 35 year old male with acute pancreatitis and a serum AST level of 200U/dL
c. A 23 female with hereditary pancreatitis and a hematocrit fall of 5 points
d. A 60 year old male with alcoholic pancreatitis and a wbc count of 10000/mm3
D.
A 39 year old male admitted under the service of Dr. Cirujano, with a working diagnosis of chronic pancreatitis was referred to you for co- management possible EUS. What can you tell the patient about the EUS?
a. C. intraductal lesions, intraductal mucus, cystic lesions and subtle ductular abnormalities are recognizable by EUS
b. None of the choices is correct
c. All of the choices are correct
d. EUS images through 3-5 mHz
transducer are able to evaluate subtle changes in 2-3 mm structures within the pancreas and can detect indolent
Ambot basi A…
What is true about the histology of the pancreas?
a. None of the choices
b. Majority of the pancreatic mass is made
up of the endocrine pancreas
c. All of the choices
d. Pancreatic amylase is secreted in its
passive form and hydrolyzes lipids
e. Only 20% of the normal pancreas is required to prevent a patient from becoming diabetic
E. Only 20% of the normal pancreas is required to prevent a px from becoming diabetic
Ranson’s Criteria for acute gallstone pancreatitis during initial 48hrs include
a. Serum calcium, base deficit, BUN
b. Serum calcium, blood glucose, BUN
c. Serum calcium, arterial PO2, BUN
d. Serum calcium, Serum LDH, BUN
e. None of the choices
A. Ca, base deficit, bun
Preferred operative interventions for a pancreatic pseudocyst, except
a. Endoscopic cystogastrostomy
b. Open cystogastrostomy
c. Ultrasound guided external drainage
of pseudocyst
d. Open cystojejunostomy
C. Ultrasound guided external drainage
According to WHO classification of primary tumors of exocrine pancreas, which has the lowest malignant potential?
a. Mucnous Cystadenocarcinoma
b. Solid Pseudopapillary Tumor
c. Mucinous Cystadenoma
d. Intraductal Mucinous Papillary Tumor
A.
Lymphoma can affect the pancreas. Primary involvement of the pancreas with no disease outside the pancreas can also occur. Which of the following is INCORRECT?
a. Mgt includes resection of pancreatic lymphoma
b. Identification of a large mass often involving the head and body of the pancreas should raise suspicion. Percutaneous or EUS guided biopsy will confirm the diagnosis in most cases
c. None of the choices
d. Can be treated by endoscopic stenting
and follows by chemotherapy
e. If the diagnosis cannot be confirmed
preoperatively, laparoscopic exploration can be done
A . RESECTION has no role in the management.
Endoscopic stenting to relief jaundice followed by chemotherapy is the standard tx
In a Whipple’s procedure, the following are resected or removed, except
a. Duodenum
b. Spleen
c. CBD
d. Gallbladder
B spleen
A 60 year old male, smoker , came in to your clinic with CT scan result of pancreatic head mass probably malignant, cT4, N1, M0, during laparoscopy, what is the contraindication for surgical resection?
A. .celiac lymph node involvement
b. Both
c. peritoneal implants
d. Neither
Both
€a 45 yr old male presented w epigastric pain that radiates to the mid back associated with serum amylase >3 times the normal.
A. Contrast ct scan to determine the diagnosis of acute pancreatitis
B. No significance correlation between the magnitude of serum amylase elevation and severity of pancreatitis
C. Contrast ct scan is needed to determine the dx of acute pancreatitis
D. AOTA
AOTA
What is true about EUS? (Endoscopic ultrasound)
A. Intraductal lesions, intraductal mucus, cystic lesions, and subtle ductular abnormalities are recognizable by EUS
b. EUS provides imaging capability but cannot obtain chemical samples of tissue and fluid aspiration
c. EUS images through 3-5 mHz transducer are able to evaluate subtle changes in 2-3 mm structures within the pancreas and can detect neoplasms in the setting of chronic inflammation
d. All of the choices are correct
A. Intraductal lesions, intraductal mucus, cystic lesions, and subtle ductular abnormalities are recognizable by EUS
—-
FALSE:
b – EUS provides not only imaging capability but also adds the capacity to obtain cytologic and chemical samples of tissue and fluid aspirated
c – EUS images are obtained through a high frequency transducer
A 60 male, came in to your clinic with CT scan findings of 2.2 c. Pancreatic head mass without involvement of the SMV and SMA, clinical staging of this patient
a. Stage Ia b. Stage Ib c. Stage IIa d. Stage IIb
C 2a
Tumors that are >2–≤4 cm are categorized as T2, and tumors >4 cm are categorized as T3. Patients without nodal involvement (N0) are stages IA, IB, and IIA based on tumor size (T1–T3, respectively). Patients with one to three regional lymph nodes involved (N2) are stage IIB regardless of tumor size.
- Treatment of pseudocyst except
â—Ź Aspirated
â—Ź Internal drainage
â—Ź Open/endoscopic cystogastrostomy
â—Źexternal drainage
External drainage
> 2cm lesions limited to pancreas
A.type 2B
B. Type 1B
C. Type 2A
D. Type 1A
B. Type1B
Risk for acalculous pancreatitis
Sepsis
Prolonged Somatostatin tx
Sepsis
Not a risk for acalculous pancreatitis
Sepsis
Prolonged Somatostatin tx
Prolonged Somatostatin tx
If pseudocyst failed to resolve after conservative therapy, and symptoms persist, external drainage is preferred than internal drainage to avoid developing pancreaticocutaneous fistula. T/F
F
Mechanisms by which ethanol causes acute pancreatitis except:
A. Acinar cells cause brief secretory inc ff by inhibition
B. Secretory burst induce spasm of sphincter of oddi
C. Induces ductal permeability causing damage to panc parenchyma
D. Increase in protein content of panc juice, bicarb, & trypsin inh conc
E. NOTA
D. Increase in protein content of panc juice, bicarb, & trypsin inh conc
