Pancreatitis and Pancreatic Cancer Fitz

Question 1

170. Risk factors for acute pancreatitis include all of the
following except:
A. hypothyroidism.
B. dyslipidemia.
C. abdominal trauma.
D. thiazide diuretic use.

Answer 1

A. hypothyroidism.

Question 2

171. Ms. Lane, a 38-year-old woman with a long-standing history of alcohol abuse, presents with a 4-day history of a midabdominal ache that radiates through to the back, remains relatively constant, and has been accompanied by nausea and three episodes of vomiting.
     She has tried taking antacids without relief.
     Her skin is cool and moist with a blood pressure of
     90/72 mm Hg, pulse rate of 120 bpm, and respiratory
     rate of 24/min. Findings that would support a diagnosis of acute pancreatitis include all of the following except:
     A. elevated serum amylase level.
     B. elevated lipase level.
     C. jaundice.
     D. upper abdominal tenderness without localization
     or rebound.

Answer 2

C. jaundice.

Question 3

172. Your next best action in caring for Ms. Lane in the
     previous question is to:
     A. refer to the acute care hospital for admission.
     B. attempt office hydration after administration of
     an analgesic agent.
     C. initiate therapy with ranitidine (Zantac®) and
     an antacid.
     D. obtain serum electrolyte levels.

Answer 3

A. refer to the acute care hospital for admission

Question 4

173. Other than the pancreas, other sources of amylase include all of the following except:
A. salivary glands.
B. lung cancer.
C. ovarian cyst.
D. adipose tissue.

Answer 4

D. adipose tissue.

Question 5

174. Elevated lipase levels can be a result of all of the
following conditions except:
A. hepatic failure.
B. renal failure.
C. perforated duodenal ulcer.
D. bowel obstruction or infarction

Answer 5

A. hepatic failure.

Question 6

175. Which of the following statements is true when
     evaluating a patient with acute pancreatitis?
     A. Diagnosis can be made by clinical assessment
     alone.
     B. The pancreas can be clearly visualized by
     abdominal ultrasound.
     C. Measuring serum lipase level along with amylase
     level increases diagnostic specificity in acute
     pancreatitis.
     D. Hypocalcemia is a nearly universal finding

Answer 6

C. Measuring serum lipase level along with amylase
level increases diagnostic specificity in acute
pancreatitis.

Question 7

176. When using the Ranson criteria to evaluate the
     severity of acute pancreatitis, a severe clinical
     course is predicted with a score of:
     A. less than 2.
     B. 3 or greater.
     C. 6 or greater.
     D. 8 or greater.

Answer 7

B. 3 or greater.

Question 8

177. Common signs and symptoms of a pancreatic
     pseudocyst include all of the following except:
     A. abdominal pain that radiates to the back.
     B. nausea and vomiting.
     C. jaundice.
     D. a mass that can be palpated in the upper
     abdomen.

Answer 8

C. jaundice.

Question 9

178. Which of the following diagnostic tests is most
     effective in determining whether a pseudocyst is
     benign?
     A. CT scan
     B. MRI scan
     C. analysis of cyst fluid
     D. serum amylase and lipase levels

Answer 9

C. analysis of cyst fluid

Question 10

179. A 56-year-old man with a history of colon cancer
     undergoes a follow-up abdominal MRI scan. A small
     mass is identified on the pancreas that is later diagnosed as a benign pseudocyst. The pseudocyst is not causing any symptoms and measures 8 mm in
     diameter. You consider:
     A. repeating the scan in 1 year to check for any
     changes.
     B. draining the pseudocyst.
     C. surgical removal of the pseudocyst.
     D. initiating a regimen of anti-inflammatory medication
     to decrease the size of the pseudocyst.

Answer 10

A. repeating the scan in 1 year to check for any

changes.

Question 11

180. Risk factors for pancreatic cancer include all of the following except:
A. hypertension.
B. history of chronic pancreatitis.
C. tobacco use.
D. diabetes mellitus

Answer 11

A. hypertension.

Question 12

181. In assessing a person with suspected pancreatic
     cancer, the nurse practitioner anticipates which
     of the following findings?
     A. palpable midline abdominal mass
     B. midepigastric pain that radiates to the midback
     or lower back region
     C. presence of Cullen’s sign
     D. positive obturator and psoas signs

Answer 12

B. midepigastric pain that radiates to the midback

or lower back region

Question 13

182. All of the following laboratory findings are expected in a patient with pancreatic cancer except:
A. elevated total bilirubin.
B. diminished platelet count.
C. elevated alkaline phosphatase.
D. elevated direct bilirubin.

Answer 13

B. diminished platelet count.

Question 14

183. The clinical presentation of pancreatic cancer
     involving the head of the pancreas usually includes:
     A. painless jaundice.
     B. polycythemia.
     C. hematuria.
     D. hyperkalemia

Answer 14

A. painless jaundice.

Question 15

184. Which of the following is least likely to be found in a person with pancreatic cancer?
A. history of chronic pancreatitis
B. lesion identified on abdominal CT
C. normocytic, normochromic anemia
D. elevation of amylase level

Answer 15

D. elevation of amylase level

Question 16

220. Cullen’s sign is most commonly associated with which of the following?
A) Acute pancreatitis
B) Myocardial infarction
C) Acute pyelonephritis
D) Preeclampsia

Answer 16

A) Acute pancreatitis Cullen’s sign is commonly seen in acute pancreatitis.

It refers to a yellowish-blue skin color change around the umbilicus. It is thought to occur due to the pancreatic enzymes that run along the ligament and subcutaneous tissues around the umbilicus.

Question 17

270. When a patient is suspected of having acute pancreatitis, initial testing should
include all of the following except:
A) Electrolyte panel
B) Serum amylase level
C) Serum lipase level
D) Barium swallow

Answer 17

D) Barium swallow When a patient has acute abdominal pain, initial labs performed are serum electrolytes, amylase, and lipase. Barium swallow would not be
performed initially.

Question 18

581. What is the best description of Cullen’s sign?
     A) The onset of hyperactive bowel sound before the onset of ileus
     B) A reddish-purple discoloration that is located on the flank area
     C) A bluish discoloration or bruising that is located on the umbilical area
     D) The acute onset of subcutaneous bleeding seen during acute pancreatitis

Answer 18

C) A bluish discoloration or bruising that is located on the umbilical area Cullen’s sign is the acute onset of bluish discoloration that is located on the
umbilical/periumbilical area, caused by bruising underneath the skin.

A bluish discoloration located on the flank area is called the Grey–Turner’s sign. It is a sign of a
severe case of pancreatitis.

Question 19

611. Grey–Turner’s sign is highly suggestive of which of the following conditions?
A) Acute pancreatitis
B) Acute appendicitis
C) Acute diverticulitis
D) Gastric cancer

Answer 19

A) Acute pancreatitis Grey–Turner’s sign is the acute onset of bluish discoloration located on the flank area that is caused by bruising. It is usually
associated with severe acute pancreatitis, but it can also be found in some cases of
ruptured ectopic pregnancy.