MOD 6.1 Flashcards
Patient Z was admitted due Acute Pancreatitis. CT scan of the pancreas showed diffuse non-viable pancreatic parenchyma about 50 percent of the pancreas. On the 7th hospital day, there was no clinical
improvement noted. There were episodes of hypotension.
What is the next appropriate step?
A. Do not start antibiotic since it is not routinely recommended in Acute pancreatitis
B. Start Metronidazole and delay minimally invasive debridement
C. Start Carbapenem antibiotic and observe
D. Start Quinolone antibiotic and perform prompt surgical debridement
D. Start Quinolone antibiotic and perform prompt surgical debridement
What is the most important treatment intervention for acute pancreatitis?
A. Pain killer medication
B. Administration of antibiotics
C. IV fluid resuscitation
D. Placing the patient on NPO
C. IV fluid resuscitation
Which of the following statements are TRUE regarding serum amylase?
A. Remains elevated up to 2 weeks
B. In patients with acidemia, serum amylase is elevated.
C. Elevated amylase correlates with severity of pancreatitis.
D. It is the preferred test in diagnosis of pancreatitis.
B. In patients with acidemia, serum amylase is elevated.
Which of the following statements are TRUE of Acute Pancreatitis?
A. Primary acinar cell injury is the initial step in the initiation of acute pancreatitis.
B. Appropriate activation of pancreatic enzymes used for normal digestive processes
C. Pancreatic duct obstruction may also be caused by parasites such as Ascaris, which leads to acute
pancreatitis.
D. All of the above
C. Pancreatic duct obstruction may also be caused by parasites such as Ascaris, which leads to acute
pancreatitis.
Which of the following is TRUE regarding diagnostic evaluation of patient suspected with acute
pancreatitis?
A. The serum amylase and lipase are usually elevated within 24h of onset and expected to return to normal
within 3 days.
B. Values greater than 2x the normal upper limit of serum amylase together with sign and symptoms of
acute pancreatitis is diagnostic already of the disease.
C. Lipase is the single best enzyme to measure for the diagnosis of acute pancreatitis.
D. Serum amylase is specific with acute pancreatitis and correlates well with severity of pancreatitis.
C. Lipase is the single best enzyme to measure for the diagnosis of acute pancreatitis.
Which of the following signs in a patient with acute pancreatitis occurs as a result of hemoperitoneum?
A. Psoas’ sign
B. Turner’s sign
C. Rovsing’s sign
D. Cullen’s sign
D. Cullen’s sign
What is the most common culprit of pancreatic duct obstruction leading to inflammation of the
pancreas?
A. Biliary stasis
B. Periampullary neoplasm
C. Gallstone
D. Pancreas divisum
C. Gallstone
Which of the following statements about gastritis is TRUE?
A. Gastritis and dyspepsia are interchangeable terms.
B. Gastritis can be seen during endoscopic evaluation of gastric mucosa.
C. The term “gastritis” can only be used as a diagnosis after doing a biopsy of the lesion.
D. Gastritis can be diagnosed based on history and PE only.
C. The term “gastritis” can only be used as a diagnosis after doing a biopsy of the lesion.
A patient diagnosed with pancreatitis was admitted. Which of the following describes a Moderately Severe Acute Pancreatitis?
A. Oral intake can be resumed anytime
B. Characterized by transient organ failure resolving in 24 hours
C. The disease is self-limited and subsides spontaneously.
D. These patients may or may not have necrosis.
D. These patients may or may not have necrosis.
A 45-year-old man with a duodenal ulcer was treated with a combination of drugs intended to heal the mucosal damage and to eradicate Helicobacter pylori. Which of the following antibacterial drugs is used commonly to eradicate intestinal H pylori?
A. Clindamycin
B. Clarithromycin
C. Cefazolin
D. Ciprofloxacin
B. Clarithromycin
Which among the following statements are TRUE regarding acute acalculous cholecystitis?
A. It occurs in patients who are hospitalized for unrelated conditions and risk factors include: sepsis
with hypotension and multisystem organ failure, immunosuppression, major trauma and burns, and
hypertension.
B. An increased risk for the development of acalculous cholecystitis is especially associated with the postpartum period following prolonged labor.
C. Acute acalculous cholecystitis is thought to result from obstruction of the neck or cystic duct by a stone
in 90% of cases.
D. Other precipitating factors include “unusual” bacterial infections of the gallbladder (e.g. Staphylococcus, Enterobacter, Klebsiella)
B. An increased risk for the development of acalculous cholecystitis is especially associated with the postpartum period following prolonged labor.
CC is a 24-year old female who was rushed to the emergency room due to abdominal pain.
History revealed that 2 days prior to admission (PTA), she noted gnawing periumbilical pain, associated with body malaise. 1 day PTA, she noted shift of pain to the right lower quadrant, radiating to the hypogastrium and bilateral lower back. On the day of admission, patient noted non-resolution of symptoms, with new-onset fever (Tmax: 38.7 degrees C) and chills. She denied history of alcoholic or illicit drug use. Patient could not recall exact LMP but mentioned it was more than 3 months prior to admission.
Pertinent PE Findings: BP: 90/60, HR: 110bpm, RR: 25cpm, T: 38 degC, O2 sat: 98% at room air; Pain Scale:
9/10
ABD: distended, hypoactive bowel sounds, (+) guarding, direct and rebound tenderness at the right lower quadrant,
GUT: (+) hypogastric tenderness; (+) costovertebral angle tenderness
EXT: cold clammy extremities, thready pulses (-) cyanosis
Question: Which is the next best step for this patient?
A. Patient must be rushed to the operating room for
STAT Appendectomy.
B. Patient must undergo STAT upper GI endoscopy.
C. Obtain a more detailed history and chronological
sequence of events
D. Narcotics or analgesics must be withheld until a
definitive diagnosis or plan has been formulated.
C. Obtain a more detailed history and chronological
sequence of events
When you are presented with a patient with abdominal pain it is important to acquire a concise history to triage patients into urgent, emergent, or critical status. All of the following are important, but which of the choices may be postponed and done once the patient is stable?
A. Chronicity of symptoms describe Chronicity
B. Current medications taken
C. Location
D. Predisposing factors/events
B. Current medications taken
One of the organisms frequently isolated in culture specimens of patients with acute cholecystitis:
A. Staphylococcus spp.
B. Pneumococcal spp.
C. Clostridium spp.
D. Campylobacter spp.
C. Clostridium spp.
The definition of what determines the disease severity in Acute Pancreatitis include:
A. BMI >30
B. Gastrointestinal bleeding: >50ml of blood
loss/24hrs
C. Pulmonary insufficiency of PaO2 <90 mmHg
D. Modified Marshall score of ≥2
D. Modified Marshall score of ≥2
Acute inflammation of the pancreatic parenchyma and peripancreatic tissues but without recognizable tissue necrosis refers to what morphologic feature of acute pancreatitis?
A. Walled-off necrosis
B. Interstitial pancreatitis
C. Pancreatic pseudocyst
D. Necrotizing pancreatitis
B. Interstitial pancreatitis
Which of the following is TRUE about Type A gastritis?
A. It involves primarily the antrum and the body.
B. It is characterized by circulating antibodies against
goblet cells and G cells.
C. It is associated with pernicious anemia.
D. It is not caused by H. pylori infection
C. It is associated with pernicious anemia.
A 46-year old female, known diabetic, was brought to the ER for severe RUQ pain noted few hours prior to consult associated with vomiting and chills. On further history, she claimed to have had recurrent episodes of RUQ pain for the past month, however, did not seek consult as the pain would resolve spontaneously.
On physical examination, she was noted to be awake however anxious, with the following vital signs:
BP 120/80 mmHg, HR 120 bpm, RR 23 cpm, T 38.2 degrees Celsius, BMI 30.
Noted icteric sclerae, pinkish conjunctivae;
Abdomen flabby, soft, (+) RUQ tenderness, (+) Murphy’s sign, (-) guarding.
Which of the following may be an expected diagnostic finding in relation to the case?
A. The serum bilirubin is mildly elevated in fewer than
half of patients.
B. Leukocytosis in the range of 10,000–15,000 cells per microliter with a right shift on differential count.
C. Ultrasound will demonstrate calculi in about 60% of
cases.
D. One-fourth of patients have significant elevations in
serum aminotransferases (usually more than a fivefold
elevation).
A. The serum bilirubin is mildly elevated in fewer than
half of patients.
What is the most common cause attributed to acute pancreatitis?
A. Acalculous cholecystitis
B. Cholelithiasis
C. Drugs
D. Hypertriglyceridemia
B. Cholelithiasis
CD is a 43-year old female who came in due to epigastric pain. History revealed that the sharp pain started night prior to admission, radiating to the back, 10/10 in severity. This was associated with nausea and 2 episodes of vomiting. Patient had no other associated symptoms such as fever, LBM, cough, or shortness of breath. Patient is a known hypertensive, diabetic and dyslipidemic for 5 years with irregular compliance to Losartan 50 mg OD, Metformin+Linagliptin 500/5mg OD and Rosuvastatin 10mg OD. She was previously
diagnosed with multiple gallbladder stones, previously advised for cholecystectomy but was lost to follow-up.
She is a known smoker for 20 pack years and an occasional alcoholic beverage drinker.
At the ER, patient had a pain scale of 10/10 with PR of 88bpm, BP of 140/90, HR of 105bpm, afebrile.
She had pink palpebral conjunctivae, anicteric sclerae.
Abdomen was slightly distended with (-) guarding and (+) tenderness on the epigastrium, (-) costovertebral
angle tenderness.
Question: Which is TRUE of the following in the diagnostic approach of this patient?
A. Urine amylase is a commonly used test and is reliable if test results are three times (3xULN) the upper limit of normal.
B. Secretin test is a reliable reference standard for
defining severity of malabsorption but does not distinguish between maldigestion and malabsorption.
C. Ultrasonography is a simple, non-invasive tool
which can provide information on edema, inflammation, calcification, pseudocysts, and mass lesions.
D. Computed Tomography provides three-dimensional
imaging of the pancreatic-biliary ductal system by a
non-invasive technique.
C. Ultrasonography is a simple, non-invasive tool
which can provide information on edema, inflammation, calcification, pseudocysts, and mass lesions.
Maria, an 18 year old female, came to your clinic with complaints of periumbilical pain for 2 days associated with bouts of fever and vomiting. She reported no changes in urination or bowel movement.
On PE, vital signs showed T 37.8C, P 86bpm, R 17cpm, BP 120/80 mmHg, PaO2 98%,
Abdominal findings showed normoactive bowel sounds, soft, non-distended and non-tender with no masses noted on palpation.
Pregnancy test was negative.
Which of the following is the most likely working impression for Maria?
A. Appendicitis
B. Pancreatitis
C. Salpingitis
D. Bowel Obstruction
A. Appendicitis
