Pncrs ABST SLYR

Question 1

Major pancreatic duct that forms in the pancreatic head and descends inferiorly
and joins the intrapancreatic portion of the common bile duct to form the
common pancreaticobiliary channel proximal to the ampulla of Vater.

Answer 1

Duct of Wirsung

Question 2

Accessory pancreatic duct that drains the anterior portion of the pancreatic head

Answer 2

Duct of Santorini

Question 3

What is the blood supply to the head of the pancreas?

Answer 3

Anterior and posterosuperior pancreaticoduodenal arteries

Question 4

Anterior and posterosuperior pancreaticoduodenal arteries are direct branches of what artery?

Answer 4

Gastroduodenal artery

Question 5

The gastroduodenal artery is a branch of

Answer 5

common hepatic artery

Question 6

The common hepatic artery is a branch of

Answer 6

coeliac artery

Question 7

Which enzyme is responsible for pancreatic necrosis in presence of bile?

Answer 7

Phospholipase A

Question 8

What defines a high-output pancreatic fistula?

Answer 8

Output in excess of 200 mL/d

Question 9

What accounts for >90% of acute pancreatitis?

Answer 9

Gallstones and alcohol

Question 10

Hyperlipidemia that cause acute pancreatitis?

Answer 10

Types I, IV and V

Question 11

How does hypercalcemia cause pancreatitis?

Answer 11

Hypercalcemia most commnly found with hyperparathyroidism could lead to intraductal precipitation of calcium.

Question 12

How is acute pancreatitis diagnosed?

Answer 12

2 of the following 3 features

1. abdominal pain characteristic of acute pancreatitis
2. serum amylase or lipase level at least 3 times the upper limit of normal
3. characteristic findings of acute pancreatits on CT

PLC

Question 13

Which enzyme is implicated in etiology of pancreatitis?

Answer 13

Trypsin

Question 14

Which serum enzyme rises within 2 hours of the onset of pancreatitis and
peaks within 48 hours?

Answer 14

Amylase

Question 15

What antibiotics are indicated for patients with mild pancreatitis?

Answer 15

None! Antibiotics neither improve the course nor prevent septic complications.

Question 16

What CT scan findings are suggestive of chronic pancreatitis?

Answer 16

CPD

Calcifications,

parenchymal atrophy

Dilated pancreatic duct,

Question 17

What are the early Ranson criteria (on admission)?

Answer 17

GAWA
Glucose >200 mg/dL,

Age >55, LDH >350 IU/L,

WBC >16k

AST >250 IU/L,

Question 18

What are the late Ranson criteria (48 hours)?

Answer 18

Calcium <8.0 mg/dL

HCT drop >10%,

PaO2 <60 mm Hg,

BUN increase by 5
or more mg/dL,

base deficit >4 mEq/L

fluid sequestration >6 L

Question 19

How do Ranson criteria predict mortality?

0 to 2 signs

Answer 19

2% mortality

Question 20

How do Ranson criteria predict mortality?

3 to 4 signs

Answer 20

15%

Question 21

How do Ranson criteria predict mortality?

5 to 6 signs

Answer 21

40%

Question 22

How many signs do you need to have 100% mortality based on Ranson Criteria

Answer 22

7 to 8 signs, ~100%

Question 23

The ff are indications for surgery in chronic pancreatitis EXCEPT

a. intermittent abdominal pain
b. common bile duct obstruction
c. pancreastic fistula
d. variceal hemorrage

Answer 23

A

Question 24

The ff are possible complications of pancreatitis except

a. pancreatic necrosis
b. pseudocyst
c. pancreatic fistulas
d. hemorrhage
e. pancreatic ascites
f. abscess/sepsis

Answer 24

NOTA

Question 25

Initial management of pancreatic duct stricture from chronic pancreatitis:

Answer 25

Pancratic duct stenting

Question 26

``` distal pancreatectomy with end-to-end pancreaticojejunostomy a. Puestow procedure b. Duval procedure c. Frey procedure d. Beger procedure ```

Answer 26

B

Question 27

duodenum-preserving pancreatic head resection a. Puestow procedure b. Duval procedure c. Frey procedure d. Beger procedure

Answer 27

D

Question 28

coring out of diseased portion of pancreatic head and then lateral pancreaticojejunostomy for chronic pancreatitis a. Puestow procedure b. Duval procedure c. Frey procedure d. Beger procedure

Answer 28

C

Question 29

``` lateral side-to-side pancreaticojejunostomy a. Puestow procedure b. Duval procedure c. Frey procedure d. Beger procedure ```

Answer 29

A

Question 30

Most widely used and preferred procedure for chronic pancreatitis a. Puestow procedure b. Duval procedure c. Frey procedure d. Beger procedure

Answer 30

A

Question 31

What surgery is done for type I DM? a. Puestow procedure b. Duval procedure c. Frey procedure d. Beger procedure

Answer 31

NOTA; pancreatic resection, pancreatic denervation, islet cell transplantation is done

Question 32

What percentage of pseudocysts spontaneously resolve within 4 to 6 weeks?

Answer 32

50%

Question 33

How long does it take a pseudocyst to mature?

Answer 33

4-6 weeks

Question 34

Indication for surgical intervention for pancreatic pseudocysts:

Answer 34

Pseudocyst has not resolved by 6 weeks and also persistently greater than 6 cm

Question 35

List the enteric methods of pseudocyst drainage

Answer 35

Cystogastrostomy, cystoduodenostomy, and Roux-en-y cystojejunostomy, lateral pancreaticojejunostomy

Question 36

What is the usual time frame for development of pancreatic abscesses associated with acute pancreatitis?

Answer 36

2-4 weeks

Question 37

What CT scan criteria are used for diagnosis of pancreatic necrosis?

Answer 37

Well-demarcated areas of nonenhancing pancreatic tissue >3 cm or occupying more than 30% of the gland

Question 38

How is infected pancreatic necrosis diagnosed?

Answer 38

CT-guided percutaneous fine-needle aspiration

Question 39

What antibiotics are indicated in pancreatic necrosis involving >30% of the gland?

Answer 39

Imipenem or meropenem

Question 40

How are pancreatic fistulas managed? The ff are involved except a. glucagon b. NPO c. parenteral nutrition d. somatostatin

Answer 40

D

Question 41

Which congential anomaly results from failure of fusion of the dorsal and ventral pancreatic ducts?

Answer 41

Pancreas divisum

Question 42

What is the most common benign neoplasm in the pancreas?

Answer 42

Serous cystadenoma

Question 43

What is the treatment for serous cystadenoma?Resection generally recommended but this lesion can be closely followed in high-operative-risk patients.

Answer 43

Resection ... generally recommended but this lesion can be closely followed in high-operative-risk patients.

Question 44

What tumor exhibits sunburst central calcification on CT scan?

Answer 44

Serous cystadenoma

Question 45

Overall 5-year survival rate for pancreatic cancer:

Answer 45

<5%

Question 46

Median survival time of pancreatic cancer patients:

Answer 46

4-6 months

Question 47

What is the most significant modifiable risk factor for pancreatic cancer?

Answer 47

Cigarette smoking

Question 48

What are the presenting signs of pancreatic cancer?

Answer 48

Abdominal pain jaundice weight loss

Question 49

Painless jaundice in patient with cancer. Where is the tumor?

Answer 49

Periampullary/ duodenal neoplasm

Question 50

What imaging studies are needed for diagnosis?

Answer 50

Ultrasound to evaluate biliary anatomy, CT scan

Question 51

The ff are inherited disorders that increase the risk of pancreatic cancer EXCEPT a. MEN1 b. Familial adenomatous polyposis c. HNPCC d. Von Hippel-Lindau e. Gardner Syndrome

Answer 51

NOTA, all increase risk

Question 52

What serologic tumor markers are measured for pancreatic CA? a. CA 19-9 b. CEA c. both d. neither

Answer 52

C

Question 53

What imaging modality is beneficial in assessing the T stage of the tumor in pancreatic cancer?

Answer 53

EUS

Question 54

FDA approved for combination with gemcitabine for first-line treatment of locally advanced, unresectable, or metastatic pancreatic cancer:

Answer 54

Erlotinib

Question 55

What percentage of patients with pancreatic cancer will have had a new diagnosis of diabetes?

Answer 55

20%

Question 56

T1 pancreatic cancer:

Answer 56

Tumor limited to the pancreas, <2 cm

Question 57

T2 pancreatic cancer:

Answer 57

Tumor limited to the pancreas, >2 cm

Question 58

T3 pancreatic cancer:

Answer 58

Tumor extends beyond the pancreas but without involvement of the celiac axis or the SMA

Question 59

T4 pancreatic cancer:

Answer 59

Tumor involves the celiac axis or the SMA

Question 60

What T stage denotes unresectable disease?

Answer 60

T4, by definition

Question 61

What reconstruction is performed during after standard | pancreaticoduodenectomy (Whipple procedure)?

Answer 61

End-to-side pancreaticojejunostomy, hepaticojejunostomy, gastrojejunostomy

Question 62

What percentage of pancreatic neoplasms are mucinous cystic neoplasms?

Answer 62

2%

Question 63

What distinguishes mucinous cystic neoplasm from intraductal papillary mucinous neoplasm?

Answer 63

Mucinous cystic neoplasm rarely communicates with the main pancreatic duct.

Question 64

Should mucinous cystic neoplasm be resected?

Answer 64

Yes, because of malignant potential.

Question 65

What rash is seen with glucagonoma?

Answer 65

Necrolytic migratory erythema

Question 66

From which islet cells do glucagonoma arise?

Answer 66

α-cells

Question 67

What laboratory test confirms the diagnosis of glucagonoma?

Answer 67

Elevated plasma glucagon >150 pg/mL (many will have levels in excess of 500 pg/mL)

Question 68

Which test is used for localization of glucagonoma?

Answer 68

CT or MRI

Question 69

What is another name for VIPoma?

Answer 69

Verner Morrison syndrome

Question 70

What triad is associated with VIPoma?

Answer 70

Watery diarrhea, hypokalemia, and achlorhydria