Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map


Self-Assessment Questions

Gastroenterology

Acute and Chronic Pancreatitis: Review Questions

Douglas G. Adler, MD

Dr. Adler is a Fellow in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.

Todd H. Baron, MD, FACP

Dr. Baron is an Associate Professor of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.



Choose the single best answer for each question.

Questions 1 and 2 refer to the following case study.

A 49-year-old woman has a 24-hour history of nausea, vomiting, escalating epigastric pain radiating to her back, and fever (temperature to 101.3°F). Medical history is remarkable for depression, cholecystectomy (because of gallstones) 5 months ago, and appendectomy during childhood. She takes fluoxetine
20 mg daily for depression. Physical examination reveals a tender epigastrium as well as tenderness in the right upper quadrant. Laboratory studies reveal the following serum levels: amylase, 14,500 U/L; lipase,
9300 U/L; aspartate aminotransferase, 500 U/L; alanine aminotransferase, 449 U/L; alkaline phosphatase, 420 U/L; total bilirubin, 1.9 mg/dL; calcium, 9.7 mg/dL; triglycerides,
430 mg/dL; and leukocyte count, 16 x 103/mm3.

1. Which of the following is the most likely cause of this patient’s pancreatitis?
  1. Alcohol abuse
  2. Fluoxetine administration
  3. Gallstones
  4. Hypercalcemia
  5. Hypertriglyceridemia
Click here to compare your answer.


2. Which of the following diagnostic tests is most appropriate to determine if gallstones are the cause of the patient’s pancreatitis?

  1. Endoscopic retrograde cholangiopancreatography
  2. Contrast-enhanced computed tomographic (CT) scan of the abdomen
  3. Percutaneous cholangiogram
  4. Plain radiographs of the abdomen
  5. Ultrasonography of the right upper quadrant
Click here to compare your answer.


  3. A contrast-enhanced CT scan of the abdomen in a 51-year-old man with a history of alcohol abuse confirms the presence of renal calculi and incidentally reveals a 4-cm pancreatic pseudocyst near the tail of the pancreas that does not appear to communicate with the pancreatic duct. The patient has had
3 successive attacks of acute pancreatitis over the past 2 years, the most recent occurring
4 months ago, and has recovered from each attack with conservative measures. He no longer consumes alcohol and currently feels well. Which of the following is the most appropriate next step in managing this patient’s pancreatitis?
  1. Observation
  2. Endoscopic drainage of the cyst
  3. Percutaneous drainage of the cyst
  4. Surgical drainage of the cyst
  5. Distal pancreatectomy with cyst removal
Click here to compare your answer.


4. A 62-year-old man with known chronic pancreatitis caused by alcoholism reports a 20-pound weight loss over the past
3 months and frequent, greasy, and malodorous stools. A 72-hour fecal fat collection confirms steatorrhea. The patient no longer consumes alcohol and reports no abdominal pain. Which of the following is the most appropriate first-line treatment for this patient?

  1. Administration of enteric-coated pancreatic enzyme replacement tablets with meals and snacks and concurrent use of calcium-containing antacids
  2. Administration of non-enteric-coated pancreatic enzyme replacement tablets with meals and snacks with concurrent dosing with a histamine2 blocker
  3. Endoscopic placement of a pancreatic duct stent
  4. Institution of a low-fat diet (less than 20 g fat/day)
  5. Subcutaneous administration of octreotide 200 µg 3 times daily
Click here to compare your answer.
 

Self-Assessment Questions Main Page Top

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 1/04/08 • kkj