55 Questions
Which cells of the pancreas secrete glucagon?
Alpha cells
Which pancreatic artery supplies the body of the pancreas?
Dorsal pancreatic artery
What is the primary function of ductal cells in the pancreas?
Secrete HCO3− solution
Which vein forms behind the neck of the pancreas?
Portal vein
Where do the uncinate process of the pancreas rest?
On aorta, behind superior mesenteric vein (SMV)
Which of the following is NOT an endocrine cell type in the pancreas?
Acinar cells
What is the primary function of acinar cells in the pancreas?
Secrete digestive enzymes
Which artery supplies the head of the pancreas?
Superior pancreaticoduodenal arteries from the gastroduodenal artery (GDA)
Caudal pancreatic arteries supply which part of the pancreas?
Tail
Which nodes receive lymphatics from the pancreas?
Celiac and superior mesenteric artery (SMA) nodes
Which of the following is a common symptom of pancreatic pseudocysts?
Vague abdominal discomfort and early satiety
What is the most appropriate initial management for pancreatic pseudocysts that are < 5 cm in size?
Expectant management for 3 months
Pancreatic pseudocysts may need to be surgically intervened if:
Symptoms continue and the cyst is growing
Which of the following is a complication associated with pancreatic pseudocysts?
Infection of the cyst and portal vein thrombosis
What is the main cause of chronic pancreatitis?
Alcohol consumption
Which diagnostic imaging modality is best for confirming chronic pancreatitis?
CT scan
What is the mainstay of treatment for patients with chronic pancreatitis?
Pain control and nutritional support
Which procedure is indicated for patients with chronic pancreatitis who have enlarged pancreatic ducts (> 6 mm) and a disease-free pancreatic head?
"Core-out" procedure with lateral pancreaticojejunostomy
"Minimal change" chronic pancreatitis may be treated with:
"Core-out" procedure with lateral pancreaticojejunostomy
"Jaundice workup" involves which initial imaging study?
"Ultrasonography"
What is the most appropriate initial management for a pleural effusion caused by retroperitoneal leakage of pancreatic fluid?
Immediate thoracentesis followed by conservative treatment
What is the main purpose of MRCP in the diagnosis of pancreatic cystic neoplasms?
To differentiate between serous and mucinous cystadenomas
In a patient with suspected Munchausen's syndrome and absence of sulfonylureas, what is the next step in localization?
Somatostatin scintigraphy
What is the preferred method for localization if a pancreatic neuroendocrine tumor (PNET) is not localized with triple phase CT scan or MRI?
Selective intra-arterial calcium injection with hepatic venous sampling for insulin
What is the treatment approach for metastatic disease of a PNET?
Chemotherapy with 5FU and streptozocin
Which diagnostic test is used to confirm Zollinger–Ellison syndrome (ZES)?
Fasting gastrin levels > 1,000
What is the most common site for finding gastrinomas?
Third portion of the duodenum
What is the single best study for localizing a gastrinoma?
Somatostatin receptor scintigraphy (SRS)
What is the recommended treatment for sporadic gastrinoma if the tumor size is less than 2 cm?
Surgical enucleation
In MEN-1 patients with gastrinoma, what is the aim of medical therapy if the tumor size is less than 2 cm?
Medical therapy with diazoxide
Which symptoms are associated with glucagonoma?
Depression, DVT, dermatitis
What is the most malignant form of pancreatic neuroendocrine tumors?
Somatostatinoma
What is the preferred method for localizing a VIPoma?
Somatostatin receptor scintigraphy (SRS)
Which treatment approach is recommended for VIPoma?
Cholecystectomy with resection
What activates trypsinogen to trypsin?
Enterokinase
Which hormone primarily increases pancreatic enzymes?
CCK
Which duct is the major pancreatic duct that merges with the common bile duct before entering the duodenum?
Duct of Wirsung
What is the most common cause of acute pancreatitis in the United States?
Gallstones
Which sign is characterized by flank ecchymosis and is associated with hemorrhagic pancreatitis?
Grey Turner sign
What is the most important risk factor for necrotizing pancreatitis?
Obesity
Which criteria includes age > 55, WBC > 16, glucose > 200, and AST > 250 as indicators of severe pancreatitis?
Ranson's criteria
Which drug is considered the best for severe pancreatitis?
Imipenem
What is the first-line treatment for infected necrosis in severe pancreatitis?
ICU care and early nutrition
Which of the following is a high-risk feature for branch duct IPMN, indicating the need for surgical resection?
Thickened wall and mural nodules
What is the most common symptom of pancreatic adenocarcinoma?
Jaundice
What is the serum marker for pancreatic adenocarcinoma?
CA 19-9
What is the most common site of metastasis for pancreatic adenocarcinoma?
Liver
What is the first line of treatment for non-functional pancreatic neuroendocrine tumors?
Formal resection
Which functional pancreatic neuroendocrine tumor commonly responds to treatment with octreotide?
Gastrinoma
What is the most common functional pancreatic neuroendocrine tumor?
Gastrinoma
What is the characteristic symptom of insulinoma?
Hypoglycemia
Which enzyme marker is elevated in insulinoma?
$ ext{Insulin}$
What is the first-line postoperative chemotherapy regimen for patients with pancreatic adenocarcinoma?
FOLFIRINOX (FOLinic acid, Fluorouracil, IRINotecan, OXaliplatnin)
What is the most significant risk factor for necrotizing pancreatitis?
Chronic pancreatitis
Which imaging study is used to differentiate dilated ducts due to chronic pancreatitis from carcinoma on the basis of its ability to detect vessel involvement?
MRCP (Magnetic Resonance Cholangiopancreatography)
Test your knowledge about pancreatic pseudocysts, their common occurrence in patients with chronic pancreatitis, symptoms, and characteristics such as being a non-epithelialized sac of pancreatic fluid. Understand the differentiation from cysts associated with pancreatitis and the need to rule out mucinous cystadenocarcinoma.
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