Pancreatitis sample questions based on neet pg , usmle, plab and fmge pattern (mci screening)

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A CT scan of acute pancreatitis will show following features, except:
A: Poor contrast enhancement
B: Dilated main pancreatic duct
C: Enlargement of the pancreas
D: Ill defined outline of the pancreas
Correct Ans:B
Explanation
Dilatation of main pancreatic duct is usually seen in chronic calcific pancreatitis.
Ref: Albert L. Baert, Guy Delorme, L. Van Hoe (1999), Chapter 5 , “Pancreatic Disease in
The Childhood”, In the Book, “Radiology of The Pancreas”, Springer Publications, USA,
Page 110 ; Text Book of Radiology and Imaging By Sutton, 7th Edition, Page 7790
Sample Previous Year Question on Pancreatitis based on previous Year Questions of
NEET PG, USMLE,PLAB,FMGE (MCI Screening). Please visit www.medicoapps.org
for more such Quizzes
Colon cut off sign in plain XRay of abdomen is seen in?
A: Mesenteric ischemia
B: Intussusception
C: Acute pancreatitis

D: Acute cholangitis
Correct Ans:C
Explanation
Abrupt termination of the gas within the colon at the level of the radiological splenic
flexure is called colon cut off sign. Inflammatory infiltration of the phrenicocolic ligament
leads to the spasm of the colon and lumen narrowing at the level where colon returns to
retroperitoneum.
“Strings of pearls” appearance is seen in?
A: SAIO
B: Gallstone ileus
C: Chronic pancreatitis
D: Duodenal perforation
Correct Ans:C
Explanation
Chronic pancreatitis is characterized by irregularities of of the pancreatic ducts, ductal
strictures, and area of duct dilation. The major as well as the side branch ducts may be
involved. For unexplained reason, some patients with chronic pancreatitis develop dilated
main pancreatic ducts (large ductal disease), whereas others retain ducts of normal or
even smaller than normal calibers (small ductal disease). Some patients with chronic
pancreatitis can be shown to have major ducts that have the appearance of a “chain of
lakes” or a ”strings of pearls” that is the result of segment of dilated duct separated by
areas of ductal stricture.
Ref: Sutton’s Radiology 7/e, Volume 1, Page 798

On radiography widened duodenal 'C' loop with irregular mucosal pattern on upper
gastrointestinal barium series is most likely due to:
A: Duodenal ileus
B: Chronic pancreatitis
C: Duodenal ulcer
D: Carcinoma head of pancreas
Correct Ans:D
Explanation
Widening of duodenal C loop, inverted 3 sign of Frostburg and rose
thorn appearance is seen in carcinoma head of pancreas. The
treatment is Whipple’s procedure.
Ref: Albert L. Baert, Guy Delorme, L. Van Hoe (1999), Chapter 5, “
Pancreatic Disease in The Childhood”, In the Book, “Radiology of
The Pancreas”, Springer Publications, USA, Page 116
A CT scan of acute pancreatitis will show following features, except:
A: Poor contrast enhancement
B: Dilated main pancreatic duct

C: Enlargement of the pancreas
D: Ill defined outline of the pancreas
Correct Ans:B
Explanation
Dilatation of main pancreatic duct is usually seen in chronic calcific pancreatitis.
Ref: Albert L. Baert, Guy Delorme, L. Van Hoe (1999), Chapter 5 , “Pancreatic Disease in
The Childhood”, In the Book, “Radiology of The Pancreas”, Springer Publications, USA,
Page 110 ; Text Book of Radiology and Imaging By Sutton, 7th Edition, Page 7790
The primary imaging technique used in a case of suspected acute pancreatitis is:
A: MRI abdomen
B: CECT abdomen with pancreatic protocol
C: USG abdomen
D: MR enterography
Correct Ans:B
Explanation
MDCT is the primary imaging technique used in evaluating patients suspected of having
acute pancreatitis.
CT useful for:
Morphologic changes in the pancreas that allow confirmation of pancreatitis
Assessment of the severity

It is the only imaging study that predicts clinical outcome.
Ref: ACR Appropriateness Criteria, Acute Pancreatitis

The CT severity index in acute pancreatitis is described by:
A: Balthazar
B: Mengini
C: Chapman
D: Napelon
Correct Ans:A
Explanation
The CT severity index (CTSI)described by Balthazar
Balthazar CT Severity Index
CT Grade Score
A. Normal 0
B. Enlarged gland 1
C. Peripancreatic inflammation 2
D. One fluid collection 3
E. Two or more collections 4
Necrosis Score
<30% (2)
30%50% (4)
>50% (6)
Ref: ACR Appropriateness Criteria,Acute Pancreatitis.

The potential limitation of CECT in the setting of the acute pancreatitis is:
A: Can not assess the severity
B: May not useful in assessing prognosis
C: Can not clearly diagnose gallstone pancreatitis
D: Can not diagnose peripancreatic fluid collection
Correct Ans:C
Explanation
MDCT is the primary imaging technique used in evaluating patients suspected of having
acute pancreatitis
CT useful for:
Morphologic changes in the pancreas that allow confirmation of pancreatitis
Assessment of the severity
It is the only imaging study that predicts clinical outcome.
A potential limitation of MDCT in assessing acute pancreatitis is that it has only moderate
sensitivity for
detecting gallstones and biliary stones.
Ref: ACR Appropriateness Criteria,Acute Pancreatitis.

A patient with abdominal pain shows "coffee bean" sign in plain abdominal Xray. He
probably have:

A: Colon carcinoma
B: Duodenal atresia
D: Sigmoid volvulus
Correct Ans:D
Explanation
Sigmoid volvulus is a closedloop colonic obstruction due to twisting along the mesenteric
or long axis of the bowel. Although colonic volvulus is not common, about 90% of cases
occur in the sigmoid colon. On plain abdominal films, the sigmoid volvulus forms an
inverted Ushaped structure with the twisted sigmoid loops lying adjacent and having an
oval appearance called the "coffee bean" sign. On barium enema examination, tapered
obstruction of the sigmoid colon is found.

Ref: Ott D.J. (2011). Chapter 10. Gastrointestinal Tract. In M.Y. Chen, T.L. Pope, D.J. Ott
(Eds), Basic Radiology, 2e.
Doublebubble sign on abdominal Xray is seen in :
A: Colon carcinoma
B: Duodenal atresia
D: Perforation

Correct Ans:B
Explanation
Double bubble sign is the characteristic abdominal Xray sign associated with duodenal
atresia. In tis, the stomach and first part of the duodenum are the only parts of the
intestine filled with gas giving the characteristic appearance.

Duodenal atresia typically presents in the first hour of life. Children presents with bilious
vomiting and epigastric distention within a few hours of birth. Meconium may be passed
normally.

It is often associated with other conditions such as esophageal atresia, intestinal atresia,
cardiac and renal anomalies.

Ref: Oski's Pediatric Certification and Recertification Board Review By Carmen Coombs,
page 404. Sundaram S.S., Hoffenberg E.J., Kramer R.E., Sondheimer J.M., Furuta G.T.
(2012). Chapter 21. Gastrointestinal Tract. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding,
J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Erythema nodosum is seen in all of the following, EXCEPT:
A: Pregnancy
B: Tuberculosis
C: SLE
D: Chronic Pancreatitis
Correct Ans:D
Explanation
Pregnancy, SLE and Tuberculosis are all associated with Erythema Nodosum. Erythema Nodosum are
painfully red nodular lesions, occuring bilaterally on the shins. This lesion occur predominantly in
woman in the fall and winter months. It is associated with SLE, Leprosy, TB, etc.
Ref: Immunology, Immunopathology and Immunity, by Stewart Sell, Edward E. Max, Page
518; Chronic Pancreatitis, by Markus Buchler, Helmutt Friess, Page 29, 30, 37.

Pancreatitis occurs with:
A: Abacavir
B: Zidovudine
C: Lamivudine
D: Didanosine
Correct Ans:D
Explanation
The most prominent dose related toxicity associated with the use of didanosine are
pancreatitis and peripheral neuropathy.
Ref: Essentials of Medical Pharmacology By KD Tripathi, 5th Edition, Page 728 30;
Pharmacogenomic Testing in Current Clinical Practice : Implementation in the Clinical
Laboratory By Alan H. B. Wu, KiangTeck J. Yeo, Page 203.
All of the following drugs cause pancreatitis as side effect, EXCEPT:
A: Captopril
B: Furosemide
C: Valproic acid

D: Didanosine
Correct Ans:A
Explanation
Adverse effects of captopril are hypotension, acute renal failure in patients with bilateral
renal artery stenosis, hyperkalemia , dry cough and angioedema.
Drugs associated with highest incidence of pancreatitis are
didanosine, sodium valproate, 5 aminosalicylates and oestrogens.
Drugs causing pancreatitis:
Didanosine
Furosemide and thiazide diuretics
Mesalazine
Metronidazole
Oestrogens
Pentamidine
Sodium valproate
Sulfasalazine
Sulfonamides
Tetracycline
Ref: Adverse Drug Reactions edited by Anne Lee page 183.
Benowitz N.L. (2012). Chapter 11. Antihypertensive Agents. In B.G.
Katzung, S.B. Masters, A.J. Trevor (Eds), Basic & Clinical
Pharmacology, 12e.
The MOST important risk factor for pancreatic cancer among the following is:
A: Cigarette smoking
B: Chronic pancreatitis
C: Diabetes

D: Alcohol
Correct Ans:A
Explanation
All are risk factors of pancreatic malignancy except alcohol.
Cigarette smoking is the most common environmental risk factor for pancreatic
malignancy. Other risk factors are chronic pancreatitis and diabetes.
ALSO NOTE:
Alcohol does not appear to be a risk factor.
Ref: Harrison, Edition 18, Page787
A 25 year old plumber comes to the clinic with complaints of abdominal colic,
constipation, weakness of hand and anemia since 2 years. What would be the most
probable diagnosis in this patient?
A: Lead poisoning
B: Gastric carcinoma
C: Chronic pancreatitis
D: Hookworm infestation
Correct Ans:A
Explanation
The occupational history and clinical features of this patient suggest that he is suffering
from chronic lead poisoning.
Characteristic features of chronic lead poisoning includes:

Facial pallor: Particularly of the mouth is the earliest and most consistent sign.
Anemia: Anemia associated with polychromasia, punctate basophilia,
reticulocytosis, poikolocytosis, anisocytosis and sideroblastosis. Basophilic stippling
refers to the presence of dark blue pin head sized spots in the cytoplasm of red
blood cells.
Lead line or Burtonian line: seen on gums in 70% cases.
Colic and constipation seen in 85% cases.
Lead palsy: Radial nerve is most commonly involved resuling in wrist drop.
Encephalopathy: It is seen in every case of plumbism. Lead encephalopathy is
irreversible and 85% have permanent brain damage.
Round worm causes all, except :
A: Obstructive jaundice
B: Pancreatitis
C: Intestinal obstruction
D: Intestinal perforation
Correct Ans:D
Explanation
A large Round worm burden can lead to malnutrition and weakness, and a mass of worms
may lead to bowel obstruction. Wandering ascaris also traverse internal organs rarely
leading to biliary obstruction, hepatic abscess, acute pancreatitis, acute appendicitis, or
hypersensitivity pneumonitis. It does not cause intestinal perforation.

Ref :VanRooyen M.J., Venugopal R. (2011). Chapter 156. World Travelers. In R.K.
Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study
Guide, 7e.

Which of the following condition is associated with migratory thrombophlebitis?
A: Pancreatitis
B: Pancreatic Ca
C: Varicose veins
D: Buerger's disease
Correct Ans:C
Explanation
Superficial vein thrombophlebitis (SVT) most commonly occurs in varicose veins but can
occur in normal veins. When SVT recurs at variable sites in normal superficial veins, it
may signify a hidden visceral malignancy or a systemic disease such as a blood dyscrasia
and/or a collagen vascular disease. This condition is known as thrombophlebitis migrans.
Clinical signs of SVT include redness, warmth, and tenderness along the distribution of the
affected veins, often associated with a palpable cord.

Ref: Liem T.K., Moneta G.L. (2010). Chapter 24. Venous and Lymphatic Disease. In F.C.
Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B. Matthews, R.E. Pollock
(Eds), Schwartz's Principles of Surgery, 9e.
All of the following statements about Pancreatic Carcinoma are true, EXCEPT:
A: Mutation in P53 gene is associated in 75% of cases
B: Hereditary Pancreatitis significantly increases the risk
C: Median survival in locally advanced (stage III) disease is 36 months

D: Five year survival after curative pancreaticoduodenectomy is 15 20%
Correct Ans:C
Explanation
Median survival for stage III pancreatic cancer is 610 months and for patients with
metastatic disease such as stage IV it is 36 months.
Staging of pancreatic cancer:
Stage I disease includes T1 (size <2cm diameter) and T2 tumors (>2cm, limited to
pancreas) with no lymph node involvement.
Stage II disease includes T3 ( lesions extend beyond the pancreas but do not involve the
celiac axis or superior mesenteric artery).
Stage III includes T4 (lesions involve the celiac axis or superior mesenteric artery and
are not resectable) without metastatic disease.
Stage IV includes T4 with metastases to distant sites such as the liver or lungs are stage
IV.
Ref: Schwartz's Principles of Surgery, 9th Edition, Chapter 33; Pancreatic Cancer By
Daniel D. Von Hoff, Page 447; Lecture Notes: General Surgery By Harold Ellis, Page 288
A patient presents in the causality with history of abdominal pain. On examination the
person is in shock, with severe abdominal tenderness and guarding. There was also one
episode of bloody diarrhoea. He gives a history of recurrent abdominal pain soon after
taking food which persists for about 3 hours after food. He also has a history of MI about 5
years back. What is your diagnosis?
A: Acute thrombotic mesenteric vascular occlusion
B: Acute pancreatitis
C: Acute duodenal ulcer perforation
D: Acute appendicitis

Correct Ans:A
Explanation
The person has had recurrent episodes of abdominal angina as shown by the pain after
food intake. He also has a history of MI which also suggests that he has atherosclerosis.
The bloody diarrhoea is again suggestive of mesenteric vascular occlusion in this patient.

Ref: Manipal Millennium Edition, Page 429; S.Das, Edition 5, Page 354
Which of the following type of pancreatitis is associated with better prognosis ?
A: Alcoholic pancreatitis
B: Gall stone pancreatitis
C: Post operative pancreatitis
D: Idiopathic pancreatitis
Correct Ans:B
Explanation
Pancreatitis caused by a remediable cause such as cholilithiasis is associated with best prognosis.
Eradication of gallsones can prevent further attacks of pancreatitis.
Gall stone pancreatitis accounts for about 90% of cases of acute pancreatitis. Women are more
affected than men. In this, gallstone is typically located in the distal common bile duct, which shares
its pathway with the main pancreatic duct. Gallstones are recoverable in the feces of over 90% of
patients within 10days of an attack of acute pancreatitis.
Treatment involves supportive care till amylase and lipase levels returns to normal. ERCP with
sphincterectomy and stone retrieval is done in patients who do not pass the stone spontaneously.
After the resolution of of an episode of gallstone pancreatitis, patient should be treated with a
laparoscopic hysterectomy with a cholangiogram.
Ref: Oxford Textbook of Surgery, 2nd Edition, Page 1766; Clinical Review of Surgery: ABSITE

Preparation By Surgisphere Corporation, Page 2378
A patient undergoes a prolonged and complicated pancreatic surgery for chronic
pancreatitis. Most preferred route for supplementary nutrition in this patient would be:
A: Total Parental Nutrition
B: Feeding Gastrostomy
C: Feeding Jejunostomy
D: Oral feeding
Correct Ans:C
Explanation
When a patient has undergone a prolonged and complicated pancreatic surgery, the
recovery of the patient will require a form of nutrition that gives rest to the pancreas and
protect the pancreatic anastomosis. A feeding jejunostomy in such a case can provide
supplementary nutrition and also gives protection to the pancreatic anastomosis and
cause minimal stimulation of pancreatic secretion thereby giving rest to the pancreas.

Ref: Clinical Nutrition in Gastrointestinal Disease By Buchman, 2006, Pages 25657;
Artificial Nutrition Support in Clinical Practice By Jason Payne, 2nd Edition, Page 273;
Essentials of General Surgery By Lawrence, 4th Edition, Page 80
All of the following statements about Pancreatic Carcinoma are true, EXCEPT:

A: Mutation in P53 gene is associated in 75% of cases
B: Hereditary Pancreatitis significantly increases the risk
C: Median survival in locally advanced (stage III) disease is 36 months
D: Five year survival after curative pancreaticoduodenectomy is 15 20%
Correct Ans:C
Explanation
Median survival for stage III pancreatic cancer is 610 months and for patients with
metastatic disease such as stage IV it is 36 months.
Staging of pancreatic cancer:
Stage I disease includes T1 (size <2cm diameter) and T2 tumors (>2cm, limited to
pancreas) with no lymph node involvement.
Stage II disease includes T3 ( lesions extend beyond the pancreas but do not involve the
celiac axis or superior mesenteric artery).
Stage III includes T4 (lesions involve the celiac axis or superior mesenteric artery and
are not resectable) without metastatic disease.
Stage IV includes T4 with metastases to distant sites such as the liver or lungs are stage
IV.
Ref: Schwartz's Principles of Surgery, 9th Edition, Chapter 33; Pancreatic Cancer By
Daniel D. Von Hoff, Page 447; Lecture Notes: General Surgery By Harold Ellis, Page 288
A lady with a history of epigastric pain radiating to back for three days with normal Serum
amylase levels and abdomen ultrasonogram (USG) revealed cholelithiasis and an
enlarged pancreas. CT scan confirmed the underlying pathology. Which of the following is
the most likely diagnosis.
A: Acute Cholecystitis
B: Acute Pancreatitis

C: Acute Appendicitis
D: Acute Peritonitis
Correct Ans:B
Explanation
History of epigastric pain radiating to back along with an enlarged (edematous) pancreas
on ultrasonography suggests a diagnosis of Acute Pancreatitis. Serum amylase levels may
be normal during an attack of acute pancreatitis.

Ref: Bailey and Love Short Practice of Surgery 24th Edition, Page11231125; Harrison's
17th Edition, Page 2003, 2004, 2007; Current Diagnosis & Treatment in Gastroenterology
(Wiley Blackwell) 4th Edition, Page 516; Basic skills in Interpreting Laboratory Data by
Mary Lee 4th Edition, Page 7251.
Which of the following can be used in the management of acute pancreatitis?
A: Octreotide
B: Aprotinin
C: Glucagone
D: All the above
Correct Ans:D
Explanation
Antibiotic, corticosteroids, H2
blockers and NSAIDS also have a role.

Which of the following is not a cause for Acute pancreatitis?
A: Gall stones
B: Hemochromatosis
C: Alcohol intake
D: Anti retroviral drug
Correct Ans:B
Explanation
Common causes of acute pancreatitis are gallstones, alcohol, ERCP, trauma, post surgery, dysfunction
of sphincter of Oddi and by drugs such as antiretroviral drugs, azathioprine, tetracycline, valproic acid,
6 mercaptopurine, sulfonamides and estrogen. Hemochromatosis is not a cause of acute pancreatitis.
Reference:
Harrison's Principles of Internal Medicine 18e, chapter 313.
All of the following are used in the treatment of acute pancreatitis EXCEPT:
A: Analgesics
B: IV fluids
C: Antibiotics
D: Nasojejunal feeds

Correct Ans:C
Explanation
In most patients (8590%) with acute pancreatitis, the disease is selflimited and subsides
spontaneously, usually within three to seven days after treatment is instituted. Conventional
measures includes
•Analgesics for pain
•IV fluids and colloids to maintain normal intravascular volume
•No oral alimentation.
Once it is clear that a patient will not be able to tolerate oral feeding (a determination that can
usually be made within 4872 hours), enteral nutrition should be considered [rather than total
parenteral nutrition (TPN)] since it maintains gut barrier integrity, thereby preventing bacterial
translocation, is less expensive, and has fewer complications than TPN.

The route through which enteral feeding is administered is under debate. Nasogastric access is easier
to establish and may be as safe as nasojejunal enteral nutrition. However, enteral nutrition that
bypasses the stomach and duodenum stimulates pancreatic secretions less and this rationale
theoretically supports the use of the nasojejunal route. It has not been demonstrated whether either
route is superior in altering morbidity and mortality. When patients with necrotizing pancreatitis
begin oral intake of food, consideration should also be given to the addition of pancreatic enzyme
supplementation and proton pump inhibitor therapy to assist with fat digestion and reduce gastric
acid.
About oral antibiotics harrisson states that:
"There is currently no role for prophylactic antibiotics in either interstitial or necrotizing pancreatitis.
Although several early studies suggested a role for prophylactic antibiotics in patients with necrotizing
pancreatitis, two recent doubleblind, randomized controlled trials failed to demonstrate a reduction in
pancreatic infection with use of antibiotic prophylaxis".

Percutaneous aspiration of necrosis with Gram stain and culture should generally not be performed
until at least 710 days after establishing a diagnosis of necrotizing pancreatitis and only if there are
ongoing signs of possible pancreatic infection such as sustained leukocytosis, fever, or organ failure.
Once a diagnosis of infected necrosis is established, appropriate antibiotics should be instituted and
surgical debridement should be undertaken
Which of the following statement regarding pancreatitis is true ?
A: Acute pancreatitis has reversible changes

B: Alcohol causes only acute pancreatitis
C: Chronic pancreatitis shows no signs of inflammation
D: Acute pancreatitis affects mainly younger population
Correct Ans:A
Explanation
Chronic pancreatitis is a disease process characterized by irreversible damage to the pancreas as
distinct from the reversible changes noted in acute pancreatitis. The condition is best defined by the
presence of histologic abnormalities, including chronic inflammation, fibrosis, and progressive
destruction of both exocrine and eventually endocrine tissue.
Alcohol is implicated in both acute and chronic pancreatitis and both can occur in young adults.
Scenario: A 40 year old immunocompromised lady presents with rapid onset of severe
addominal symptoms.

Assertion: “Sentinel loop” is a Xray finding in acute pancreatitis.

Reason: The finding is due to patient's posture of leaning forward like a loop, because of pain.
A:
Both Assertion and Reason are true, and Reason is the correct explanation for
Assertion
B:
Both Assertion and Reason are true, and Reason is not the correct explanation
for Assertion
C: Assertion is true, but Reason is false
D: Assertion is false, but Reason is true

Correct Ans:C
Explanation
It is an Xray finding of acute pancreatitis. Sentinel loop is a single dilated atonic loop of
small bowel in straight Xray which is a diagnostic feature of acute pancreatitis.
Ref: A Manual of Clinical Surgery by S. Das, 6th Edition, Page 352
The 'beading' appearance is seen in the condition:
A: Chronic pancreatitis
B: Acute pancreatitis
C: Gall stone ileus
D: Subacute intestinal obstruction
Correct Ans:A
Explanation
In chronic pancreatitis, the pancreatic duct may show beading or a chainoflakes or
stringofpearls appearance because of alternating stenosis and dilatation of the
pancreatic duct. Other features of chronic pancreatitis include strictures, cysts and ductal
calculi.
Pancreatitis may be produced by which of the following drugs?

A: Colchicine
B: L asparagine
C: Ciprofloxacin
D: Nalidixic acid
Correct Ans:B
Explanation
Exposure to certain drugs is the third most common frequent cause of pancreatitis after
gallstones and alcohol.
Drugs associated with pancreatitis:
Definitive cause
5 Aminosalicylate
6 Mercaptopurine
Azathioprine
Cytosine arabinoside
Dideoxyinosine
Diuretics
Estrogens
Furosemide
Metronidazole
Pentamidine
Tetracycline
Thiazide
Trimethoprim sulphamethoxazole
Valproic acid
Probable cause
Acetaminophen
a Methyl DOPA
Isoniazid
L asparagine
Phenformin
Procainamide
Sulindac

Ref: Sabiston 18/e, Page 1595

Which of the following is NOT a bad prognostic sign for pancreatitis?
A: TLC > 16000
B: Calcium < 8 mmol/L
C: Glucose > 200 mg%
D: Prothrombin > 2 time the control
Correct Ans:D
Explanation
Ranson’s Prognostic signs of Acute Pancreatitis (Caused by causes other than gallstones)
At Admission During the initial 48 hrs
Age > 55 years
WBC > 16,000/mm^3
Blood glucose > 200 mg/dl
Serum LDH > 350 IU/dl
Serum AST > 250 U/dl
Hematocrit fall > 10 points
BUN elevation > 5 mg/dL
Serum calcium < 8 mg/dL
Arterial PO2 < 60 mmHg
Base deficit > 4 mEq/dL
Estimated fluid sequestration > 6L
Also know
Prognosis criteria for gallstone pancreatitis
At Admission During the initial 48 hrs
Age > 70 years
WBC > 18,000/mm^3
Blood glucose > 220 mg/dl
Serum LDH > 400 IU/dl
Serum AST > 250 U/dl
Hematocrit fall > 10 points
BUN elevation > 2 mg/dL
Serum calcium < 8 mg/dL
Arterial PO2 < 60 mmHg
Base deficit > 5 mEq/dL
Estimated fluid sequestration > 4L

Ref: Sabiston 18/e, Page 1600; Schwartz 9/e, Page 1183; Washington Manual of Surgery
4/e, Page 282v.

Poor prognostic factors for acute pancreatitis are all, EXCEPT:
A: Hyperglycemia
B: Hypocalcemia
C: Raised LDH levels in blood
D: Hyperamylasemia
Correct Ans:D
Explanation
Hyperamylasemia is not mentioned as the poor prognostic factor. Increased blood glucose,
Increased LDH, and decreased serum calcium, all are included in the ranson’s criteria of
severe pancreatitis.
Ref: Sabiston 18/e, Page 1600; Schwartz 9/e, Page 1183; Washington Manual of Surgery
4/e, Page 282.
All of the following can be used to predict severe acute pancreatitis, EXCEPT:
A: Glasgow score 3

B: Apache II score 9
C: CT severity score 6
D: C reactive protein < 100
Correct Ans:D
Explanation
On account of difference in the outcome between patients with mild and severe disease, it
is important to define that group of patients who will develop severe pancreatitis.
Criteria used to determine the severity of acute pancreatitis:

Criteria used Score at which severity is indicated
Apache score 8
Glasgow score 3
Ranson criteria 3
CT severity index 6
C reactive protein > 150 mg L
Ref: Harrison 17/e, Page 2008; Bailey & Love 1140.
Persistent organ failure in the setting of acute pancreatitis is defined, when the organ
failure lasts for more than:
A: 12 hours
B: 24 hours

C: 48 hours
D: 72 hours
Correct Ans:C
Explanation
The determinant of the severity of acute pancreatitis during the early phase is the
presence and duration of organ failure, if organ failure persists for >48 h.
Ref: Gut 2013;62:102–111. doi:10.1136/gutjnl2012302779.
Areas of peripancreatic fluid seen within the first 4 weeks after onset of interstitial
oedematous pancreatitis is called:
A: Acute Peripancreatic fluid collection
B: Pseudocyst
C: WOPN
D: Abscess
Correct Ans:A
Explanation
APFC (acute peripancreatic fluid collection)
This term applies only to areas of peripancreatic fluid seen within the first 4 weeks
after onset of interstitial oedematous pancreatitis
CECT criteria of peripancreatic fluid collection
In the setting of interstitial oedematous pancreatitis

Homogeneous collection
Confined by normal peripancreatic planes
No definable wall encapsulating the collection
Ref: Gut 2013; 62:102–111. doi:10.1136/gutjnl2012302779.
Ranson’s score is associated with:
A: Volvulus
B: Pancreatitis
C: Appendicitis
D: None of the above
Correct Ans:B
Explanation
Pancreatitis can be classified as severe based on predictors such as APACHEII scores and
Ranson's signs, and any evidence that the condition is severe mandates care of the
patient in the intensive care unit. Such evidence may take various forms, such as the
onset of encephalopathy, a hematocrit >50%, urine output <50 mL/h, hypotension, fever,
or peritonitis.
Elderly patients with three or more Ranson's criteria should also be monitored carefully
despite the absence of severe pain.

Ref: Schwartz’s principle of surgery 9th edition, chapter 33.


Surgical intervention in acute pancreatitis is indicated in all, EXCEPT:
A: Infected necrosis
B: Infected collection
C: Impacted gallstone in ampulla
D: None of the above
Correct Ans:D
Explanation
Surgical intervention in acute pancreatitis is reserved for patients with infected collections
or infected necrosis only, or to relieve an impacted gallstone in the ampulla if endoscopic
or radiologic treatments are unavailable or unsuccessful.

Ref: Schwartz’s principle of surgery 9th edition, chapter 33.
A 58 year old male alcoholic with chronic pancreatitis develops a palpable abdominal
mass. Ultrasound reveals a 9 cm cystic lesion adjacent to the pancreas. An important
complication that might occur if this cyst ruptured would be?
A: Anaphylactic shock
B: Carcinomatosis
C: Disseminated infection
D: Intestinal hemorrhage

Correct Ans:D
Explanation
The patient most likely has a pancreatic pseudocyst, which is a complication of
pancreatitis. Pancreatic pseudocyst is not a true cyst; it is lined by granulation tissue and
collagen. It contains pancreatic juices and lysed blood, so rupture would spill the active
digestive enzymes onto the adjacent viscera, particularly the stomach, small intestine,
and transverse colon. Digestive action produces potentially severe gastrointestinal
hemorrhage.

Anaphylactic shock results from massive activation of the IgEmediated branch of the
immune system. Pancreatic secretions do not elicit an IgE response. The classic
abdominal cyst that ruptures, producing anaphylactic shock, is a hydatid cyst.

Carcinomatosis is widespread serosal spread of a carcinoma, typically due to tumor
spillage into a body cavity. Although this may occur with pancreatic mucinous
cystadenocarcinoma, this disease is far less likely to occur than is pancreatic pseudocyst
in a patient with chronic pancreatitis.

Pancreatic pseudocyst is not an infective disease. Although septic abscesses do occur in
the abdomen, and may even complicate a pancreatic pseudocyst, the danger of rupture is
more associated with tissue destruction by pancreatic enzymes than with infection.

Ref: Fisher W.E., Anderson D.K., Bell R.H., Saluja A.K., Brunicardi F.C. (2010). Chapter 33.
Pancreas. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G. Hunter, J.B.
Matthews, R.E. Pollock (Eds), Schwartz's Principles of Surgery, 9e.

A 23 year old female presented with symptoms of severe pancreatitis. All of the following
are the bad prognostic signs in this patient, EXCEPT:
A: TLC> 16000
B: Calcium less than 8 mmol/L
C: Glucose > 200 mg%

D: Prothrombin > 2 times the control
Correct Ans:D
Explanation
Ranson criteria differentiates mild and severe pancreatitis. It includes five parameters
determined at the time of admission and six parameters determined during the
subsequent 48 hours.

Ranson Criteria:

On admission Within Next 48 h
Age >55 y (>70 y) Decrease in hematocrit by >10% (same)
White blood cell count
>16,000/mm3
(>18,000/mm3)
Estimated fluid sequestration >6 L (>4 L)
Blood glucose level >200
milligrams/dL (>220
milligrams/dL)
Serum calcium level <8.0 milligrams/dL (same)
Serum lactate dehydrogenase
level >350 IU/L (>400 IU/L)
Partial pressure of arterial oxygen <60 mm Hg
(omitted)
Serum aspartate
aminotransferase level >250
IU/L (same)
Increase in blood urea nitrogen level >5
milligrams/dL after IV fluid hydration (>2
milligrams/dL)
Base deficit of >4 mmol/L (>6 mmol)
Patients with three or more Ranson criteria have more severe disease and an increased
risk of complications and death.
Ref: Atilla R., Oktay C. (2011). Chapter 82. Pancreatitis and Cholecystitis. In J.E. Tintinalli,
J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's
Emergency Medicine: A Comprehensive Study Guide, 7e.
Which of the following is NOT a prognostic factor for acute pancreatitis?

A: Hypocalcemia
B: Hyperglycemia
C: AST elevation
D: Increased serum amylase
Correct Ans:D
Explanation
The prognostic factors considered for predicting the severity of acute pancreatitis are :
Arterial PaO2 less than 60 mmHg
LDH more than 600 IU/L
AST more than 200 IU/L
WBC more than 15,000/mm3
Serum albumin less than 3.2gm/dl
Serum calcium less than 8 mg/dl
Blood glucose more than 180 mg/dl
Blood urea more than 45 mg/dl
Ref: Grading and Staging in Gastroenterology By Guido N. J.
Tytgat, page 300.
Child's ChildTurcottePugh is used in :
A: Pancreatitis
B: Cirrhosis
C: Multiple myeloma
D: AIDS

Correct Ans:B
Explanation
The ChildTurcottePugh (CTP) score was originally developed to evaluate the risk of
portacaval shunt procedures secondary to portal hypertension and subsequently has been
shown to be useful in predicting surgical risks of other intraabdominal operations
performed on cirrhotic patients. Numerous studies have demonstrated overall surgical
mortality rates of 10% for patients with class A cirrhosis, 30% for those with class B
cirrhosis, and 75 to 80% for those with class C cirrhosis.

Ref : Tsung A. (2010). Chapter 31. Liver. In T.R. Billiar, D.L. Dunn (Eds), Schwartz's
Principles of Surgery, 9e.
Gallstones may be complicated by which of the following?
1. Pancreatitis
2. Choledocholithisasis
3. Acute cholecystitis
4. Carcinoma stomach
5. Carcinoma pancreas
A: 1,2 & 3
B: 2,3 & 4
C: 1,3 & 5
D: 2,3 & 5
Correct Ans:A
Explanation
Effects and complications of gallbladder stones are:
In Gallbladder In Bile ducts In the intestine
Silent stone
Obstructive jaundice
Acute intestinal obstruction

Acute cholecystitis
Chronic cholecystitis
Mucocele
Empyema
Perforation
Gangrene
Carcinoma
Cholangitis
Acute pancreatitis
(Gallstone ileus)
Ref: Bailey & Love 25/e, Page 1120.
The Reynold's pentad of fever, jaundice, right upper quadrant pain, septic shock and
mental status change in typical of:
A: Cholangitis
B: Hepatitis
C: Cholecystitis
D: Pancreatitis
Correct Ans:A
Explanation
Cholangitis is one of the two main complications of choledochal stones, the other being
gallstone pancreatitis. The most common presentation is fever, epigastric or right upper
quadrant pain, and jaundice. These classic symptoms, well known as Charcot's triad, are
present in about two thirds of patients.

The illness may progress rapidly with septicemia and disorientation, known as Reynolds
pentad (e.g., fever, jaundice, right upper quadrant pain, septic shock, and mental status
changes).

Ref: Oddsdottir M., Pham T.H., Hunter J.G. (2010). Chapter 32. Gallbladder and the

Extrahepatic Biliary System. In F.C. Brunicardi, D.K. Andersen, T.R. Billiar, D.L. Dunn, J.G.
Hunter, J.B. Matthews, R.E. Pollock (Eds), Schwartz's Principles of Surgery, 9e.
In case of choledochal cyst, sidetoside choledochoduodenostomy is NOT recommended
because of the risk of:
A: Malignancy
B: Pancreatitis
C: Recurrent Cholangitis
D: Gall stones
Correct Ans:C
Explanation
The treatment for choledochal cyst is complete excision with RouxenY
hepaticojejunostomy. The duodenal end of the bile duct should be oversewn without
injury to the anomalous entry of the pancreatic duct, limiting the amount of residual
biliary tissue at risk for malignancy. Sidetoside choledochoduodenostomy is not
recommended because it is followed by a high incidence of stricture of the anastomosis
and recurrent cholangitis. Cholecystectomy is always performed.

Ref: Albanese C.T., Sylvester K.G. (2010). Chapter 43. Pediatric Surgery. In G.M. Doherty
(Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
What will be the likely diagnosis in a thirty year old male presenting with epigastric pain
radiating to back that wakes him up at night and is relieved by consuming food. He has a
past history of surgery for a perforated duodenal ulcer, treated with omental patch and
proton pump inhibitors and analgesics:

A: Atrophic Gastritis
B: Duodenal Ulcer
C: Gastric Ulcer
D: Chronic Pancreatitis
Correct Ans:B
Explanation

Epigastric pain relieved by food that awakens the patient of night (when stomach is
empty) suggests a diagnosis of duodenal ulcer. Gastric ulcer pain is exacerbated by food
and usually does not awaken the patient at night. Pancreatic pain is not relieved by food &
is typically relieved by bending forwards & worsened on lying down.

Ref: Bailey and Love Short Practice of Surgery 24th Edition, Page 10389; Current
Diagnosis & Treatment in Surgery (CSDT) 13th Edition, Page85.
Ten days after a splenectomy for blunt abdominal trauma, a 23yearold man complains of
upper abdominal and lower chest pain exacerbated by deep breathing. He is anorectic but
ambulatory and otherwise making satisfactory progress. On physical examination, his
temperature is 38.2°C (108°C) rectally, and he has decreased breath sounds at the left
lung base. His abdominal wound appears to be healing well, bowel sound are active and
there are no peritoneal signs. Rectal examination is negative. The W.B.C. count is 12,500
mm3 with a shift to left. Chest Xrays show platelike atelectasis of the left lung field.
Abdominal Xrays show a nonspecific gas pattern in the bowel and an airfluid level in the
left upper quadrant. Serum amylase is 150 Somogyi units dl (normal 60 to 80). The most
likely diagnosis is:
A: Subphrenic abscess
B:
C: Pancreatitis

D: Pulmonary embolism
Correct Ans:A
Explanation
Patient is showing features of subphrenic abcess. Patient presents with local or subcostal pain and
tenderness, unexplained fever and tachycardia.
Investigation: CBC shows leucocytosis.
Xray chest shows elevated hemidiaphragm, blunting of the costophrenic angle, pleural effusion and
pulmonary infiltrates or atelectasis.
CT scan of abdomen is used to confirm the diagnosis. Scanning techniques such as gallium
technetium subtraction or following injection of gallium labeled leucocytes is also useful in the
localization of subphrenic abscess.
Treatment includes surgical drainage and appropriate antibiotic therapy.
Ref: Crofton and Douglas's Respiratory Diseases: 2 Volume Set, 5th Edition By Anthony Seaton, Page
1239; Common Surgical Emergencies By S. K. Kochar, Page 139; SRB's Manual of Surgery By Bhat,
3rd Edition, Page 508
In which of the following condition is Alvarado's score indicated?
A: Pancreatitis
B: Appendicitis
C: Cholecystitis
D: Cholangitis
Correct Ans:B
Explanation

Alvarado’s score is a 10 point clinical scoring system designed to predict appendicitis
based on clinical parameters.
Alvarado’s clinical scoring for appendicitis:

Clinical parameter Score
Migration of pain 1
Anorexia 1
Nausea or Vomiting 1
Right iliac fossa tenderness 2
Rebound tenderness 1
Temperature more than 37.3 degree celsius 1
WBC more than 10,000 2
Left shift more than 75% PMNs 1
Total 10
An Alvarado score of 8 or greater is about 96% sensitive for appendicitis, while a score
less than 5 rules out the diagnosis.
Ref: Case Studies in Emergency Medicine edited by Rebecca Jeanmonod, page 27
Child with hyperammonemia, later develops pancreatitis and basal ganglia stroke. He may
have:
A: Homocystinuria
B: Maple syrup urine disorder
C: Methylmalonic acidemia

D: Tyrosinemia
Correct Ans:C
Explanation
Children with severe methylmalonic acidemia present with acute, lifethreatening
metabolic acidosis, hyperammonemia, and bone marrow depression in early infancy or
with metabolic acidosis, vomiting, and failure to thrive during the first few months of life.
Most patients with severe disease have mild or moderate mental retardation. Late
complications include pancreatitis, cardiomyopathy, and basal ganglia stroke, and in
methylmalonic aciduria, interstitial nephritis.

Ref: Thomas J.A., Van Hove J.L. (2012). Chapter 36. Inborn Errors of Metabolism. In W.W.
Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis
& Treatment: Pediatrics, 21e.
A patient undergoes a prolonged and complicated pancreatic surgery for chronic
pancreatitis. Most preferred route for supplementary nutrition in this patient would be:
A: Total Parental Nutrition
B: Feeding Gastrostomy
C: Feeding Jejunostomy
D: Oral feeding
Correct Ans:C
Explanation
When a patient has undergone a prolonged and complicated pancreatic surgery, the
recovery of the patient will require a form of nutrition that gives rest to the pancreas and
protect the pancreatic anastomosis. A feeding jejunostomy in such a case can provide
supplementary nutrition and also gives protection to the pancreatic anastomosis and
cause minimal stimulation of pancreatic secretion thereby giving rest to the pancreas.


Ref: Clinical Nutrition in Gastrointestinal Disease By Buchman, 2006, Pages 25657;
Artificial Nutrition Support in Clinical Practice By Jason Payne, 2nd Edition, Page 273;
Essentials of General Surgery By Lawrence, 4th Edition, Page 80
Which of the following is the most common cause of pancreatic pseudocyst?
A: Ca pancreas
B: Pancreatitis
C: Trauma
D: ERCP
Correct Ans:B
Explanation
Pancreatic pseudocysts mostly occur as a complication of acute and chronic pancreatitis. In children,
abdominal trauma is the most common cause.
The immunoglobulin level, which is specifically elevated in
autoimmune pancreatitis is which of the following?
A: IgM
B: IgE

C: IgG4
D: IgG2
Correct Ans:C
Explanation
Serum IgG4 is elevated at least twofold higher than 135 mg/dL in those
with autoimmune pancreatitis.
Reference:
Harrisons Principles of Internal Medicine, 18th Edition, Page 2644
Cobalamin absorption may be abnormal in all, EXCEPT:
B: Achlorhydria
C: Bacterial overgrowth syndromes
D: Diverticular disease of colon
Correct Ans:D
Explanation
Cobalamin absorption may be abnormal in:
Pernicious anemia: Due to absence of both gastric acid and intrinsic factor secretion.
Chronic pancreatitis as a result of deficiency of pancreatic proteases to split the
cobalamin–R binder complex.

Achlorhydria or absence of another factor secreted with acid that is responsible for
splitting cobalamin away from the proteins in food to which it is bound
Bacterial overgrowth syndromes: leading to bacterial utilization of cobalamin (often
referred to as stagnant bowel syndrome).
Ileal dysfunction: due to impaired function of the mechanism of cobalamin–intrinsic
factor uptake by ileal intestinal epithelial cells.
Ref: Harrison, Edition18, e371, e371t.
Pancreatitis, pituitary tumor and phaeochromocytoma may be associated with which of
the following type of thyroid cancer?
A: Anaplastic carcinoma of thyroid
B: Medullary carinoma of thyroid
C: Papillary carcinoma of thyroid
D: Follicular carcinoma of thyroid
Correct Ans:B
Explanation
A MEN 1, or Wermer’s syndrome, is inherited as an autosomal dominant trait. This
syndrome is characterized by neoplasia of the parathyroid glands, enteropancreatic
tumors, anterior pituitary adenomas, and other neuroendocrine tumors with variable
penetrance. Among the types of thyroid cancer given in the question stem, medullary
carcinoma of the thyroid is associated with multiple endocrine neoplasia syndrome.

Ref: Harrison’s Internal Medicine, 18th Edition, Chapter 351

Which is the commonest complication of Mumps in adults ?

A: Encephalitis
B: Orchitis
C: Pancreatitis
D: Carditis
Correct Ans:B
Explanation
Meningoencephalitis is common in children. Unilateral deafness and thyroiditis are also known
complication.
A 25 year old woman presents with bloody diarrhea and is diagnosed as a case of
Ulcerative colitis. Which of the following condition is not associated with ulcerative colitis?
A: Iritis
B: Pancreatitis
C: Sclerosing cholangitis
D: Ankylosing spondylitis
Correct Ans:B
Explanation
Pancreatitis is not an associated extraintestinal manifestation of ulcerative colitis.
Ulcerative Colitis is associated with:

?   Dermatologic:
?  ?  ?  Erythema nodosum
?  ?  ?  Pyoderma gangrenosum
?   Rheumatologic:
?  ?  ?  Peripheral arthritis
?  ?  ?  Ankylosing spondylitis
?  ?  ?  Sacroiliitis
?   Ocular:
?  ?  ?  Conjunctivitis
?  ?  ?  Anterior uveitis/iritis
?  ?  ?  Episcleritis
?   Hepatobiliary:
?  ?  ?  Hepatic steatosis
?  ?  ?  Fatty liver
?  ?  ?  Cholelithiasis
?  ?  ?  Primary sclerosing cholangitis
?   Urologic:
?  ?  ?  Calculi
?  ?  ?  Ileal bladder fistulas
?   Metabolic bone disorders
?   Thromboembolic disorders
Ref: Harrisons Internal Medicine, 18th Edition, Chapter 295, Pages 24872489
Maldigestion of protein and fat is manifested in chronic
pancreatitis only if the damage of pancreatic tissue exceeds?
A: 30 %
B: 50 %
C: 90 %

D: 75 %
Correct Ans:C
Explanation
There is a very large reservoir of pancreatic exocrine function. > 90% of
the pancreas must be damaged before maldigestion of fat and protein is
manifested.
Reference:
Elevated serum amylase usually returns to normal after 7 days of
acute pancreatitis. If it remains elevated after 7 days, the possible
causes include all except:
A: Pancreatic ductal disruption
B: Pancreatic ductal obstruction
C: Pseudocyst formation
D: Chronic calcific pancreatitis
Correct Ans:D
Explanation
In acute pancreatitis, the serum amylase and lipase are elevated within 24
hours of onset and remains for 3–7 days. Levels return to normal within
7 days unless there is pancreatic ductal disruption, ductal obstruction, or
pseudocyst formation.

Reference:
Risk factors for post ERCP pancreatitis include all, except
A: Minor papilla sphincterotomy
B: Sphincter of Oddi dysfunction
C: Age <60 years
D: Age > 60 years
Correct Ans:D
Explanation
Risk factors for postERCP pancreatitis are minor papilla sphincterotomy,
sphincter of Oddi dysfunction, prior history of postERCP pancreatitis, age
<60 years, >2 contrast injections into the pancreatic duct.
Reference:
The genetic factors that can increase the susceptibility and modify
the severity of pancreatic injury in acute pancreatitis are all,
except:

A: Cationic trypsinogen mutations
B: Pancreatic secretory trypsin inhibitor
C: CFTR
D: ATP7a gene mutation
Correct Ans:D
Explanation
There are some genetic factors that can increase the susceptibility and/or
modify the severity of pancreatic injury in acute pancreatitis. They are,
(1) Cationic trypsinogen mutations
(2) Pancreatic secretory trypsin inhibitor (SPINK1)
(3) CFTR, and
(4) Monocyte chemotactic protein (MCP1)

Menkes syndrome is caused by mutations in the ATP7A gene.
Reference:

A 30 year old patient is investigated for acute pancreatitis. Which
scoring system is used for early prediction of mortality?
A: BISAP

B: Balthazar scoring system
C: Ranson’s
D: APACHE II
Correct Ans:A
Explanation
Early predictors of severity at 48 hours included 3 Ranson's signs
and APACHE II score 8. A recent scoring system for the early
prediction of mortality was developed in acute pancreatitis. This
scoring system known as the Bedside Index of Severity in Acute
Pancreatitis (BISAP), incorporates five clinical and laboratory
parameters obtained within the first 24 hours of hospitalization.
BUN >25, Impaired mental status, SIRS, Age >60 years, Pleural
effusion on radiography. Presence of three or more of these factors
was associated with increased risk for inhospital mortality.
Reference:
All are indications of elective ERCP with sphincterotomy in acute
pancreatitis, except:
A: Incipient biliary obstruction
B: Those who are poor candidates for cholecystectomy in biliary pancreatitis
C: Bile duct stones after cholecystectomy

D: Walled off pancreatic necrosis
Correct Ans:D
Explanation
Elective ERCP with sphincterotomy is considered in patients with persistent
/ incipient biliary obstruction, those who are poor candidates for
cholecystectomy, and for those in whom there is strong suspicion for bile
duct stones after cholecystectomy. ERCP with stent placement is
indicated for pancreatic ductal disruptions.
Reference:
Which of the following is an indication of urgent ERCP in
pancreatitis?
A: Acute alcoholic pancreatitis
B: Acute necrotising pancreatitis
C: Acute biliary pancreatitis with cholangitis
D: Chronic calcific pancreatitis with pseudocyst
Correct Ans:C
Explanation
Urgent ERCP is indicated in patients who have severe acute biliary
pancreatitis with cholangitis.

Reference:
Which of the following is the usual presenting symptom of
pseudocyst in pancreatitis?
A: Abdominal swelling
B: Abdominal pain
C: Persistent vomiting
D: Early satiety and postprandial fullness
Correct Ans:B
Explanation
Pseudocysts are caused by pancreatitis in 90% of cases and by trauma in
10%. Approximately 85% are located in the body or tail of the pancreas.
Some patients have two or more pseudocysts. Abdominal pain is the usual
presenting complaint.
Reference:
Which is the most frequently involved artery in acute pancreatitis
leading to pseudoaneurysm?

A: Splenic artery
B: Superior pancreatico duodenal artery
C: Inferior pancreaticoduodenal artery
D: Gastroduodenal artery
Correct Ans:A
Explanation
Pseudoaneurysms develop in up to 10% of patients with acute
pancreatitis. The splenic artery is most frequently involved.
Reference:
Purtscher’s retinopathy in acute pancreatitis is due to which of the
following?
A: Occlusion of the posterior retinal artery with aggregated granulocytes
B: Occlusion of ciliary artery with exudation
C: Central retinal artery occlusion with cotton wool spots and hemorrhage
D: Inflammatory exudates in the retinal vein
Correct Ans:A

Explanation
Purtscher's retinopathy a sudden and severe loss of vision in a patient with
acute pancreatitis. It is due to occlusion of the posterior retinal artery with
aggregated granulocytes.
Reference:
The immunoglobulin level, which is specifically elevated in
autoimmune pancreatitis is which of the following?
A: IgM
B: IgE
C: IgG4
D: IgG2
Correct Ans:C
Explanation
Serum IgG4 is elevated at least twofold higher than 135 mg/dL in those
with autoimmune pancreatitis.
Reference:

Medical therapy can be tried in gallstone patients with:
A: Contracted and small non functioning gallbladder
B: Radiolucent gallstones
C: Gallstones of size < 30 mm in diameter
D: Gallstone pancreatitis
Correct Ans:B
Explanation
Ursodeoxycholic acid (UDCA) decreases cholesterol saturation of bile. In carefully
selected patients with functioning gallbladder and with radiolucent stones <10 mm in
diameter, complete dissolution with UDCA can be achieved in 50% of patients within 6
months to 2 years.
Reference:

A 14 year old male was presented to the casualty on a saturday night with left sided upper
abdominal pain. Clinical examination revealed massive splenomegaly. He has history of
massive hematemesis 2 year back, and was diagnosed to have Extrahepatic Portal Venous
Obstruction (EHPVO) and bleeding was controlled by ligation of the esophageal varices.
What is the likely diagnosis?

A: Acute pancreatitis
B: Aortic dissection
C: Splenic infarction
D: Intussusception
Correct Ans:C
Explanation
EHPVO is a common cause of portal hypertension in children. It commonly presents with
stable massive variceal bleeding during childhood. Patients have massive splenomegaly.
Splenic infarction and mesenteric vein thrombosis are the two possibilities if EHPVO
develops sudden onset of abdominal pain. Here we have splenic infarction as the answer.
A 30 year old male presented with insidious onset of diarrhea, steatorrhea, abdominal
pain, weight loss, migratory large joint arthropathy, fever and dementia. The most
probable diagnosis is:
A: Chronic calcific pancreatitis
B: Whipple's disease
C: Tropical sprue
D: Celiac sprue
Correct Ans:B
Explanation
Whipple’s disease is a chronic multisystem disease caused by tropheryma whipplei
bacteria. Dementia is a late symptom. Diagnosed by PAS positive macrophages in small

intestinal biopsy. DOC is double strength trimethoprim / sulfamethoxazole.
Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2479
About autoimmune pancreatitis:
a) It is associated with other autoimmune disorders
b) Obstructive jaundice is a feature
c) Elevated serum IGM 4 is a marker
d) Distinct enlargement of the head of pancreas in CT abdomen
e) Glucocorticoids are effective in alleviating symptoms
A: b,c,d,e True & aFalse
B: c,d,eTrue & a,bFalse
C: a,eTrue & b,c,dFalse
D: a,b,d, eTrue & cFalse
Correct Ans:D
Explanation
Elevated IgG4 is a marker of autoimmune pancreatitis. 5075 patients presents with
obstructive jaundice. Steroids are effective in treatment. CT showed diffuse enlargement,
focal enlargement and distinct enlargement of the head of the pancreas. MRCP reveals
strictures in the bile duct.
Ref: Harrisons , Edition 18 , Page 2644
All are important hypersensitivity related side effects of high dose sulfasalazine therapy,

EXCEPT:
A: Hepatitis
B: Agranulocytosis
C: Pancreatitis
D: Thrombocytopenia
Correct Ans:D
Explanation
Although sulfasalazine is more effective at higher doses, up to 30% of patients experience
allergic reactions or intolerable side effects such as headache, anorexia, nausea, and
vomiting that are attributable to the sulfapyridine moiety.
ALSO KNOW:
Hypersensitivity reactions, independent of sulfapyridine levels, include rash, fever,
hepatitis, agranulocytosis, hypersensitivity pneumonitis, pancreatitis, worsening of colitis,
and reversible sperm abnormalities.

Sulfasalazine can also impair folate absorption, and patients should be given folic acid
supplements.
Ref: Harrison, Edition18, Page2489.
Cobalamin absorption may be abnormal in all, EXCEPT:
B: Achlorhydria

C: Bacterial overgrowth syndromes
D: Diverticular disease of colon
Correct Ans:D
Explanation
Cobalamin absorption may be abnormal in:
Pernicious anemia: Due to absence of both gastric acid and intrinsic factor secretion.
Chronic pancreatitis as a result of deficiency of pancreatic proteases to split the
cobalamin–R binder complex.
Achlorhydria or absence of another factor secreted with acid that is responsible for
splitting cobalamin away from the proteins in food to which it is bound
Bacterial overgrowth syndromes: leading to bacterial utilization of cobalamin (often
referred to as stagnant bowel syndrome).
Ileal dysfunction: due to impaired function of the mechanism of cobalamin–intrinsic
factor uptake by ileal intestinal epithelial cells.
Ref: Harrison, Edition18, e371, e371t.
The modified Mayo score used in clinical trials to assess the severity of:
A: Ulcerative colitis
B: Crohn's disease
C: Diverticulosis
D: Pancreatitis
Correct Ans:A
Explanation

Modifications of the original Truelove and Witts' criteria are used in daily practice, the modified Mayo
score is used in current clinical trials.
The mayo score uses:
Stool frequency
Rectal bleeding
Mucosal appearance in endoscopy
Physician's global assessment

Ref: Journal of Crohn's and Colitis (2012) 6, 965–990
Which of the following is the most rare complication of acute pancreatitis?
A: Hypotension
B: Jaundice
C: Retinopathy
D: Hypertriglyceridemia
Correct Ans:C
Explanation
Due to blockage of the posterior retinal artery by aggregated granulocytes, hemorrhage
and cottonwool spots are seen in the optic disk and macula in a patient with acute
pancreatitis. Such an unusual complication of acute pancreatitis is known as Purtscher's
retinopathy, which is characterized by sudden and severe loss of vision.
Hypertriglyceridemia is seen in 15% of the patients with acute pancreatitis.

Ref: Friedman L.S. (2013). Chapter 16. Liver, Biliary Tract, & Pancreas Disorders. In M.A.
Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment
2013.


What does HbA1c level in the blood indicate?
A: Acute rise of sugar
B: Long terms status of blood sugar
C: Hepatorenal syndrome
D: Chronic pancreatitis
Correct Ans:B
Explanation
Glycosylated Hemoglobin (HbA1C) is the standard method for assessing longterm
glycemic control. When plasma glucose is excessively elevated, it enters the erythrocytes,
and glycates the amino group of lysine residues and the amino terminals of hemoglobin.
This results in the formation of glycosylated hemoglobin. Since the halflife of an
erythrocyte is typically 120 days, the level of glycated hemoglobin (HbA1c) reflects the
mean blood glucose concentration over the preceding 23 months. Measurement of HbA1c
therefore provides valuable information for management of diabetes mellitus.

Ref: Harrison’s Internal Medicine, 18th Edition, Page 2992 ; Harper's Illustrated
Biochemistry, 28th Edition, Chapter 6 ; Tintinalli's Emergency Medicine : A Comprehensive
Study Guide, 7th Edition, Chapter 218.
Pancreatitis, pituitary tumor and phaeochromocytoma may be associated with which of
the following type of thyroid cancer?

A: Anaplastic carcinoma of thyroid
B: Medullary carinoma of thyroid
C: Papillary carcinoma of thyroid
D: Follicular carcinoma of thyroid
Correct Ans:B
Explanation
A MEN 1, or Wermer’s syndrome, is inherited as an autosomal dominant trait. This
syndrome is characterized by neoplasia of the parathyroid glands, enteropancreatic
tumors, anterior pituitary adenomas, and other neuroendocrine tumors with variable
penetrance. Among the types of thyroid cancer given in the question stem, medullary
carcinoma of the thyroid is associated with multiple endocrine neoplasia syndrome.

Ref: Harrison’s Internal Medicine, 18th Edition, Chapter 351

The clinical situations in which intestinal absorption is increased among the following?
A: Wilson disease
B: Pernicious disease
C: Chronic calcific pancreatitis
D: Cystic fibrosis
Correct Ans:A
Explanation
Almost all clinical problems are associated with diminished intestinal absorption of one or

more dietary nutrients. The only clinical situations in which absorption is increased
is Wilson disease, in which absorption of copper is increased.
ALSO NOTE:
Another example is hemochromatosis in which iron absorption is increased.
Ref: Harrison, E18, P2460.

Pancreatitis sample questions based on neet pg , usmle, plab and fmge pattern (mci screening)

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