Pancreas and Spleen Final Year Class test 2nd Test 2012

Pancreas and SpleenFinal Year Class test2nd Test 2012Professor Dr. Khalid Javed AbidFRCS(Glas), FRCS(IRE)King Edward Medical UniversityMayo Hospital, Lahore

InstructionsEach MCQ is to be given 30 secondsPlease put your roll number on the answer sheet and clip it in timePlease write the MCQ number and answer on the answer sheetCutting and over-writing may be considered as wrong

MCQ No. 1A patient with cystic fibrosis is :A. more than 45 years of ageB. subject to recurrent pulmonary infectionsC. obeseD. subject to spontaneous fracturesE. diabetic

MCQ No. 2Idiopathic Acute pancreatitis is associated with:A. gallstonesB. excessive alcohol intakeC. DiabetesD. Viruses or drugsE. HTNMCQ No. 3Each of the following is a pathologic feature of chronic pancreatitis except:A. atrophy of aciniB. diffuse fibrosisC. focal calcificationD. islet cell hyperplasiaE. squamous metaplasia of ducts

MCQ No. 4A 55-year-old man experienced severe epigastric and back pain following a cocktail party. He was brought to the hospital in shock. Which of the following lab tests would be most helpful in establishing the diagnosis early?A. cholecystogramB. upper GI seriesC. serum aspartate aminotransferaseD. serum alkaline phosphataseE. serum amylase

MCQ No. 5Pancreatic islet cell tumors may present with:A. gastric carcinomaB. hypoglycemic episodesC. hypertensionD. chronic venous insufficiencyE. Headaches

MCQ No. 6Rare site for Carcinoma Pancreas is Head Body Tail Diffuse Body and Tail

MCQ No. 7Which of the following is not true regarding blood supply of pancreas?Pancreas receives blood supply from coeliac trunk andsuperiormesenteric artery.Body and tail of pancreas is supplied by Splenic arteryPosterior superior pancreaticoduodenal artery is a branch of Superior mesenteric artery.All major pancreatic arteries lie posterior to pancreatic ducts.The largest branch to pancreas is called Arteria Pancreatica Magna

MCQ No. 8The most frequent cause of death in cystic fibrosis isA. cirrhosis of the liverB. diabetes mellitusC. malabsorption syndromeD. meconium ileusE. pulmonary infectionMCQ No. 9Typical morphologic features of chronic alcoholic pancreatitis include each of the following exceptA. fibrosis of parenchymaB. islets better preserved than aciniC. focal calcificationD. epithelioid cell granulomasE. Vascular changesMCQ No. 10A healthy young patient presents with recurrent attacks of hypoglycemia that seem to follow fasting or strenuous exercise. The likely diagnosis is:A. beta-cell adenoma of pancreatic isletsB. carcinoma of the tail of the pancreasC. diabetes insipidusD. hemochromatosisE. Diabetes MellitusMCQ No. 11Surgery in pancreatic pseudocysts is usually done what time after appearance of the disease :A. After first weekB. 2nd weekC. 4 weeksD. 6 weeksE. 8 weeksMCQ No. 12A 50 year male develops intractable chronic peptic ulcer disease. He is found to have an elevated serum gastrin level. The likely diagnosis is:A. carcinoid syndromeB. Zollinger Ellison syndromeC. Gardners syndromeD. Klatskin syndromeE. Peutz Jeghers syndromeMCQ No. 13Spontaneous venous thrombosis and migratory thrombophlebitis are associated with:A. chronic cholecystitisB. adenocarcinoma of the pancreasC. choledocholithiasisD. islet cell tumorE. Gastrinoma

MCQ No. 14Which of the following enzymes is correctly matched with its site of production? Pepsin liver.Lipase stomach. Elastase pancreas.Trypsin salivary glandsCCK- Spleen

MCQ No. 15CommonestCause of deathin early acute Pancreatitis is:

Renal FailureCardiac failureRespiratory FailureUncontrolled CoagulopathySepsis

MCQ No.16Marseilles classification is based on:Clinical findingsClinical and pathological findingsLaboratory findings onlyImaging studiesSerum enzyme levelsMCQ No. 17The commonest Vein to be involved in Extrahepatic portal hypertension in chronic pancreatitis isPortal veinSplenic veinSuperior mesenteric veinInferior mesenteric veinGastric Vein

MCQ No. 18The initial goal of therapy for acute toxic cholangitis is to:A. Broad spectrum antibiotic therapy.B. Remove the obstructing lesion, if one is present.C. Alleviate jaundice and prevent permanent liver damage.D. Prevent the development of gallstone pancreatitis. E. Identify the cause.MCQ No. 19Which of the following statement about pancreatic embryonic malformations is correct?A. Pancreas divisum can cause GIT bleedB. Heterotopic pancreatic tissue predisposes to pancreatic adenocarcinoma.C. Annular pancreas may cause upper gastrointestinal obstructionD. In pancreatic divisum , the ventral duct drains 70% of the pancreas. E. Annular pancreas is a common conditionMCQ No.20Which of the following parameters is not included in the Ranson's criteria?A. Elevated blood glucose.B. Leukocytosis.C. Amylase value greater than 1000 U per dl.D. Serum lactic dehydrogenase (LDH) greater than 350 IU per dl.E. AST > 250 IU/LitreMCQ No.21Standard supportive measures for patients with mild pancreatitis does not include which one of the following:A. Intravenous fluid and electrolyte therapy.B. Withholding of analgesics to allow serial abdominal examinations.C. Subcutaneous octreotide therapy.D. Nasogastric decompression.E. Prophylactic antibioticsMCQ No. 22Which of the following statements about chronic pancreatitis is correct?A. Chronic pancreatitis usually progresses to pancreatic carcinomaB. Patients with chronic pancreatitis most commonly present with jaundice, pruritus, and fever.C. Mesenteric angiography is useful in the evaluation of many patients with chronic pancreatitis.D. Total pancreatectomy usually offers the best outcome in patients with chronic pancreatitis.E. For patients with disabling chronic pancreatitis and a dilated pancreatic duct with associated stricture formation, a longitudinal pancreaticojejunostomy (Peustow procedure) is an appropriate surgical option.

MCQ No. 23Which of the following is not a sign of acute pancreatitis?Kehrs signCullens SignGrey Turner signRovsings signEpigastric tenderness

MCQ No. 24With regard to the control of pancreatic exocrine function, which of the following statement is incorrect?

.A. Cholecystokinin, a hormone released from the duodenal mucosa, is the predominant stimulus for pancreatic enzyme secretionB. Gastrin is a major stimulant for pancreatic bicarbonate secretionC. Secretin is released from the duodenum upon mucosal acidification and stimulates pancreatic bicarbonate secretionD. Acetylcholine, released from pancreatic nerves, stimulates enzyme secretionE. Pancreatic juice is rich in bicarbonatesMCQ No. 25The islets of Langerhans contain four major endocrine cell types that secrete which of the following hormones?

A. Insulin, somatostatin, glucagon, secretinB. Insulin, somatostatin, cholecystokinin, pancreatic polypeptideC. Insulin, somatostatin, glucagon, pancreatic polypeptideD. Insulin, secretin, glucagon, cholecystokininE. Insulin , Glucagon, CCK

MCQ No. 26Which of the following Xray findings is associated with pancreatic trauma:A. Gas bubbles in the retroperitoneum near the Rt. Psoas muscleB. Free intraperitoneal gas may be present.C. # of transverse process of sacral vertebrae.D. Displacement of stomach or t.colon.E. Fracture 12th ribMCQ No. 27What is the investigation of choice in pancreatic trauma?Serum amylaseCT ScanERCPSerum LipaseXrayMCQ No. 28Which of the following is incorrect regarding MRCP?Does not need contrast materialAccurate & rapid in assessing pancreatic ductIt is minimally invasiveDemonstrate disruption of the CBDDemonstrate dilatation of pancreatic ductMCQ No.29Which of the following is not a surgical option for chronic pancreatitis:Begers procedurePuestow procedurePancreaticoduodenectomyERCP sphincterotomyLaser therapy to destroy focal calcificationMCQ No. 30Which of the following is not implicated in pathogenesis of acute pancreatitis:Acinar Cell injuryActivation of pro-enzymesBack pressure in pancreatic ductFat accumulation in pancreasRelease of enzymes into the circulation

MCQ No. 31Pancreatic percutaneous biopsy may predispose to:Pancreatic fistulaPancreatic pseudocystPancreatic carcinomaDisruption of the ductsBack pressure in the pancreatic ductMCQ No. 32A 50-year-old man develops acute pancreatitis due to alcohol abuse. Hyperamylasemia resolves by the third day after admission. By the eighth day, the patient is noted to have spiking fever (38.5C), progressive leukocytosis (18,500 WBC/mm3), and tachypnea. The most appropriate management includes which as the next step?

A. Laparotomy with pancreatic debridementB. CT guided aspiration of peripancreatic fluid collectionsC. ERCP with sphincterotomy and placement of biliary stentD. Intravenous amphotericin BE. Laparotomy and cystogastrotomy

MCQ No. 33Which of the following procedures has not been associated with an increased risk of post-procedure acute pancreatitis?

A. Common bile duct explorationB. Endoscopic retrograde cholangiopancreatographyC. Coronary bypass graftingD. Distal gastrectomy E. Right hemicolectomyMCQ No. 34Which of the following is not true regarding Accessory pancreatic duct?It is also called Duct of SantoriniOpens at the Minor duodenal papillaIn some cases may act as the main ductJoins the CBD two cms away from duodenumDrains the uncinate process of pancreasMCQ No. 35Which of the following statement(s) about malignant neoplasms of the liver is not true?A. Hepatocellular carcinoma is the number 1 cause of death from cancers worldwide.B. The commonest resectable hepatic malignant neoplasm is colorectal metastasis.C. Focal nodular hyperplasia is a premalignant condition.D. Hepatomas are generally slower growing than was formerly believed.E. Hepatomas usually cause peritoneal seedingMCQ No. 36Which of the following statement concerning bile duct strictures due to chronic pancreatitis is not true?A. Most patients present with progressive jaundiceB. Strictures are classically long and tapered involving the entire intrapancreatic bile ductC. Patients may be asymptomatic and diagnosed only by persistent elevation of serum alkaline phosphataseD. An excellent option for surgical management is choledochoduodenostomyE. ERCP can be usefulMCQ No. 37A 42-year-old male alcoholic develops acute pancreatitis. One week after onset of symptoms, CT abdomen reveals a pancreatic phlegmon and associated pseudocyst. Which of the following factors, if present, would increase the likelihood of spontaneous resolution of the pseudocyst?

A. Size greater than 5 cmB. Diffuse calcification of the pancreatic glandC. MultilocularityD. Location in the pancreatic tailE. Development of infection in peri pancreatic fluidMCQ No. 38A 36-year-old woman is admitted to hospital with upper abd pain, hyperamylasemia, elevation of serum AlkPO4 and usg evidence of cholelithiasis. With IV hydration and analgesia, symptoms rapidly resolved. After 48 hours, serum amylase and alkPO4 values had returned to normal and physical examination revealed lessening tenderness in the RHC of the abdomen. Appropriate management consists of which of the following as the next step?

A. Cholecystectomy and intraoperative cholangiography before hospital dischargeB. Elective cholecystectomy at approximately 8 weeksC. Endoscopic sphincterotomy before discharge followed by cholecystectomy at approximately 8 weeksD. ObservationE. No follow up neededMCQ No. 39Which of the following is an indication for immediate surgical intervention in acute pancreatitis?Severe acute pancreatitisPancreatic pseudocystNecrotizing PancreatitisAcute hemorrhagic pancreatitisPancreatic phlegmonMCQ No. 40What is the function of cortical zone of spleen related to infection control?A. Filtration of red cells, encapsulated bacteria, and other foreign material.B. Red pulp for formation of red cells.C. White pulp for its role in formation of granulocytes.D. Gray areas, so formed because of the production of platelets.E. Fibrous trabeculae.MCQ No. 41Which of the following is true regarding splenectomy and perioperative therapy for ITP:A. Done if steroid therapy fails.B. Respond permanently to high-dose intravenous gamma globulin.C. Used as first line treatment for ITPD. Cannot be done laparoscopically.E. Is associated with splenomegaly.MCQ No. 42A 15 year patient presents with pallor, intermittent jaundice and RHC pain. CBC shows Hb 6.7mg/dl, reticulocyte count is raised and abdominal USG shows gall stones. The most likely diagnosis is:ITPWilsons diseaseHereditary spherocytosisHyperlipidemiaTyphoid feverMCQ No. 43Which of the following statements regarding post splenectomy sepsis is not true?

A. The incidence in children is generally reported as less than 5%B. Haemophilus influenzae, Streptococcus pneumoniae and Neiseria meningitidis are the most common causative organismsC. Autotransplantation techniques eliminate this riskD. The mortality rate is now approximately 50%E. The incidence in adults in approximately 1%MCQ No. 44Which of the following is not true regarding splenorrhaphy:Use of coagulator beam Argon is superior to other techniquesGrade 2 and grade 3 injuries can be managed by suture repairAtleast 1/3rd of the spleen should be maintained to maintain immune functionMesh wrapping is recommended for grade 4 injuriesGrade 1 injuries donot require any suture repair.

MCQ No. 45Which of the following statement relating to chronic pancreatitis is correct?

A. Approximately 50% of chronic alcoholics develop chronic pancreatitisB. Clinically significant chronic pancreatitis develops on average after five years of alcohol abuse in menC. The risk of alcohol-induced chronic pancreatitis can be decreased by consumption of a high-protein dietD. Idiopathic pancreatitis occurs in newbornsE. In the US, the commonest cause of chronic pancreatitis is alcohol abuse

MCQ No. 46Glasgow criteria for assessment of pancreatitis severity does not include:WBC > 15,000Hct > 36BUN > 16Arterial PO2 < 60 mm HgCa < 8

MCQ No. 47In prospective, randomized trials which of the following agents or therapeutic measures has been demonstrated to accelerate recovery from acute pancreatitis?

A. Peritoneal dialysisB. Anticholinergic blockadeC. OctreotideD. H2 receptor blockadeE. IV analgesia

MCQ No. 48All of the following are components of the MEN type 2B syndrome except:A. Multiple neuromas on the lips, tongue, and oral mucosa.B. Hyperparathyroidism.C. Medullary carcinoma of thyroid.D. Pheochromocytoma.E. Marfanoid body habitusMCQ No. 49MEN 2A and MEN 2B syndromes are associated with germline mutations in:A. The p53 tumor suppressor gene.B. The H-ras gene.C. The N-myc gene.D. The RET proto-oncogene.E. The BRCA 2 geneMCQ No. 50The best therapy for a patient with Thrombotic Thrombocytopenic Purpura (TTP) is:CorticosteroidsSplenectomyPlasma apharesisVaccinationIV immunoglobulinsMCQ No: 51A patient presents with epigastric pain and tenderness for 1 day. On investigating his serum amylase is raised. His Xray abdomen shows gas under diaphragm. What is the diagnosis?Acute PancreatitisPancreatic pseudocystCholelithiasisAPDUpper GIT perforationMCQ No: 52Which of the following is False about carcinoma pancreas : A) Smoking is a risk factor B) CA19-9 is a good tumor marker C) Laparoscopy is required for staging D) Pylorus Preserving Pancreoduodenectomy should not be done. E) Pancreatic Tail is a rare site

MCQ No:53Which of the following is not a complication of splenectomy:Pancreatic fistulaThrombocytosisOpportunistic infectionsGastric dilatationPortal HypertensionMCQ No: 54Which of the following is a relation of the posterior surface of the body of pancreas:

A. Abdominal aortaB. Splenic veinC. Superior mesenteric vesselsD. Left kidneyE. Splenic arteryMCQ No: 55A patient presents with blunt trauma abdomen. S-amylase is raised and CT shows peri-pancreatic fluid. Which of the following is not true regarding this patient?

Other organs are likely to be injuredIt is important to ascertain the patency of pancreatic ductSurgery is not indicated in all casesCT and ERCP are most useful testsExternal drainage can be attempted

MCQ No: 56A patient admitted to the hospital with acute pancreatitis, develops bluish red discoloration around the umbilicus and flanks. Which of the following is FALSE regarding this:This is rare sign of acute pancreatitisIt indicates worst prognosisIt develops due to bleeding in the reteroperitoneumIt indicates resolving pancreatitisIt is not pathognomonic of acute pancreatitis

MCQ No: 57Hyersplenism is not associated with which of the following diseases:

A. Portal HTNB. LymphomaC. SLED. Dubin Johnson syndromeE. Infectious Mononucleosis MCQ No: 58Which of the following is not the standard treatment for pancreatic pseudocyst of size >5 cm:Endoscopic drainagePercutaneous drainageSurgical drainageConservative managementTranspapillary drainageMCQ No:59A 45 year old male, known case of ulcerative colitis presents with recurrent attacks of jaundice, pruritis and fever. Labs show increased Alk PO4 and Gamma glutamyl transferase. The likely diagnosis is:Acute cholecystitisAcute on chronic cholecystitisPrimary sclerosing cholangitisSecondary sclerosing cholangitisAsiatic Cholangiohepatic MCQ No: 60A patient presents with obstructive jaundice. He is diagnosed with unresectable pancreatic cancer. The treatment of choice would be:

ChemotherapyPalliative radiotherapyNPO and symptomatic treatmentSurgical debulkingRelief of jaundice by stenting or surgery

MCQ No: 61Which of the following is not an indicator of severe attack of acute pancreatitis?APACHE II score >8Ranson Score >7Persistantly elevated amylase levelC-Reactive Protein of < 45 mg/LARDSMCQ No:62The fluid aspirated from a pancreatic pseudocyst should always be sent for CEA measurement to distinguish it from:Infected cystPancreatic abscessCysto-enteric fistulaMucinous neoplasmPancreatic fistula64MCQ No:63A patient is admitted to ICU for acute pancreatitis. From 10th day of admission his CBC shows a marked and persistant elevation of platelets. This should raise the suspiscion of:

Retero-peritoneal hematomaBone marrow hyperplasiaIdiopathic thrombocytosisPortal or splenic vein thrombosisSide effect of TPN

MCQ No:64The mechanism of action of Octreotide is:Reduction of secretion of GastrinReduction of secretion of CCKReduction of the secretions of pancreasReduction of secretion of fluids by the intestinesReduction of gastric secretionsMCQ No:65A 45 year old, chronic alcoholic presents with recurrent attacks of acute on chronic pancreatitis. Which of the following is not true regarding his nutritional and digestive measures:Diet should be low in proteinsVit B12 supplementationStop alcohol consumptionPancreatic enzyme supplementationMedium chain triglyceridesMCQ No:66A patient presents in the ER with high velocity blunt trauma abdomen and back. His X-ray shows fracture transverse process of L1 and L2. One should suspect:

Injury to IVCInjury to pancreasInjury to LiverInjury to coeliac ganglionInjury to jejunum

MCQ No:67The standard procedure for the resection of a resectable tumor of Pancreatic head or ampulla is:PancreaticoduodenectomyLocal excision of the tumorPre-op ChemotherapyPalliationPylorus preserving pancreatico-duodenectomyMCQ No:68A 45 year old male, has had recurrent attacks of recurrent hypoglycemia. He is found to have a nodule bulging in the medial wall of duodenum on endoscopy. What is the most likely diagnosis?Duodenal adenomaFamilial adenomatous polyposisInsulinomaPancreatic adenocarcinomaCarcinoid tumorMCQ No:69A 67-year-old male presents with complaints of itching, dark urine, and epigastric pain. Physical examination reveals jaundice. Initial laboratory tests show total bilirubin of 6.5 mg/dL, alk PO4 elevated at 3 times normal, and mild elevation in ALT/AST. Appropriate management includes which diagnostic test as a next step?

A. Abdominal ultrasonographyB. Computed tomography of the abdomenC. Magnetic resonance imaging of the abdomenD. Endoscopic retrograde cholangiographyE. Conservative management

MCQ No:70During the course of a laparotomy being performed for blunt trauma abdomen, which of the following is not a clue suggesting a major pancreatic injury:Lesser sac fluid collectionRetroperitoneal bile stainingPulsatile hematoma peri-umbilical regionCrepitus or heamatomas overlying pancreasFat necrosis of omentum or retroperitoneal fat.

MCQ No:71All of the following are features of obstructive jaundice except:A.Conjugated hyper-bilirubinaemiaB.Marked elevation of alkaline phosphataseC.Presence of urobilinogen in the urineD.Marked elevation of gamma GTE.Mild elevation of transaminases

MCQ No:72A 53 year old man with liver cirrhosis develops malaise, upper abdominal pain and 20 pounds weight loss. Physical exam shows a palpable mass Right upper quadrant. Which of the following tumor markers can help in diagnosis?Beta HCGCarcino-embryonic Antigen (CEA)Serum LDHCA125Alpha Feto Protein (AFP)

MCQ No:73A victim of a major car accident presents in ER with BP 90/50 and pulse rate 130/min. He has multiple fractured lower ribs on right side and also distended abdomen. What is the most appropriate next step in management ?Emergency Exploratory LaparotomySpiral CT Abdomen with contrastDiagnostic Peritoneal LavageImmediate resuscitationRadiology for multiple fractures

MCQ No:74Multiple pancreatic neuro-endocrine tumors maybe found in which hereditary autosomal dominant disorder?MEN IMEN IIaMEN IIbFAPPeutz-Jeghers syndromeMCQ No: 75A patient presents with non-responding hyperglycemia and migratory necrolytic dermatitis. His CT abdomen shows a mass in pancreas with liver metastasis. The most likely diagnosis is: Gastrinoma VIPoma Carcinoid tumor Glucagonoma InsulinomaMCQ No:76According to Courvoisiers law, a non tender palpable gall bladder is most probably the sign of?

CBD obstructionEmpyema Gall bladderCBD stonesPerforated Gall bladderPeri- ampulary malignancy

MCQ No:77A 29 year old male presents with pancreatic insulinoma. His blood tests show elevated Calcium and low Phosphate levels. He also has a family history of pituitary and pancreatic tumors. The most likely gene involved in this syndrome is:FPC geneGermline mutation in menin geneRET proto-onco gene mutationP53 gene mutationMultiple mutations on chromosome 18 long armMCQ No:78In children less than 5 years undergoing splenectomy, prophylactic antibiotics should be given :Life longTill the age of 10 yearsTill the age of 16 yearsFor 2 years post-operativelyTill the age of 20 yearsMCQ No:79A 15 year old female presents with abdominal pain, jaundice and mass in the right upper abdomen. USG reveals dilated intrahepatic biliary tree. The correct diagnosis is?Cystic disease of the liverObstruction of CBD with dilatationsHydatid cystCholedochal CystMultifocal abscesses

MCQ No:80A patient of enteric fever develops LHC pain and fever with chills. O/E there is fullness and tenderness in LHC. USG shows a cystic lesion in spleen. The most likely diagnosis is:Splenic HematomaKalazar splenomegallySplenic abscessSplenic infarctSplenic artery aneurysm