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Pancreas

Pancreas. All of the following are true about Tropical Pancreatitis EXCEPT: It is common in adolescent It is associated with protein-caloric malnutrition It has a familial pattern Frequently leads to chronic pancreatitis It is not associated with diabetes.

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Pancreas

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  1. Pancreas

  2. All of the following are true about Tropical Pancreatitis EXCEPT: • It is common in adolescent • It is associated with protein-caloric malnutrition • It has a familial pattern • Frequently leads to chronic pancreatitis • It is not associated with diabetes

  3. All of the following are true about Topical Pancreatitis EXCEPT: • It is common in adolescent • It is associated with protein-caloric malnutrition • It has a familial pattern • Frequently leads to chronic pancreatitis • It is not associated with diabetes

  4. Tropical panreas • Genetic mutation of the pancreas secretorytrypsinogen inhibiter or SPINK1 gene • Abd pain & DM • Pancreatic duct stone • Risk of cancer • Ttt: pain + enzymes

  5. Which of the following is the leastfaverable management option for a chronic large pancreatic cyst: • Endoscopic transpapillary drainage using stent • CT-guided pig tail catheter • Open Roux-en Y cystojejunostomy • Laparascopiccystogastrostomy • Endoscpictransgasriccystogastrostomy

  6. Which of the following is the least faverable management option for a chronic large pancreatic cyst: • Endoscopic transpapillary drainage using stent • CT-guided pig tail catheter • Open Roux-en Y cystojejunostomy • Laparascopiccystogastrostomy • Endoscpictransgasriccystogastrostomy

  7. A 65 year old man present with persistent skin rash over the lower abdomen and perineum with mild left upper quadrant pain. Serum glucose 160 mg/dl. Ct showed a large mass in the tail of pancreas. Most likely Dx: • VIPoma • Glucagonoma • Somatostatinoma • Gastrinoma • Insulinoma

  8. A 65 year old man present with persistent skin rash over the lower abdomen and perineum with mild left upper quadrant pain. Serum glucose 160 mg/dl. Ct showed a large mass in the tail of pancreas. Most likely Dx: • VIPoma • Glucagonoma • Somatostatinoma • Gastrinoma • Insulinoma Necrolytic Migratory Erythema

  9. 45 yo woman presents with RUQ pain and jaundice. Greasy floating stool. US showed GS and pancreatic head mass. Most likely Dx: • VIPoma • Glucagonoma • Somatostatinoma • Gastrinoma • Insulinoma

  10. 45 yo woman presents with RUQ pain and jaundice. Greasy floating stool. US showed GS and pancreatic head mass. Most likely Dx: • VIPoma • Glucagonoma • Somatostatinoma • Gastrinoma • Insulinoma • Proximal Pancreas • Metastatic at Dx • Dx >>> elevated serum somatostatin

  11. The most common functional pancreatic endocrine neoplasm: • VIPoma • Glucagonoma • Somatostatinoma • Gastrinoma • Insulinoma

  12. The most common functional pancreatic endocrine neoplasm: • VIPoma • Glucagonoma • Somatostatinoma • Gastrinoma • Insulinoma • Whipple triad • High fasting blood sugar • Low C peptide • Even distribution • 90% benign • TTT>> enucleation

  13. Octereotide scanning is most usaful for localization of which of the following: • VIPoma • Glucagonoma • Pancreatic polypeptide-secreting tumor • Gastrinoma • Insulinoma

  14. Octereotide scanning is most usaful for localization of which of the following: • VIPoma • Glucagonoma • Pancreatic polypeptide-secreting tumor • Gastrinoma • Insulinoma • Detect smaller than 1 cm • Somatostatinoma and VIPoma are large bulky >> CT • 40% of insulinoma have no sufficient somatostatin receptors

  15. A 35 yo female present with episodic sever watery diarrhea. Stool cultures are negative. O/E a mass is palpable in the epigastric and RUQ. CT showed large bulky pancreatic mass with extention into the SMV and adjecnt organs. Best pallitiveMx: • Octreotide • Streptotazocin • Embolization • Chemotherapy • Radiation therapy

  16. A 35 yo female present with episodic sever watery diarrhea. Stool cultures are negative. O/E a mass is palpable in the epigastric and RUQ. CT showed large bulky pancreatic mass with extention into the SMV and adjecnt organs. Best pallitiveMx: • Octreotide • Streptotazocin • Embolization • Chemotherapy • Radiation therapy • VIPoma • Tail • Metastsis at Dx

  17. All of the following are true regarding alcohol EXCEPT: • It relaxes the sphincter of Oddi • It has metabolic toxins to the pancreatic acinar cells • It increases pancreatic duct permeability • It transiently decreases pancreatic blood flow • It inappropriately activates trypsin

  18. All of the following are true regarding alcohol EXCEPT: • It relaxes the sphincter of Oddi • It has metabolic toxins to the pancreatic acinar cells • It increases pancreatic duct permeability • It transiently decreases pancreatic blood flow • It inappropriately activates trypsin Spasm

  19. Which of the following is true regarding panceatogenic (type3) diabetes: • Ketoacidosis is common • The diabetes is easily controlled • Peripheral insulin sensitivity is decrease • Glucagon and pancreatic polypeptide (PP) levels are low • Hyperglycemia is usually sever

  20. Which of the following is true regarding panceatogenic (type3) diabetes: • Ketoacidosis is common • The diabetes is easily controlled • Peripheral insulin sensitivity is decrease • Glucagon and pancreatic polypeptide (PP) levels are low • Hyperglycemia is usually sever

  21. All of the following are true regarding PP EXCEPT: • Proximal pancreactomy is associated with a greater PP deficiency than distal pancreactomy • Patients with PP producing tumor present with sever hypoglycemia • PP regulates expression of the hepatic insulin receptor gene • PP deficiency corelates with sverity of chronic pancreatitis • It is secreted by F cells

  22. All of the following are true regarding PP EXCEPT: • Proximal pancreactomy is associated with a greater PP deficiency than distal pancreactomy • Patients with PP producing tumor present with sever hypoglycemia • PP regulates expression of the hepatic insulin receptor gene • PP deficiency corelates with sverity of chronic pancreatitis • It is secreted by F cells

  23. Which is true regarding pancreatic divisum: • The duct of Santorini ends in a blind bouch • The inferior portion of the pancreas drains through the duct of Santorini • The majority of the pancreas drains through the duct of Wirsung • The duct of Santorini drains through the major papilla • The duct of Santorini and Wirsung fail to fuse

  24. Which is true regarding pancreatic divisum: • The duct of Santorini ends in a blind bouch • The inferior portion of the pancreas drains through the duct of Santorini • The majority of the pancreas drains through the duct of Wirsung • The duct of Santorini drains through the major papilla • The duct of Santorini and Wirsung fail to fuse

  25. The preferred definitive treatment of recurrent acute pancreatitis d.t. pancreatic divisim is: • Lateral pancreaticojeunostomy (Puestow procedure) • Pancreaticoduodenectomy (Wipple) • Minor papilla sphincterotomy • Major papilla sphinctrotomy and pancreatic ductalseptotomy • Distal pancreatictomy

  26. The preferred definitive treatment of recurrent acute pancreatitis d.t. pancreatic divisim is: • Lateral pancreaticojeunostomy (Puestow procedure) • Pancreaticoduodenectomy (Wipple) • Minor papilla sphincterotomy • Major papilla sphinctrotomy and pancreatic ductalseptotomy • Distal pancreatictomy

  27. Insulinomas • Usually require selective venous sampling for localization • Are more common in the head of the pancreas • Are usually benign • Are treated with anatomic pancreactomy

  28. Insulinomas • Usually require selective venous sampling for localization • Are more common in the head of the pancreas • Are usually benign • Are treated with anatomic pancreactomy • 90% spradic • 10% MEN 1

  29. Which of the following is the most common presenting symptom in patients with Somatostatinoma: • Cholelithiasis • Constipation • Hypoglycemia • Hypocalcemia

  30. Which of the following is the most common presenting symptom in patients with Somatostatinoma: • Cholelithiasis • Constipation • Hypoglycemia • Hypocalcemia Diabetes steatorhea

  31. What percentage of patients with gastrinoma have a MEN1 syndrome: • 5% • 10% • 25% • 40%

  32. What percentage of patients with gastrinoma have a MEN1 syndrome: • 5% • 10% • 25% • 40%

  33. The majority of gastrinoma are found in : • Triangle of Calot • Passaro’s triangle • Body of the pancreas • Tail of the pancreas

  34. The majority of gastrinoma are found in : • Triangle of Calot • Passaro’s triangle • Body of the pancreas • Tail of the pancreas

  35. 70 to 90%

  36. For VIP-secreting tumor all are true EXCEPT: • Diarrhea unresponsive to anti-diarreal agents • Diarrhea that persists during fasting • Hypokalemia • Sever metabolic alkalosis

  37. For VIP-secreting tumor all are true EXCEPT: • Diarrhea unresponsive to anti-diarreal agents • Diarrhea that persists during fasting • Hypokalemia • Sever metabolic alkalosis

  38. During abdominal exploration after RTA, a deep laceration across the body of the pancreas with disruption of the pancreatic duct was discovered,Mx is external drainage and: • Direct repair of the duct • Distal pancreatictomy • Implantation of the pancreas into the posterior wall of the stomach • Lateral pancreaticojejunostomy

  39. During abdominal exploration after RTA, a deep laceration across the body of the pancreas with disruption of the pancreatic duct was discovered,Mx is external drainage and: • Direct repair of the duct • Distal pancreatectomy • Implantation of the pancreas into the posterior wall of the stomach • Lateral pancreaticojejunostomy

  40. Pancreatograph is performed in 54 y o m, alcoholic with chronic pancreatitis. The study showed a “chain of lakes” pattern, with areas of ductal dilatation joined by areas of ductalstenosis. Mx: • Cholecystectomy with CBD exploration • Cholecystectomy with sphincteroplasty • Open the pancreatic duct longitudinally and perform side to side pancreaticojejunostomy • Resect the tail of the pancreas and perform a pancreaticjejunostomy

  41. Pancreatograph is performed in 54 y o m, alcoholic with chronic pancreatitis. The study showed a “chain of lakes” pattern, with areas of ductal dilatation joined by areas of ductalstenosis. Mx: • Cholecystectomy with CBD exploration • Cholecystectomy with sphincteroplasty • Open the pancreatic duct longitudinally and perform side to side pancreaticojejunostomy • Resect the tail of the pancreas and perform a pancreaticjejunostomy

  42. What is the recommended treatment of an adult with duodenal obstruction caused by annular pancreas: • Endoscopic division • Gastrojejunostomy • Duodenojejunostomy • Surgical division • pancreaticoduodenectomy

  43. What is the recommended treatment of an adult with duodenal obstruction caused by annular pancreas: • Endoscopic division • Gastrojejunostomy • Duodenojejunostomy • Surgical division • pancreaticoduodenectomy

  44. Which of the following is more characterestic of pancreatic centroacinar cells than acinar cells: • Carbonic anhydrase • Zymogen granules • Golgi apparatus • Rough endoplasmic reticulum • Contractile proteins

  45. Which of the following is more characterestic of pancreatic centroacinar cells than acinar cells: • Carbonic anhydrase • Zymogen granules • Golgi apparatus • Rough endoplasmic reticulum • Contractile proteins H2O + CO2 >> H + HCO3

  46. A 45 y o non-diabetic male with chroinc alcoholic pancreatitis and intractable abdominal pain has a 10 mm pancreatic duct. The best option of Mx: • Sphincteroplasty • Lateral pancreaticojejunostomy • Distal pancreatectomy • Total pancreatectomy • Continued non-operative therapy

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