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Pancreas

Learn about tropical pancreatitis, management options for chronic large pancreatic cysts, different types of pancreatic neoplasms, and the effects of alcohol on the pancreas. Also, explore pancreatogenic diabetes and its characteristics.

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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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