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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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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
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
Tropical panreas • Genetic mutation of the pancreas secretorytrypsinogen inhibiter or SPINK1 gene • Abd pain & DM • Pancreatic duct stone • Risk of cancer • Ttt: pain + enzymes
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
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
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
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
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
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
The most common functional pancreatic endocrine neoplasm: • VIPoma • Glucagonoma • Somatostatinoma • Gastrinoma • Insulinoma
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
Octereotide scanning is most usaful for localization of which of the following: • VIPoma • Glucagonoma • Pancreatic polypeptide-secreting tumor • Gastrinoma • Insulinoma
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Which of the following is the most common presenting symptom in patients with Somatostatinoma: • Cholelithiasis • Constipation • Hypoglycemia • Hypocalcemia
Which of the following is the most common presenting symptom in patients with Somatostatinoma: • Cholelithiasis • Constipation • Hypoglycemia • Hypocalcemia Diabetes steatorhea
What percentage of patients with gastrinoma have a MEN1 syndrome: • 5% • 10% • 25% • 40%
What percentage of patients with gastrinoma have a MEN1 syndrome: • 5% • 10% • 25% • 40%
The majority of gastrinoma are found in : • Triangle of Calot • Passaro’s triangle • Body of the pancreas • Tail of the pancreas
The majority of gastrinoma are found in : • Triangle of Calot • Passaro’s triangle • Body of the pancreas • Tail of the pancreas
For VIP-secreting tumor all are true EXCEPT: • Diarrhea unresponsive to anti-diarreal agents • Diarrhea that persists during fasting • Hypokalemia • Sever metabolic alkalosis
For VIP-secreting tumor all are true EXCEPT: • Diarrhea unresponsive to anti-diarreal agents • Diarrhea that persists during fasting • Hypokalemia • Sever metabolic alkalosis
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
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
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
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
What is the recommended treatment of an adult with duodenal obstruction caused by annular pancreas: • Endoscopic division • Gastrojejunostomy • Duodenojejunostomy • Surgical division • pancreaticoduodenectomy
What is the recommended treatment of an adult with duodenal obstruction caused by annular pancreas: • Endoscopic division • Gastrojejunostomy • Duodenojejunostomy • Surgical division • pancreaticoduodenectomy
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
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
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