Acute Pancreatitis Post-test

36 Questions | Total Attempts: 2538

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Acute Pancreatitis Post-test - Quiz

Questions and Answers
  • 1. 
    What is an alternate bedside test, with the most number of clinical studies to support its use in the diagnosis of acute pancreatitis?
    • A. 

      Urinary trypsinogen activation peptide (TAP)

    • B. 

      Urinary trypsinogen-1

    • C. 

      Urinary trypsinogen-2

    • D. 

      Urinary elastase.

  • 2. 
    Which is the best first step in the evaluation of a patient with idiopathic recurrent acute pancreatitis?
    • A. 

      Secretin-stimulated MRCP

    • B. 

      Empiric cholecystectomy

    • C. 

      Endoscopic ultrasound

    • D. 

      ERCP

  • 3. 
    Which biochemical test is an early predictor of biliary etiology of acute pancreatitis?
    • A. 

      Serum elastase

    • B. 

      Lipase

    • C. 

      Bilirubin

    • D. 

      G-Glutamyltransferase

    • E. 

      None of the above

  • 4. 
    What is the optimal timing for the initial intervention in a clinically stable patient with infected pancreatic necrosis?  Choose the one best answer:
    • A. 

      10 days after the onset of pancreatitis

    • B. 

      20 days after the onset of pancreatitis

    • C. 

      30 days after the onset of pancreatitis

    • D. 

      40 days or later after the onset of pancreatitis

  • 5. 
    You are caring for a patient with acute necrotizing pancreatitis who is developing worsening sepsis and organ failure despite maximal intensive care and broad spectrum antibiotic administration 12 days after the onset of pancreatitis.  You obtain a percutaneous, CT-guided fine needle aspirate of his pancreatic necrosis that demonstrates bacterial infection.  The optimal intervention at this time is:
    • A. 

      Continued antibiotic administration and supportive therapy only

    • B. 

      Percutaneous drainage

    • C. 

      Endoscopic transluminal drainage

    • D. 

      Video assisted retroperitoneal debridement

  • 6. 
    Which of the following patients with acute necrotizing pancreatitis are most likely to benefit from surgical intervention early in the course of disease?
    • A. 

      Patients with sterile necrosis

    • B. 

      Patients with duodenal obstruction

    • C. 

      Patients with hemorrhage

    • D. 

      Patients with colonic infarction

  • 7. 
    A 55 year old patient with acute necrotizing pancreatitis has been on the Intensive Care unit with multiple organ failure for approximately 4.5 weeks. Although his clinical situation improved over the last few days, the patient now deteriorates. There is fever up to 104 °F, a rising CRP of 398 and white blood cell count of 27 x 109/L. A contrast enhanced CT demonstrates a large, heterogeneous, walled off, peripancreatic collection with gas inside. What is your diagnosis based on clinical and radiological information?
    • A. 

      Acute pseudocyst

    • B. 

      Infected necrosis

    • C. 

      SIRS as commonly seen in the acute phase of severe acute pancreatitis

    • D. 

      Abdominal compartment syndrome

  • 8. 
    A 55 year old patient with acute necrotizing pancreatitis has been on the Intensive Care unit with multiple organ failure for approximately 4.5 weeks. Although his clinical situation improved over the last few days, the patient now deteriorates. There is fever up to 104 °F, a rising CRP of 398 and white blood cell count of 27 x 109/L. A contrast enhanced CT demonstrates a large, heterogeneous, walled off, peripancreatic collection with gas inside. What is the preferred treatment strategy at this point?
    • A. 

      Conservative treatment

    • B. 

      Image-guided percutaneous or endoscopic catheter drainage

    • C. 

      Primary open necrosectomy

    • D. 

      Primary minimally invasive surgical necrosectomy

  • 9. 
    A 55 year old patient with acute necrotizing pancreatitis has been on the Intensive Care unit with multiple organ failure for approximately 4.5 weeks. Although his clinical situation improved over the last few days, the patient now deteriorates. There is fever up to 104 °F, a rising CRP of 398 and white blood cell count of 27 x 109/L. A contrast enhanced CT demonstrates a large, heterogeneous, walled off, peripancreatic collection with gas inside. If a patient with infected necrosis undergoes percutaneous catheter drainage, what is the chance the patient will need additional surgical necrosectomy?
    • A. 

      20%

    • B. 

      40%

    • C. 

      60%

    • D. 

      80%

  • 10. 
    What is the best fluid type to use for resuscitation in acute pancreatitis?
    • A. 

      Normal saline

    • B. 

      Ringers lactate

    • C. 

      Dextrose saline

    • D. 

      Gelofusine

  • 11. 
     What is the optimal rate for infusion of fluid in resuscitation of acute pancreatitis?
    • A. 

      10-15 ml/kg/h

    • B. 

      5-10 ml/kg/h

    • C. 

    • D. 

      >15 ml/kg/h

  • 12. 
    What is the best laboratory goal to use to guide fluid resuscitation in acute pancreatitis?
    • A. 

      Haematocrit

    • B. 

      Blood urea nitrogen

    • C. 

      Serum creatinine

    • D. 

      Amylase

  • 13. 
    Who is not at high risk for rapid deterioration of acute pancreatitis and thus should be treated at ITU or HDU?
    • A. 

      Elderly

    • B. 

      Persistent SIRS

    • C. 

      Obese patients

    • D. 

      Drug induced pancreatitis

  • 14. 
    Which statement is correct in patients with severe acute pancreatitis?
    • A. 

      Transient organ failure is the key determinant of mortality in acute pancreatitis

    • B. 

      Transient SIRS < 48 h results in a mortality of 25.4% compared to 8% in persistent SIRS.

    • C. 

      Fluid resuscitation can prevent necrosis formation.

    • D. 

      Lactate Ringer’s solution reduces systemic inflammation compared to saline

  • 15. 
    43 year old man with a history of severe alcohol induced necrotising pancreatitis in mid 2011 is readmitted with abdominal pain, normal serum lipase level, WBC 29 Gpt/l [4.3-10], platelets 444 Gpt/l [140-440], sodium 126 mmol/l [135-145], potassium 5.6 mm0l/l [3.5-4.6], creatinin 180 µmol/l [74-110], BUN 18 mmol/l [2.5-6.4], CRP 173 mg/l [<5 ], IL6 362 pg/ml [<10], <0.02 ‰ Ethanol. CT scan shows the following:   ERP shows the following:       What would be your treatment approach?
    • A. 

      My suspicion would spontaneous bacterial peritonitis and I would treat with antibiotics and ascites drainage.

    • B. 

      My suspicion would be an infected pancreatic collection resulting from a disrupted pancreatic duct and I would drain the collection transabdominally

    • C. 

      My suspicion would be an infected pancreatic collection resulting from a disrupted pancreatic duct and I would drain the collection transabdominally and via the papillary route. In addition I would give antibiotics.

    • D. 

      My suspicion would be an infected pancreatic collection resulting from a disrupted pancreatic duct and I would immediately perform a pancreatic left resection.

  • 16. 
    A 47 year old patient with known alcohol abuse is admitted to the ER with sudden onset of abdominal belt like pain 10 hours before admission, lipase levels of 494 µkatal/l [1.59-6.36], leukocytosis of 17.4 Gpt/l [4.3-10], CRP <3.1 mg/dl [<5.0 ], ALAT 1.9 µkatal/l [0.22-0.77], ASAT 0.88 µkatal/l [<0.59], gamma-GT 4.5 µkatal/l [<0.96], Bilirubin 8.5 µmol/l [0-17]. Abdominal ultrasound shows gallbladder stones. The common bile duct cannot be visualized. HR 124/min. RR 90/60 mmHg. How should this patient be treated:
    • A. 

      Fluids, antibiotics, pain treatment

    • B. 

      Fluids, pain treatment

    • C. 

      Fluids, antibiotics, selective gut decontamination, pain treatment

    • D. 

      Fluids, antibiotics, selective gut decontamination, probiotics, pain treatment

  • 17. 
    Is prophylactic antibiotic therapy mandatory in acute pancreatitis?
    • A. 

      Yes, always

    • B. 

      No, never

    • C. 

      Only in severe cases with a CRP> 50 mg/dl

    • D. 

      Only in severe biliary pancreatitis with cholangitis

  • 18. 
    What is the risk of probiotic therapy in severe pancreatitis?
    • A. 

      Severe fungal pneumonia

    • B. 

      Bowel ischemia

    • C. 

      Urinary tract infections with E.coli 1917 Nissle or Lactobacillus

    • D. 

      There is no risk of treatment

  • 19. 
    What is the optimal timing of cholecystectomy in mild pancreatitis?
    • A. 

      Within the index admission

    • B. 

      Never if ERC and endoscopic sphincterotomy is performed

    • C. 

      After normalisation of CRP levels

    • D. 

      Within 6 weeks after discharge

  • 20. 
    Which statement is correct in patients with biliary pancreatitis?
    • A. 

      Endoscopic sphincterotomy reduces recurrence of biliary pancreatitis

    • B. 

      Only cholecystectomy prevents recurrence of biliary pancreatitis

    • C. 

      Every patients should undergo cholecystectomy within index admission

    • D. 

      There is no need for cholecystectomy in biliary pancreatitis as all stones pass within 48h hours

  • 21. 
    When would you schedule cholecystectomy? Ultrasound shows gall bladder stones and cholestasis, patients was admitted 6 days prior to the CT-scan below.
    • A. 

      I would perform cholecystectomy within the next 72 hrs

    • B. 

      I would perform a sphincterotomy within the next 72 hrs and never perform a cholecystectomy

    • C. 

      I would wait for the resolution of the collection and then schedule for a laparoscopic cholecystectomy

    • D. 

      I would perform a endoscopic sphincterotomy within the index admission and schedule cholecystectomy after the pseudocysts or fluid collections either resolve or persist beyond 6 weeks at

  • 22. 
    A 63-year old patient has been admitted for 2 weeks with acute biliary pancreatitis. Because of spiking fevers and positive blood cultures without organ failure a CT scan is made which demonstrates pancreatic necrosis without encapsulating wall and without impacted gas bubbles in the collection.   What is probably the best strategy for this patient:
    • A. 

      Conservative, monitor vitals

    • B. 

      Antibiotics, initially conservative, monitor vitals

    • C. 

      Fine needle aspiration, if positive intervention, if negative conservative, vitals

    • D. 

      Emergency intervention (e.g. percutaneous drainage)

  • 23. 
    Regarding fine needle aspirations in necrotizing pancreatitis?
    • A. 

      It should be performed routinely in all patients with necrotizing pancreatitis

    • B. 

      It is mandatory prior to intervention for necrotizing pancreatitis

    • C. 

      False negative outcome of FNA in necrotizing pancreatitis is rare, below 10%

    • D. 

      None of the above

  • 24. 
    Regarding interventions for sterile necrotizing pancreatitis
    • A. 

      May be indicated in rare cases of ‘disconnected duct syndrome’

    • B. 

      May be indicated in cases of ongoing gastric outlet obstruction

    • C. 

      May be indicated in patients with pancreaticopleural fistula

    • D. 

      All of the above

  • 25. 
    A 73-year old patient has been admitted for 1 week with acute biliary pancreatitis and is in the intensive care unit with multisystem organ failure. Despite placing an NG tube and attempting to start elemental feeding, the patient has high tube feed residuals and tube feeding cannot be continued. What is probably the best strategy for this patient?
    • A. 

      Switch tube feeding formulation

    • B. 

      Place an NJ tube and begin elemental feeding

    • C. 

      Initiate total parenteral nutrition

    • D. 

      Initiate probiotics

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