Irap Pre-test

33 Questions | Total Attempts: 39

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Irap Pre-test

APA Pre-Meeting: International State of the Science on Idiopathic Recurrent Acute Pancreatitis


Questions and Answers
  • 1. 
    According to ASGE guidelines which of the following statements is false:
    • A. 

      Pancreas divisum is an established cause of recurrent acute pancreatitis

    • B. 

      The need for ERCP after a single episode of unexplained pancreatitis is not established

    • C. 

      Further studies are needed before wide acceptance of sphincter manometry and sphincterotomy as therapy in patients with abdominal pain without pancreatic enzyme elevation or ductal dilatation

    • D. 

      More than 90% of patients with typical biliary colic, abnormal liver chemistries and with dilated bile duct will have resolution of pain after biliary sphincterotomy

  • 2. 
    An 18 yr girl comes with post-prandial upper abdominal bloating and episodic vomiting for 6 months duration. Her pancreatic enzymes have on multiple occasions been normal. An MRI of the abdomen demonstrates pancreas divisum without any other pancreatic abnormality. Which of the following statements is false regarding pancreas divisum?
    • A. 

      >95% of patients have no symptoms

    • B. 

      Is seen in ~7% of the Western population

    • C. 

      Tests for minor papilla narrowing (e.g., ductal dilatation following secretin) correlate very well with a response to therapy

    • D. 

      Only 25% of patients with abdominal pain without documented pancreatic disease will experience at least a 50% reduction in pain after minor papilla sphincterotomy

  • 3. 
    Which of the following statements is true re sphincter of Oddi dysfunction;
    • A. 

      It is easy to differentiate type III SOD from disorders such as irritable bowel syndrome and chronic functional abdominal pain

    • B. 

      Endoscopic sphincterotomy should be offered to patients with type III SOD

    • C. 

      Type I SOD should be referred for endoscopic manometry followed by sphincterotomy if pressures are high

    • D. 

      The role of nitrates in the management of SOD has not yet been established by well-designed controlled trials

  • 4. 
    Which of the following statement is true about endoscopic treatment in patients with idiopathic recurrent acute pancreatitis (iRAP)?
    • A. 

      Performing a biliary and pancreatic sphincterotomy prevents future episodes of pancreatitis

    • B. 

      Randomized trials have proven that endoscopic treatment is better than sham therapy in patients with iRAP

    • C. 

      Patients with underlying sphincter of Oddi dysfunction have better clinical outcomes after pancreatic sphincterotomy.

    • D. 

      In patients with normal sphincter of Oddi manometry, performing an empiric biliary sphincterotomy is superior to not performing any treatment.

    • E. 

      None of the above is true.

  • 5. 
    In patients with iRAP who undergo endoscopic treatment, which of the following is true about the natural progression of the disease?
    • A. 

      In patients undergoing pancreatic sphincterotomy, the incidence of developing chronic pancreatitis is negligible.

    • B. 

      Nearly 8-17% of patients with iRAP on long-term follow-up develop chronic pancreatitis irrespective of whether they undergo any treatment.

    • C. 

      There is no relationship between iRAP and chronic pancreatitis

    • D. 

      None of the above is true

  • 6. 
    A 61 year old female, status-post cholecystectomy, presented to the office with a history of three attacks of pancreatitis that warranted a two day hospitalization during each episode. In between her episodes of pancreatitis, she is asymptomatic and is unable to identify any precipitating factors. At outpatient ERCP, pancreatogram revealed pancreas divisum. However, despite administration of intravenous secretin, cannulation of the minor papilla was unsuccessful. What will be the next correct step in the management of this patient?
    • A. 

      Perform an empiric biliary sphincterotomy

    • B. 

      Inject botox into the minor papilla

    • C. 

      Reattempt ERCP another day or refer to an expert center

    • D. 

      Surgical minor papiila sphincteroplasty

  • 7. 
    A 36 year old patient has had four episodes of acute recurrent pancreatitis over a two year period. The a secretin MRCP is obtained and show the following results. The findings include:
    • A. 

      A normal pancreatic duct

    • B. 

      Bile duct consistent with primary sclerosing cholangitis

    • C. 

      Post cholecystectomy

    • D. 

      Pancreas divisum with a Santorinicele

  • 8. 
    A 7 year old girl has had acute recurrent pancreatitis since age 3, and currently has intractable chronic pain. MRCP shows dilated pancreatic duct with multiple strictures and pancreatic stones. Her mother and maternal uncle have had a similar problem since childhood.  Mutation in the following gene or genes is most to be associated with her disorder:
    • A. 

      SPINK-1

    • B. 

      PRSS-1

    • C. 

      CFTR homozygous

    • D. 

      CFTR heterozygous

  • 9. 
    A 34 year old woman presents with acute recurrent pancreatitis. She is 5 years post cholecystectomy. Endoscopic ultrasound and MRCP are normal. She undergoes ERCP with sphincter of Oddi manometry and sphincterotomy. Which of the following statements are true:
    • A. 

      Placement of a pancreatic stent will reduce the risk of post-ERCP pancreatitis

    • B. 

      Administration of indomethacin suppository will not reduce the risk of post-ERCP pancreatitis more than placement of a pancreatic stent alone.

    • C. 

      Performance of a pancreatic sphincterotomy in addition to biliary sphincterotomy has been shown to result in greater reduction of frequency of pancreatitis attacks than biliary sphincterotomy alone.

    • D. 

      Minor papillotomy will reduce frequency of pancreatitis attacks.

  • 10. 
    A 55 year old woman presents to the physician with complaints of abdominal pain and difficulty eating 8 weeks after a bout of severe unexplained pancreatitis requiring intensive care unit hospitalization.   Liver chemistries and right upper quadrant ultrasound were normal.  Which of the following statement is true:
    • A. 

      The patient has a pseudocyst

    • B. 

      The patient has walled off necrosis

    • C. 

      The best therapy would be open drainage of this collection

    • D. 

      Empirical cholecystectomy is likely to prevent another attack of pancreatitis.

  • 11. 
    A 24 year old patient has recurrent acute pancreatitis and recurrent bloating and vomiting between episodes. An MRCP shows the following findings, including a narrowed duodenum. The arrow points to a duct that is in an unusual location. An ERCP shows: 
    • A. 

      A dilated bile duct

    • B. 

      Pancreas divisum

    • C. 

      Annular pancreas

    • D. 

      A bifid pancreas

  • 12. 
    A 44 year old woman has had two episodes of acute pancreatitis with normal liver chemistries. She is obese and has had 4 children. A right upper quadrant ultrasound was negative for gallstones. Which of the following tests or interventions is the most appropriate next step?
    • A. 

      Empiric cholecystectomy

    • B. 

      ERCP

    • C. 

      MRCP

    • D. 

      Endoscopic ultrasound

  • 13. 
    The most sensitive test for occult microlithiasis is:
    • A. 

      Empiric cholecystectomy

    • B. 

      ERCP

    • C. 

      MRCP

    • D. 

      Endoscopic ultrasound

  • 14. 
    What is the prevalence of pancreas divisum in the general Western population?
    • A. 

    • B. 

      5-10%

    • C. 

      10-15%

    • D. 

      15-20%

    • E. 

      >20%

  • 15. 
    Which of the following statements is true regarding drug-induced pancreatitis:
    • A. 

      Most drug induced pancreatitis is idiosyncratic

    • B. 

      Resumption of a drug that has caused pancreatitis predictably causes recurrence

    • C. 

      Drug induced pancreatitis is dose dependent

    • D. 

      Answer option 4

  • 16. 
    Acute pancreatitis is currently defined as:
    • A. 

      Abdominal pain especially in the epigastric region

    • B. 

      Elevation of amylase and or lipase to > 3 times the normal range

    • C. 

      Imaging (CT/MRI) suggestive of inflammation

    • D. 

      Any 2 of the above 3 criteria

  • 17. 
    A 24 year old woman presents after 2 episodes of abdominal pain over the last 5 years each requiring hospitalization for 2-3 days.  Pancreatitis was documented by a more than three fold elevation of serum amylase and lipase.  She has no history of alcohol ingestion or a family history of pancreatitis.  She is otherwise healthy.  Serum triglycerides were normal.  Endoscopic ultrasound showed sludge in the gallbladder.  The next step should be:
    • A. 

      Cholecystectomy

    • B. 

      Genetic testing

    • C. 

      Biliary sphincterotomy

    • D. 

      Therapy with URSO

    • E. 

      A or d

  • 18. 
    Recurrent pancreatitis in patients with Crohn’s disease or ulcerative colitis may be due to:
    • A. 

      An increased prevalence of biliary stone disease

    • B. 

      Idiosyncratic reactions to medications used for treatment of IBD

    • C. 

      Possible immunological disturbances

    • D. 

      All of the above

  • 19. 
    For which of the following patients is acute pancreatitis more likely to be a part of the clinical presentation:
    • A. 

      A 55 year old male with jaundice, a diffusely swollen pancreas on CT and a markedly elevated serum IgG4 level.

    • B. 

      A 30 year old female with IBDa diffusely strictured small caliber pancreatic duct by MRCP, a normal serum IgG4, and a presumptive diagnosis of type 2 autoimmune pancreatitis.

    • C. 

      A 56 year old woman with cholestatic liver enzymes and MRCP showing multifocal diffuse intrahepatic strictures, with an intraductal biopsy of the bile duct staining strongly for IgG4 postitive plasma cells.

    • D. 

      Answer option 4

  • 20. 
    In population based studies, the risk of recurrent acute pancreatitis after an index episode has been noted to be:
    • A. 

      5-10%

    • B. 

      10-20%

    • C. 

      20-30%

    • D. 

      Over 30%

  • 21. 
    After the first clinical attack of acute alcoholic pancreatitis, what is the risk of developing chronic pancreatitis?
    • A. 

      5-10%

    • B. 

      10-20%

    • C. 

      20-30%

    • D. 

      30-50%

    • E. 

      Over 50%

  • 22. 
    Which of the following patients is at the highest risk of developing chronic pancreatitis after initial presentation with acute pancreatitis?
    • A. 

      Idiopathic pancreatitis

    • B. 

      Gallstone pancreatitis

    • C. 

      Hereditary pancreatitis

    • D. 

      Alcoholic pancreatitis

  • 23. 
    Which of the following is true for acute pancreatitis in children
    • A. 

      Recurrence rates of acute pancreatitis in children are lower than for adults

    • B. 

      There is good evidence that use of pancreatic enzyme supplements and antioxidants prevent recurrent episodes.

    • C. 

      Genetic testing is the first line investigation.

    • D. 

      The most common etiologies are biliary, trauma and metabolic

  • 24. 
    Which of the following statements is true for quality of life in acute recurrent pancreatiits:
    • A. 

      There is no significant impairment since the patients have only intermittent episodes of pain

    • B. 

      Pancreatic enzymes and antioxidants are useful in improvement of quality of life

    • C. 

      Most endoscopic therapy data have shown improvement of quality of life especially in patients with pancreas divisum or sphincter of Oddi dysfunction

    • D. 

      No validated instruments are available at the moment

  • 25. 
    What is the difference between a biliary crystal, a microlith and biliary sludge?
    • A. 

      No significant difference, only a matter of semantics

    • B. 

      Differ in appearance but similar clinical connotation

    • C. 

      Similar pathophysiology, differ in clinical context

    • D. 

      Different in appearance, pathophysiology and clinical relevance