[MCQ] Acute and Chronic Pancreatitis- Part 6

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Acute and Chronic Pancreatitis- Part 6

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Question 1

Immunologic abnormalities in autoimmune pancreatitis include ?

A	Hypergammaglobulinemia
B	Autoantibodies against carbonic anhydrase
C	Autoantibodies against lactoferrin
D	All of the above

Question 1 Explanation:

Autoimmune pancreatitis is characterized by the presence of increased serum gammaglobulin levels (IgG4), presence of autoantibodies (antinuclear antibodies, antilactoferrin antibodies, anticarbonic anhydrase antibodies & rheumatoid factor), pancreatic fibrosis with lymphocytic infiltration & an absence of pancreatic calcification, an association with other autoimmune diseases and response to steroid therapy.

Question 2

Serum levels of which of the following immunoglobulin is elevated in AIP ?

A	Immunoglobulin G1
B	Immunoglobulin G2
C	Immunoglobulin G3
D	Immunoglobulin G4

Question 2 Explanation:

IgG constitutes ~75–85% of total serum immunoglobulin. The four IgG subclasses are numbered in order of their level in serum, IgG1 being found in greatest amounts and IgG4 the least. Serum IgG4 normally accounts for only 5–6% of the total IgG in healthy patients but is elevated at least twofold higher than 135 mg/dL in those with AIP.

Question 3

Which of the following syndrome is related to IgG4 ?

A	IgG4-related immunologic disease
B	IgG4-related systemic disease
C	IgG4-related pulmonary disease
D	IgG4-related neuronal disease

Question 3 Explanation:

IgG4-related systemic disease is a variety of acute tubulointerstitial disorder and a form of Acute Interstitial Nephritis (AIN). It is characterized by a dense inflammatory infiltrate containing IgG4- expressing plasma cells. Glucocorticoids lead to response.

Question 4

Which of the following syndrome is related to IgG4 ?

A	Immunoglobulin G4–associated carditis
B	Immunoglobulin G4–associated neuritis
C	Immunoglobulin G4–associated pneumonitis
D	Immunoglobulin G4–associated cholangitis

Question 4 Explanation:

Immunoglobulin G4–associated cholangitis is a biliary disease of unknown etiology with biochemical & cholangiographic features indistinguishable from PSC. It is associated with autoimmune pancreatitis and is characterized by elevated serum IgG4 and infiltration of IgG4-positive plasma cells in bile ducts and liver tissue. In contrast to PSC, it is not associated with inflammatory bowel disease.

Question 5

Which of the following is characteristic imaging finding in AIP ?

A	Enlargement at the head of pancreas
B	Strictures in bile duct
C	Narrowing of pancreatic bile duct
D	All of the above

Question 6

Which of the following drug is useful in AIP ?

A	Glucocorticoids
B	Azathioprine
C	6-mercaptopurine
D	All of the above

Question 7

Which of the following is false about chronic pancreatitis ?

A	Deficiencies of fat-soluble vitamins are uncommon
B	Serum amylase & lipase levels are raised
C	Best diagnostic test is secretin stimulation test
D	Vitamin B12 malabsorption is corrected by oral pancreatic enzymes

Question 7 Explanation:

Serum amylase & lipase levels are normal.

Question 8

In chronic pancreatitis, secretin stimulation test is abnormal when how much of pancreatic exocrine function is lost ?

A	20 %
B	40 %
C	60 %
D	80 %

Question 8 Explanation:

In chronic pancreatitis, secretin stimulation test becomes abnormal when 60% of the pancreatic exocrine function has been lost. This correlates well with the onset of chronic abdominal pain.

Question 9

Which of the following tests is useful in identifying severe pancreatic exocrine insufficiency ?

A	D-xylose excretion test
B	Fecal elastase
C	Serum amylase
D	Serum lipase

Question 9 Explanation:

Fecal elastase levels of < 100 μg per gram of stool strongly suggests severe pancreatic exocrine insufficiency.

Question 10

Severe pancreatic exocrine insufficiency is obvious when serum trypsinogen levels are ?

A	< 20 mg/mL
B	< 40 mg/mL
C	< 60 mg/mL
D	< 80 mg/mL

Question 10 Explanation:

Decrease of serum trypsinogen level to < 20 mg/mL strongly suggests severe pancreatic exocrine insufficiency.

Question 11

Absence of pancreatic calcification is a feature of ?

A	Idiopathic chronic pancreatitis
B	Islet cell tumors
C	Autoimmune Pancreatitis
D	Severe protein-calorie malnutrition

Question 12

Most common cause of pancreatic calcification is ?

A	Idiopathic chronic pancreatitis
B	Hypercalcemic pancreatitis
C	Alcohol
D	Severe protein-calorie malnutrition

Question 12 Explanation:

Alcohol is the most common cause of pancreatic calcification. Diffuse pancreatic calcifications on FP abdomen indicates ~80% damage to pancreas. Pancreatic calcification is also seen in severe protein-calorie malnutrition, hereditary pancreatitis, posttraumatic pancreatitis, hypercalcemic pancreatitis, islet cell tumors, idiopathic chronic pancreatitis and tropical pancreatitis.

Question 13

Tropical pancreatitis is characterized by all except ?

A	Early onset
B	Slow progression
C	Severe pancreatic damage
D	No history of alcohol abuse or biliary disease

Question 13 Explanation:

Tropical pancreatitis is characterized by early onset, rapid progression & severe pancreatic damage in the absence of a history of alcohol abuse or biliary disease. Both exocrine & endocrine insufficiency is evident at very early stages, often at the time of presentation in majority (70%) of patients.

Question 14

Which of the following is an uncommon complication of chronic pancreatitis ?

A	Diabetic ketoacidosis
B	Pancreatic cancer
C	Gastrointestinal bleeding
D	Biliary cirrhosis

Question 14 Explanation:

In chronic pancreatitis, most patients have impaired glucose tolerance, diabetic ketoacidosis and coma are uncommon

Question 15

According to the American Diabetes Association, which of the following diabetes in found in chronic pancreatitis ?

A	Type I
B	Type II
C	Type IIIc
D	Any of the above

Question 15 Explanation:

Diabetes of chronic pancreatitis is classified as type IIIc according to ADA & is characterized by destruction of both insulin & glucagon-producing cells.

Question 16

Increased incidence of pancreatic carcinoma is seen in which of the following ?

A	Idiopathic chronic pancreatitis
B	Hypercalcemic pancreatitis
C	Hereditary pancreatitis
D	Severe protein-calorie malnutrition

Question 16 Explanation:

Patients with hereditary pancreatitis develop pancreatic calcification, diabetes mellitus & steatorrhea. They have a tenfold higher risk of pancreatic carcinoma (40% by 70 years).

Question 17

Source of pancreatic enzymes in treatment of chronic pancreatitis is ?

A	Cow
B	Pig
C	Human
D	Horse

Question 17 Explanation:

Pancreatic enzymes from porcine sources is the cornerstone of pancreatic therapy.

Question 18

Which of the following significantly relieves pain in severe refractory large-duct chronic pancreatitis ?

A	UDCA
B	Cholestyramine
C	Domperidone
D	Octreotide

Question 18 Explanation:

Octreotide significantly relieves pain in patients with severe chronic pancreatitis refractory to other forms of therapy, including surgery. In patients with large-duct disease usually from alcohol-induced chronic pancreatitis, ductal decompression has been the therapy of choice.

Question 19

Small-duct chronic pancreatitis patients who respond best to serine proteases are those with ?

A	Abnormal hormone stimulation test
B	Minimal changes on ERCP
C	Normal fat absorption
D	All of the above

Question 20

The ideal pancreatic enzyme preparation is ?

A	Enteric-coated lipase & free proteases
B	Enteric-coated lipase & enteric-coated proteases
C	Free lipase & enteric-coated proteases
D	Free lipase & free proteases

Question 20 Explanation:

Ideal pancreatic enzyme preparation is enteric-coated lipase & free proteases. Free proteases enter duodenum & evoke a positive feedback control mechanism & enteric-coated lipase open beyond duodenum & enhance fat absorption. Recent data suggests that dosages up to 80,000–100,000 units of lipase per meal may be necessary to normalize nutritional parameters in malnourished chronic pancreatitis patients.

Question 21

The major cause of death in alcoholic CP is ?

A	Cardiovascular disease
B	Severe infection
C	Malignancy
D	All of the above

Question 21 Explanation:

Major causes of death in alcoholic CP are cardiovascular disease, infection & malignancy.

Question 22

The most common congenital anatomic variant of human pancreas is ?

A	Annular pancreas
B	Pancreas divisum
C	Sphincter of Oddi disorders
D	Pancreatic duct scars

Question 22 Explanation:

Pancreas divisum is the most common congenital anatomic variant of the human pancreas.

Question 23

Which of the following does not predispose to the development of pancreatitis ?

A	Hereditary Pancreatitis
B	Annular Pancreas
C	Pancreas Divisum
D	All of the above

Question 23 Explanation:

Pancreas divisum does not predispose to the development of pancreatitis in the great majority of patients who harbor it.

Question 24

Macroamylasaemia is characterised by formation of large molecular complexes between amylase and ?

A	Urea
B	Haem
C	Clotting factors
D	Abnormal immunoglobulins

Question 24 Explanation:

Macroamylasaemia is a syndrome characterised by formation of large molecular complexes between amylase & abnormal immunoglobulins.

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See all quizzes of Acute and Chronic Pancreatitis at here:

1. Immunologic abnormalities in autoimmune pancreatitis
include ?
A. Hypergammaglobulinemia
B. Autoantibodies against carbonic anhydrase
C. Autoantibodies against lactoferrin
D. All of the above

2. Serum levels of which of the following immunoglobulin is
elevated in AIP ?
A. Immunoglobulin G1
B. Immunoglobulin G2
C. Immunoglobulin G3
D. Immunoglobulin G4

3. Which of the following syndrome is related to IgG4 ?
A. IgG4-related immunologic disease
B. IgG4-related systemic disease
C. IgG4-related pulmonary disease
D. IgG4-related neuronal disease

4. Which of the following syndrome is related to IgG4 ?
A. Immunoglobulin G4–associated carditis
B. Immunoglobulin G4–associated neuritis
C. Immunoglobulin G4–associated pneumonitis
D. Immunoglobulin G4–associated cholangitis

5. Which of the following is characteristic imaging finding in
AIP ?
A. Enlargement at the head of pancreas
B. Strictures in bile duct
C. Narrowing of pancreatic bile duct
D. All of the above
6.Which of the following drug is useful in AIP ?
A. Glucocorticoids
B. Azathioprine
C. 6-mercaptopurine
D. All of the above
7. Which of the following is false about chronic pancreatitis ?
Harrison’s 18th Ed. 2645
A. Deficiencies of fat-soluble vitamins are uncommon
B. Serum amylase & lipase levels are raised
C. Best diagnostic test is secretin stimulation test
D. Vitamin B12 malabsorption is corrected by oral pancreatic
enzymes

8. In chronic pancreatitis, secretin stimulation test is abnormal
when how much of pancreatic exocrine function is lost ?
A. 20 %
B. 40 %
C. 60 %
D. 80 %

9. Which of the following tests is useful in identifying severe
pancreatic exocrine insufficiency ?
A. D-xylose excretion test
B. Fecal elastase
C. Serum amylase
D. Serum lipase

10. Severe pancreatic exocrine insufficiency is obvious when
serum trypsinogen levels are ?
A. < 20 mg/mL
B. < 40 mg/mL
C. < 60 mg/mL
D. < 80 mg/mL

11. Absence of pancreatic calcification is a feature of ?
A. Idiopathic chronic pancreatitis
B. Islet cell tumors
C. Autoimmune Pancreatitis
D. Severe protein-calorie malnutrition
12.Most common cause of pancreatic calcification is ?
A. Idiopathic chronic pancreatitis
B. Hypercalcemic pancreatitis
C. Alcohol
D. Severe protein-calorie malnutrition

13. Tropical pancreatitis is characterized by all except ?
A. Early onset
B. Slow progression
C. Severe pancreatic damage
D. No history of alcohol abuse or biliary disease

14. Which of the following is an uncommon complication of chronic
pancreatitis ?
A. Diabetic ketoacidosis
B. Pancreatic cancer
C. Gastrointestinal bleeding
D. Biliary cirrhosis

15. According to the American Diabetes Association, which of the
following diabetes in found in chronic pancreatitis ?
A. Type I
B. Type II
C. Type IIIc
D. Any of the above

16. Increased incidence of pancreatic carcinoma is seen in which
of the following ?
A. Idiopathic chronic pancreatitis
B. Hypercalcemic pancreatitis
C. Hereditary pancreatitis
D. Severe protein-calorie malnutrition

17. Source of pancreatic enzymes in treatment of chronic
pancreatitis is ?
A. Cow
B. Pig
C. Human
D. Horse

18. Which of the following significantly relieves pain in severe
refractory large-duct chronic pancreatitis ?
A. UDCA
B. Cholestyramine
C. Domperidone
D. Octreotide

19. Small-duct chronic pancreatitis patients who respond best to
serine proteases are those with ?
A. Abnormal hormone stimulation test
B. Minimal changes on ERCP
C. Normal fat absorption
D. All of the above

20. The ideal pancreatic enzyme preparation is ?
A. Enteric-coated lipase & free proteases
B. Enteric-coated lipase & enteric-coated proteases
C. Free lipase & enteric-coated proteases
D. Free lipase & free proteases

21. The major cause of death in alcoholic CP is ?
A. Cardiovascular disease
B. Severe infection
C. Malignancy
D. All of the above

22., The most common congenital anatomic variant of human
pancreas is ?
A. Annular pancreas
B. Pancreas divisum
C. Sphincter of Oddi disorders
D. Pancreatic duct scars

23. Which of the following does not predispose to the development
of pancreatitis ?
A. Hereditary Pancreatitis
B. Annular Pancreas
C. Pancreas Divisum
D. All of the above

24. Macroamylasaemia is characterised by formation of large
molecular complexes between amylase and ?
A. Urea
B. Haem
C. Clotting factors
D. Abnormal immunoglobulins

Acute and Chronic Pancreatitis

[MCQ] Acute and Chronic Pancreatitis- Part 6

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Acute and Chronic Pancreatitis- Part 6

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