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Pancreas and Spleen

Final Year Class test

2nd Test 2012
Professor Dr. Khalid Javed Abid
King Edward Medical University
Mayo Hospital, Lahore

Each MCQ is to be given 30 seconds
Please put your roll number on the
answer sheet and clip it in time
Please write the MCQ number and
answer on the answer sheet
Cutting and over-writing may be
considered as wrong

MCQ No. 1
A patient with cystic fibrosis is :
A. more than 45 years of age
B. subject to recurrent pulmonary
C. obese
D. subject to spontaneous fractures
E. diabetic

MCQ No. 2
Idiopathic Acute pancreatitis is associated
A. gallstones
B. excessive alcohol intake
C. Diabetes
D. Viruses or drugs

MCQ No. 3
Each of the following is a pathologic
feature of chronic pancreatitis except:
A. atrophy of acini
B. diffuse fibrosis
C. focal calcification
D. islet cell hyperplasia
E. squamous metaplasia of ducts

MCQ No. 4
A 55-year-old man experienced severe
epigastric and back pain following a
cocktail party. He was brought to the
hospital in shock. Which of the following
lab tests would be most helpful in
establishing the diagnosis early?
A. cholecystogram
B. upper GI series
C. serum aspartate aminotransferase
D. serum alkaline phosphatase
E. serum amylase

MCQ No. 5
Pancreatic islet cell tumors may present
A. gastric carcinoma
B. hypoglycemic episodes
C. hypertension
D. chronic venous insufficiency
E. Headaches

MCQ No. 6
Rare site for Carcinoma Pancreas is
A. Head
B. Body
C. Tail
D. Diffuse
E. Body and Tail

MCQ No. 7
Which of the following is not true regarding
blood supply of pancreas?
A. Pancreas receives blood supply from coeliac trunk
and superior mesenteric artery.
B. Body and tail of pancreas is supplied by Splenic artery
C. Posterior superior pancreaticoduodenal artery is a
branch of Superior mesenteric artery.
D. All major pancreatic arteries lie posterior to pancreatic
E. The largest branch to pancreas is called Arteria
Pancreatica Magna

MCQ No. 8
The most frequent cause of death in
cystic fibrosis is
A. cirrhosis of the liver
B. diabetes mellitus
C. malabsorption syndrome
D. meconium ileus
E. pulmonary infection

MCQ No. 9
Typical morphologic features of
chronic alcoholic pancreatitis include
each of the following except
A. fibrosis of parenchyma
B. islets better preserved than acini
C. focal calcification
D. epithelioid cell granulomas
E. Vascular changes

MCQ No. 10
A healthy young patient presents with
recurrent attacks of hypoglycemia that
seem to follow fasting or strenuous
exercise. The likely diagnosis is:
A. beta-cell adenoma of pancreatic islets
B. carcinoma of the tail of the pancreas
C. diabetes insipidus
D. hemochromatosis
E. Diabetes Mellitus

MCQ No. 11
Surgery in pancreatic pseudocysts is
usually done what time after
appearance of the disease :
A. After first week
B. 2nd week
C. 4 weeks
D. 6 weeks
E. 8 weeks

MCQ No. 12
A 50 year male develops intractable
chronic peptic ulcer disease. He is
found to have an elevated serum
gastrin level. The likely diagnosis is:
A. carcinoid syndrome
B. Zollinger Ellison syndrome
C. Gardners syndrome
D. Klatskin syndrome
E. Peutz Jeghers syndrome

MCQ No. 13
Spontaneous venous thrombosis and
migratory thrombophlebitis are
associated with:
A. chronic cholecystitis
B. adenocarcinoma of the pancreas
C. choledocholithiasis
D. islet cell tumor
E. Gastrinoma

MCQ No. 14
Which of the following enzymes is
correctly matched with its site of

Pepsin liver.
Lipase stomach.
Elastase pancreas.
Trypsin salivary glands
CCK- Spleen

MCQ No. 15
Commonest Cause of death in early
acute Pancreatitis is:

Renal Failure
Cardiac failure
Respiratory Failure
Uncontrolled Coagulopathy

MCQ No.16
Marseilles classification is based on:
A. Clinical findings
B. Clinical and pathological findings
C. Laboratory findings only
D. Imaging studies
E. Serum enzyme levels

MCQ No. 17
The commonest Vein to be involved in
Extrahepatic portal hypertension in
chronic pancreatitis is
A. Portal vein
B. Splenic vein
C. Superior mesenteric vein
D. Inferior mesenteric vein
E. Gastric Vein

MCQ No. 18
The initial goal of therapy for acute
toxic cholangitis is to:
A. Broad spectrum antibiotic therapy.
B. Remove the obstructing lesion, if one
is present.
C. Alleviate jaundice and prevent
permanent liver damage.
D. Prevent the development of gallstone
E. Identify the cause.

MCQ No. 19
Which of the following statement about
pancreatic embryonic malformations is

A. Pancreas divisum can cause GIT bleed

B. Heterotopic pancreatic tissue
predisposes to pancreatic
C. Annular pancreas may cause upper
gastrointestinal obstruction
D. In pancreatic divisum , the ventral duct
drains 70% of the pancreas.
E. Annular pancreas is a common

MCQ No.20
Which of the following parameters is not
included in the Ranson's criteria?

A. Elevated blood glucose.

B. Leukocytosis.
C. Amylase value greater than 1000 U
per dl.
D. Serum lactic dehydrogenase (LDH)
greater than 350 IU per dl.
E. AST > 250 IU/Litre

MCQ No.21
Standard supportive measures for
patients with mild pancreatitis does
not include which one of the following:
A. Intravenous fluid and electrolyte
B. Withholding of analgesics to allow
serial abdominal examinations.
C. Subcutaneous octreotide therapy.
D. Nasogastric decompression.
E. Prophylactic antibiotics

MCQ No. 22
Which of the following statements about
chronic pancreatitis is correct?
A. Chronic pancreatitis usually progresses to pancreatic
B. Patients with chronic pancreatitis most commonly
present with jaundice, pruritus, and fever.
C. Mesenteric angiography is useful in the evaluation of
many patients with chronic pancreatitis.
D. Total pancreatectomy usually offers the best outcome
in patients with chronic pancreatitis.
E. For patients with disabling chronic pancreatitis and a
dilated pancreatic duct with associated stricture formation,
a longitudinal pancreaticojejunostomy (Peustow
procedure) is an appropriate surgical option.

MCQ No. 23
Which of the following is not a sign of
acute pancreatitis?
A. Kehrs sign
B. Cullens Sign
C. Grey Turner sign
D. Rovsings sign
E. Epigastric tenderness

MCQ No. 24
With regard to the control of pancreatic exocrine
function, which of the following statement is
.A. Cholecystokinin, a hormone released from the duodenal
mucosa, is the predominant stimulus for pancreatic enzyme
B. Gastrin is a major stimulant for pancreatic bicarbonate
C. Secretin is released from the duodenum upon mucosal
acidification and stimulates pancreatic bicarbonate secretion
D. Acetylcholine, released from pancreatic nerves, stimulates
enzyme secretion
E. Pancreatic juice is rich in bicarbonates

MCQ No. 25
The islets of Langerhans contain four
major endocrine cell types that
secrete which of the following
A. Insulin, somatostatin, glucagon, secretin
B. Insulin, somatostatin, cholecystokinin,
pancreatic polypeptide
C. Insulin, somatostatin, glucagon, pancreatic
D. Insulin, secretin, glucagon, cholecystokinin
E. Insulin , Glucagon, CCK

MCQ No. 26
Which of the following Xray findings is
associated with pancreatic trauma:
A. Gas bubbles in the retroperitoneum near the Rt.
Psoas muscle
B. Free intraperitoneal gas may be present.
C. # of transverse process of sacral vertebrae.
D. Displacement of stomach or t.colon.
E. Fracture 12th rib

MCQ No. 27
What is the investigation of choice in
pancreatic trauma?
A. Serum amylase
B. CT Scan
D. Serum Lipase
E. Xray

MCQ No. 28
Which of the following is incorrect
regarding MRCP?
A. Does not need contrast material
B. Accurate & rapid in assessing
pancreatic duct
C. It is minimally invasive
D. Demonstrate disruption of the CBD
E. Demonstrate dilatation of pancreatic

MCQ No.29
Which of the following is not a
surgical option for chronic
A. Begers procedure
B. Puestow procedure
C. Pancreaticoduodenectomy
D. ERCP sphincterotomy
E. Laser therapy to destroy focal

MCQ No. 30
Which of the following is not
implicated in pathogenesis of acute
A. Acinar Cell injury
B. Activation of pro-enzymes
C. Back pressure in pancreatic duct
D. Fat accumulation in pancreas
E. Release of enzymes into the circulation

MCQ No. 31
Pancreatic percutaneous biopsy may
predispose to:
A. Pancreatic fistula
B. Pancreatic pseudocyst
C. Pancreatic carcinoma
D. Disruption of the ducts
E. Back pressure in the pancreatic duct

MCQ No. 32
A 50-year-old man develops acute pancreatitis due to
alcohol abuse. Hyperamylasemia resolves by the third
day after admission. By the eighth day, the patient is
noted to have spiking fever (38.5C), progressive
leukocytosis (18,500 WBC/mm3), and tachypnea. The
most appropriate management includes which as the next
A. Laparotomy with pancreatic debridement
B. CT guided aspiration of peripancreatic fluid collections
C. ERCP with sphincterotomy and placement of biliary
D. Intravenous amphotericin B
E. Laparotomy and cystogastrotomy

MCQ No. 33
Which of the following procedures has
not been associated with an increased
risk of post-procedure acute
A. Common bile duct exploration
B. Endoscopic retrograde
C. Coronary bypass grafting
D. Distal gastrectomy
E. Right hemicolectomy

MCQ No. 34
Which of the following is not true
regarding Accessory pancreatic duct?
A. It is also called Duct of Santorini
B. Opens at the Minor duodenal papilla
C. In some cases may act as the main duct
D. Joins the CBD two cms away from
E. Drains the uncinate process of pancreas

MCQ No. 35
Which of the following statement(s) about
malignant neoplasms of the liver is not true?
A. Hepatocellular carcinoma is the number 1 cause of
death from cancers worldwide.
B. The commonest resectable hepatic malignant
neoplasm is colorectal metastasis.
C. Focal nodular hyperplasia is a premalignant condition.
D. Hepatomas are generally slower growing than was
formerly believed.
E. Hepatomas usually cause peritoneal seeding

MCQ No. 36
Which of the following statement concerning
bile duct strictures due to chronic
pancreatitis is not true?
A. Most patients present with progressive
B. Strictures are classically long and tapered
involving the entire intrapancreatic bile duct
C. Patients may be asymptomatic and
diagnosed only by persistent elevation of serum
alkaline phosphatase
D. An excellent option for surgical management
is choledochoduodenostomy
E. ERCP can be useful

MCQ No. 37
A 42-year-old male alcoholic develops acute
pancreatitis. One week after onset of symptoms, CT
abdomen reveals a pancreatic phlegmon and
associated pseudocyst. Which of the following
factors, if present, would increase the likelihood of
spontaneous resolution of the pseudocyst?

A. Size greater than 5 cm

B. Diffuse calcification of the pancreatic gland
C. Multilocularity
D. Location in the pancreatic tail
E. Development of infection in peri pancreatic fluid

MCQ No. 38
A 36-year-old woman is admitted to hospital with upper
abd pain, hyperamylasemia, elevation of serum AlkPO4
and usg evidence of cholelithiasis. With IV hydration and
analgesia, symptoms rapidly resolved. After 48 hours,
serum amylase and alkPO4 values had returned to
normal and physical examination revealed lessening
tenderness in the RHC of the abdomen. Appropriate
management consists of which of the following as the next
A. Cholecystectomy and intraoperative cholangiography
before hospital discharge
B. Elective cholecystectomy at approximately 8 weeks
C. Endoscopic sphincterotomy before discharge followed
by cholecystectomy at approximately 8 weeks
D. Observation

MCQ No. 39
Which of the following is an indication
for immediate surgical intervention in
acute pancreatitis?
A. Severe acute pancreatitis
B. Pancreatic pseudocyst
C. Necrotizing Pancreatitis
D. Acute hemorrhagic pancreatitis
E. Pancreatic phlegmon

MCQ No. 40
What is the function of cortical zone of
spleen related to infection control?
A. Filtration of red cells, encapsulated bacteria,
and other foreign material.
B. Red pulp for formation of red cells.
C. White pulp for its role in formation of
D. Gray areas, so formed because of the
production of platelets.
E. Fibrous trabeculae.

MCQ No. 41
Which of the following is true regarding
splenectomy and perioperative therapy for

A. Done if steroid therapy fails.

B. Respond permanently to high-dose
intravenous gamma globulin.
C. Used as first line treatment for ITP
D. Cannot be done laparoscopically.
E. Is associated with splenomegaly.

MCQ No. 42
A 15 year patient presents with pallor, intermittent
jaundice and RHC pain. CBC shows Hb 6.7mg/dl,
reticulocyte count is raised and abdominal USG
shows gall stones. The most likely diagnosis is:
B. Wilsons disease
C. Hereditary spherocytosis
D. Hyperlipidemia
E. Typhoid fever

MCQ No. 43
Which of the following statements regarding
post splenectomy sepsis is not true?
A. The incidence in children is generally
reported as less than 5%
B. Haemophilus influenzae, Streptococcus
pneumoniae and Neiseria meningitidis are the
most common causative organisms
C. Autotransplantation techniques eliminate this
D. The mortality rate is now approximately 50%
E. The incidence in adults in approximately 1%

MCQ No. 44
Which of the following is not true regarding
A. Use of coagulator beam Argon is superior to
other techniques
B. Grade 2 and grade 3 injuries can be managed
by suture repair
C. Atleast 1/3rd of the spleen should be
maintained to maintain immune function
D. Mesh wrapping is recommended for grade 4
E. Grade 1 injuries donot require any suture

MCQ No. 45
Which of the following statement relating to
chronic pancreatitis is correct?
A. Approximately 50% of chronic alcoholics
develop chronic pancreatitis
B. Clinically significant chronic pancreatitis
develops on average after five years of alcohol
abuse in men
C. The risk of alcohol-induced chronic
pancreatitis can be decreased by consumption
of a high-protein diet
D. Idiopathic pancreatitis occurs in newborns
E. In the US, the commonest cause of chronic
pancreatitis is alcohol abuse

MCQ No. 46
Glasgow criteria for assessment of
pancreatitis severity does not include:
A. WBC > 15,000
B. Hct > 36
C. BUN > 16
D. Arterial PO2 < 60 mm Hg
E. Ca < 8

MCQ No. 47
In prospective, randomized trials which of
the following agents or therapeutic
measures has been demonstrated to
accelerate recovery from acute pancreatitis?

A. Peritoneal dialysis
B. Anticholinergic blockade
C. Octreotide
D. H2 receptor blockade
E. IV analgesia

MCQ No. 48
All of the following are components of
the MEN type 2B syndrome except:
A. Multiple neuromas on the lips, tongue,
and oral mucosa.
B. Hyperparathyroidism.
C. Medullary carcinoma of thyroid.
D. Pheochromocytoma.
E. Marfanoid body habitus

MCQ No. 49
MEN 2A and MEN 2B syndromes are
associated with germline mutations in:
A. The p53 tumor suppressor gene.
B. The H-ras gene.
C. The N-myc gene.
D. The RET proto-oncogene.
E. The BRCA 2 gene

MCQ No. 50
The best therapy for a patient with
Thrombotic Thrombocytopenic
Purpura (TTP) is:
A. Corticosteroids
B. Splenectomy
C. Plasma apharesis
D. Vaccination
E. IV immunoglobulins

MCQ No: 51
A patient presents with epigastric pain and
tenderness for 1 day. On investigating his
serum amylase is raised. His Xray abdomen
shows gas under diaphragm. What is the


Acute Pancreatitis
Pancreatic pseudocyst
Upper GIT perforation

MCQ No: 52
Which of the following is False about
carcinoma pancreas :
A) Smoking is a risk factor
B) CA19-9 is a good tumor marker
C) Laparoscopy is required for staging
D) Pylorus Preserving
Pancreoduodenectomy should not be
E) Pancreatic Tail is a rare site

MCQ No:53
Which of the following is not a
complication of splenectomy:
A. Pancreatic fistula
B. Thrombocytosis
C. Opportunistic infections
D. Gastric dilatation
E. Portal Hypertension

MCQ No: 54
Which of the following is a relation of
the posterior surface of the body of
A. Abdominal aorta
B. Splenic vein
C. Superior mesenteric vessels
D. Left kidney
E. Splenic artery

MCQ No: 55
A patient presents with blunt trauma
abdomen. S-amylase is raised and CT shows
peri-pancreatic fluid. Which of the following
is not true regarding this patient?

A. Other organs are likely to be injured

B. It is important to ascertain the patency
of pancreatic duct
C. Surgery is not indicated in all cases
D. CT and ERCP are most useful tests
E. External drainage can be attempted

MCQ No: 56
A patient admitted to the hospital with acute
pancreatitis, develops bluish red
discoloration around the umbilicus and
flanks. Which of the following is FALSE
regarding this:

A. This is rare sign of acute pancreatitis

B. It indicates worst prognosis
C. It develops due to bleeding in the
D. It indicates resolving pancreatitis
E. It is not pathognomonic of acute

MCQ No: 57
Hyersplenism is not associated with which
of the following diseases:

A. Portal HTN
B. Lymphoma
D. Dubin Johnson syndrome
E. Infectious Mononucleosis

MCQ No: 58
Which of the following is not the
standard treatment for pancreatic
pseudocyst of size >5 cm:
A. Endoscopic drainage
B. Percutaneous drainage
C. Surgical drainage
D. Conservative management
E. Transpapillary drainage

MCQ No:59
A 45 year old male, known case of ulcerative
colitis presents with recurrent attacks of
jaundice, pruritis and fever. Labs show
increased Alk PO4 and Gamma glutamyl
transferase. The likely diagnosis is:
A. Acute cholecystitis
B. Acute on chronic cholecystitis
C. Primary sclerosing cholangitis
D. Secondary sclerosing cholangitis
E. Asiatic Cholangiohepatic

MCQ No: 60
A patient presents with obstructive jaundice.
pancreatic cancer. The treatment of choice
would be:


Palliative radiotherapy
NPO and symptomatic treatment
Surgical debulking
Relief of jaundice by stenting or surgery

MCQ No: 61
Which of the following is not an
indicator of severe attack of acute
A. APACHE II score >8
B. Ranson Score >7
C. Persistantly elevated amylase level
D. C-Reactive Protein of < 45 mg/L

MCQ No:62
The fluid aspirated from a pancreatic
pseudocyst should always be sent for
CEA measurement to distinguish it
A. Infected cyst
B. Pancreatic abscess
C. Cysto-enteric fistula
D. Mucinous neoplasm
E. Pancreatic fistula

MCQ No:63
A patient is admitted to ICU for acute
pancreatitis. From 10th day of admission his
CBC shows a marked and persistant
elevation of platelets. This should raise the
suspiscion of:


Retero-peritoneal hematoma
Bone marrow hyperplasia
Idiopathic thrombocytosis
Portal or splenic vein thrombosis
Side effect of TPN

MCQ No:64
The mechanism of action of Octreotide
A. Reduction of secretion of Gastrin
B. Reduction of secretion of CCK
C. Reduction of the secretions of pancreas
D. Reduction of secretion of fluids by the
E. Reduction of gastric secretions

MCQ No:65
A 45 year old, chronic alcoholic presents
with recurrent attacks of acute on chronic
pancreatitis. Which of the following is not
true regarding his nutritional and digestive


Diet should be low in proteins

Vit B12 supplementation
Stop alcohol consumption
Pancreatic enzyme supplementation
Medium chain triglycerides

MCQ No:66
A patient presents in the ER with high
velocity blunt trauma abdomen and back. His
X-ray shows fracture transverse process of
L1 and L2. One should suspect:


Injury to IVC
Injury to pancreas
Injury to Liver
Injury to coeliac ganglion
Injury to jejunum

MCQ No:67
The standard procedure for the resection of a
resectable tumor of Pancreatic head or ampulla


Local excision of the tumor
Pre-op Chemotherapy
Pylorus preserving pancreaticoduodenectomy

MCQ No:68
A 45 year old male, has had recurrent attacks
of recurrent hypoglycemia. He is found to
have a nodule bulging in the medial wall of
duodenum on endoscopy. What is the most
likely diagnosis?


Duodenal adenoma
Familial adenomatous polyposis
Pancreatic adenocarcinoma
Carcinoid tumor

MCQ No:69
A 67-year-old male presents with complaints of
itching, dark urine, and epigastric pain. Physical
examination reveals jaundice. Initial laboratory
tests show total bilirubin of 6.5 mg/dL, alk PO4
elevated at 3 times normal, and mild elevation in
ALT/AST. Appropriate management includes
which diagnostic test as a next step?

A. Abdominal ultrasonography

B. Computed tomography of the abdomen

C. Magnetic resonance imaging of the abdomen
D. Endoscopic retrograde cholangiography
E. Conservative management

MCQ No:70
During the course of a laparotomy being
performed for blunt trauma abdomen, which of
the following is not a clue suggesting a major
pancreatic injury:


Lesser sac fluid collection

Retroperitoneal bile staining
Pulsatile hematoma peri-umbilical region
Crepitus or heamatomas overlying pancreas
Fat necrosis of omentum or retroperitoneal

MCQ No:71
All of the following are features of obstructive
jaundice except:

A. Conjugated hyper-bilirubinaemia
B. Marked elevation of alkaline
C. Presence of urobilinogen in the urine
D. Marked elevation of gamma GT
E. Mild elevation of transaminases

MCQ No:72
A 53 year old man with liver cirrhosis
develops malaise, upper abdominal pain and
20 pounds weight loss. Physical exam
shows a palpable mass Right upper
quadrant. Which of the following tumor
markers can help in diagnosis?


Beta HCG
Carcino-embryonic Antigen (CEA)
Serum LDH
Alpha Feto Protein (AFP)

MCQ No:73
A victim of a major car accident presents in
ER with BP 90/50 and pulse rate 130/min. He
has multiple fractured lower ribs on right
side and also distended abdomen. What is
the most appropriate next step in
management ?


Emergency Exploratory Laparotomy

Spiral CT Abdomen with contrast
Diagnostic Peritoneal Lavage
Immediate resuscitation
Radiology for multiple fractures

MCQ No:74
Multiple pancreatic neuro-endocrine tumors
maybe found in which hereditary autosomal
dominant disorder?


Peutz-Jeghers syndrome

MCQ No: 75
A patient presents with non-responding
hyperglycemia and migratory necrolytic
dermatitis. His CT abdomen shows a mass in
pancreas with liver metastasis. The most
likely diagnosis is:


Carcinoid tumor

MCQ No:76
According to Courvoisiers law, a non
tender palpable gall bladder is most
probably the sign of?

CBD obstruction
Empyema Gall bladder
CBD stones
Perforated Gall bladder
Peri- ampulary malignancy

MCQ No:77
A 29 year old male presents with pancreatic
insulinoma. His blood tests show elevated Calcium
and low Phosphate levels. He also has a family
history of pituitary and pancreatic tumors. The most
likely gene involved in this syndrome is:


FPC gene
Germline mutation in menin gene
RET proto-onco gene mutation
P53 gene mutation
Multiple mutations on chromosome 18 long

MCQ No:78
In children less than 5 years undergoing
splenectomy, prophylactic antibiotics
should be given :
A. Life long
B. Till the age of 10 years
C. Till the age of 16 years
D. For 2 years post-operatively
E. Till the age of 20 years

MCQ No:79
A 15 year old female presents with
abdominal pain, jaundice and mass in the
right upper abdomen. USG reveals dilated
intrahepatic biliary tree. The correct
diagnosis is?


Cystic disease of the liver

Obstruction of CBD with dilatations
Hydatid cyst
Choledochal Cyst
Multifocal abscesses

MCQ No:80
A patient of enteric fever develops LHC
pain and fever with chills. O/E there is
fullness and tenderness in LHC. USG
shows a cystic lesion in spleen. The most
likely diagnosis is:
A. Splenic Hematoma
B. Kalazar splenomegally
C. Splenic abscess
D. Splenic infarct
E. Splenic artery aneurysm