ABSITE - Pancreas – Questions with Correct
Answers
All of the following inherited familial syndromes are associated with an increased incidence of pancreatic endocrine neoplasms except:
A. von Hippel-Lindau (VHL) syndrome.
B. tuberous sclerosis (TSC).
C. multiple endocrine neoplasia type 1 (MEN-1).
D. Peutz-Jeghers syndrome (PJS).
E. neurofibromatosis (NF-1). - Correct Answer Peutz-Jeghers syndrome (PJS).
Correct.
The majority of pancreatic endocrine neoplasms are sporadic. Some of them, however, occur as part of inherited familial syndromes such as MEN-1, VHL syndrome, NF-1, and TSC. MEN-1 is associated with gastrinoma, while NF-1 is associated with somatostatinomas. VHL and TSC are both associated with increased pancreatic endocrine neoplasms. PJS is characterized by the development of benign hamartomatous polyps in the gastrointestinal tract. It is associated with an increased risk of developing carcinomas of the pancreas, liver, lungs, breast, ovaries, uterus, testicles, and other organs.
Which of the following statements is true regarding pseudocysts in chronic pancreatitis?
A. Pseudocysts, although common following an episode of acute pancreatitis, rarely occur in patients
with chronic pancreatitis.
B. Recurrence of a pancreatic pseudocyst after aspiration implies an ongoing communication with the pancreatic duct.
C. In patients with chronic pancreatitis and a pseudocyst, adequate drainage of the pseudocyst will usually result in significant pain relief and decreased narcotic requirements.
D. Percutaneous drainage successfully treats pancreatic pseudocysts in nearly all cases. - Correct Answer Recurrence of a pancreatic pseudocyst after aspiration implies an ongoing communication with the pancreatic duct.
Correct.
Pancreatic pseudocysts are a common complication of chronic pancreatitis. The underlying ductal abnormalities in patients with chronic pancreatitis make pseudocysts less likely to regress spontaneously in these patients. Pseudocysts can be an important additional cause of pain in patients with chronic pancreatitis, but treatment of the pseudocyst rarely leads to complete pain relief. Ideally, the pancreatic ductal anatomy should be defined prior to any attempt at treatment. A pseudocyst that recurs after percutaneous drainage has by definition an ongoing communication with the pancreatic ductal system and is best treated by operative internal drainage. This procedure can be combined with a ductal drainage procedure if indicated to address the patient's chronic pancreatitis.
A 35-year-old woman is evaluated for a seizure disorder, mental obtundation, and personality change. The findings on physical examination are normal. The fasting serum glucose is 44 mg/dL. Other serum values are normal. An insulin-to-glucose (I:G) ratio of 0.5 was documented after 28 hours of fasting. Symptoms of mental obtundation developed concurrently and were reversed by means of oral administration of glucose. Endoscopic ultrasonography showed a 1.2-cm mass in the head of the pancreas. Appropriate management consists of which of the following?
A. Long-term administration of octreotide
B. Surgical enucleation of the tumor
C. Pancreaticoduodenectomy
D. Total pancreatectomy - Correct Answer Surgical enucleation of the tumor
Correct.
Management of an insulinoma is surgical in nearly all cases. Insulinomas are evenly distributed in the
pancreas; approximately one third are located in the head and uncinate process, one third in the body of the gland, and one third in the tail of the gland. Ninety percent of patients have a benign solitary adenoma amenable to surgical cure. Small benign insulinomas not close to the pancreatic duct can be removed by means of enucleation, independent of location within the gland. In the body
and tail of the pancreas, insulinomas larger than 2 cm in diameter and those close to the pancreatic duct are most commonly excised by means of a distal pancreatectomy. Large insulinomas deep in the
head of pancreas or uncinate process of the pancreas may not be amenable to local excision and may necessitate pancreaticoduodenectomy.
Which of the following genetic alterations is found in high frequency (50% or greater) in patients with pancreatic cancer?
A. Disorders of DNA mismatch-repair genes B. Absence of the tumor-suppressor gene DPC4 C.
Answers
All of the following inherited familial syndromes are associated with an increased incidence of pancreatic endocrine neoplasms except:
A. von Hippel-Lindau (VHL) syndrome.
B. tuberous sclerosis (TSC).
C. multiple endocrine neoplasia type 1 (MEN-1).
D. Peutz-Jeghers syndrome (PJS).
E. neurofibromatosis (NF-1). - Correct Answer Peutz-Jeghers syndrome (PJS).
Correct.
The majority of pancreatic endocrine neoplasms are sporadic. Some of them, however, occur as part of inherited familial syndromes such as MEN-1, VHL syndrome, NF-1, and TSC. MEN-1 is associated with gastrinoma, while NF-1 is associated with somatostatinomas. VHL and TSC are both associated with increased pancreatic endocrine neoplasms. PJS is characterized by the development of benign hamartomatous polyps in the gastrointestinal tract. It is associated with an increased risk of developing carcinomas of the pancreas, liver, lungs, breast, ovaries, uterus, testicles, and other organs.
Which of the following statements is true regarding pseudocysts in chronic pancreatitis?
A. Pseudocysts, although common following an episode of acute pancreatitis, rarely occur in patients
with chronic pancreatitis.
B. Recurrence of a pancreatic pseudocyst after aspiration implies an ongoing communication with the pancreatic duct.
C. In patients with chronic pancreatitis and a pseudocyst, adequate drainage of the pseudocyst will usually result in significant pain relief and decreased narcotic requirements.
D. Percutaneous drainage successfully treats pancreatic pseudocysts in nearly all cases. - Correct Answer Recurrence of a pancreatic pseudocyst after aspiration implies an ongoing communication with the pancreatic duct.
Correct.
Pancreatic pseudocysts are a common complication of chronic pancreatitis. The underlying ductal abnormalities in patients with chronic pancreatitis make pseudocysts less likely to regress spontaneously in these patients. Pseudocysts can be an important additional cause of pain in patients with chronic pancreatitis, but treatment of the pseudocyst rarely leads to complete pain relief. Ideally, the pancreatic ductal anatomy should be defined prior to any attempt at treatment. A pseudocyst that recurs after percutaneous drainage has by definition an ongoing communication with the pancreatic ductal system and is best treated by operative internal drainage. This procedure can be combined with a ductal drainage procedure if indicated to address the patient's chronic pancreatitis.
A 35-year-old woman is evaluated for a seizure disorder, mental obtundation, and personality change. The findings on physical examination are normal. The fasting serum glucose is 44 mg/dL. Other serum values are normal. An insulin-to-glucose (I:G) ratio of 0.5 was documented after 28 hours of fasting. Symptoms of mental obtundation developed concurrently and were reversed by means of oral administration of glucose. Endoscopic ultrasonography showed a 1.2-cm mass in the head of the pancreas. Appropriate management consists of which of the following?
A. Long-term administration of octreotide
B. Surgical enucleation of the tumor
C. Pancreaticoduodenectomy
D. Total pancreatectomy - Correct Answer Surgical enucleation of the tumor
Correct.
Management of an insulinoma is surgical in nearly all cases. Insulinomas are evenly distributed in the
pancreas; approximately one third are located in the head and uncinate process, one third in the body of the gland, and one third in the tail of the gland. Ninety percent of patients have a benign solitary adenoma amenable to surgical cure. Small benign insulinomas not close to the pancreatic duct can be removed by means of enucleation, independent of location within the gland. In the body
and tail of the pancreas, insulinomas larger than 2 cm in diameter and those close to the pancreatic duct are most commonly excised by means of a distal pancreatectomy. Large insulinomas deep in the
head of pancreas or uncinate process of the pancreas may not be amenable to local excision and may necessitate pancreaticoduodenectomy.
Which of the following genetic alterations is found in high frequency (50% or greater) in patients with pancreatic cancer?
A. Disorders of DNA mismatch-repair genes B. Absence of the tumor-suppressor gene DPC4 C.
