Exam Master GI II Questions with Complete Solutions
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Course
Gastroenterology
Institution
Gastroenterology
A 42 year old man presents with acute abdominal pain. He describes the pain as constant and severe. Upon further questions, he affirms that the pain radiates to his back. He leans forward in attempt to alleviate the pian. One physical examination, his temperature is 101.1F and his pulse is 94. His ...
Exam Master GI II Questions with
Complete Solutions
A 42 year old man presents with acute abdominal pain. He describes the pain as
constant and severe. Upon further questions, he affirms that the pain radiates to his
back. He leans forward in attempt to alleviate the pian. One physical examination, his
temperature is 101.1F and his pulse is 94. His abdomen is tender, but there is no
guarding or rigidity. There is discoloration in the flanks and discoloration around his
umbilicus. His nose is bulbous and red, and he appears malnourished. He states that he
does not use recreational drugs. His labs are a s follows.
Discoloration of the flanks in this patient is indicative of what sign? - Answer-Grey
Turner's sign is ecchymosis of the flanks that can sometimes be seen with acute
pancreatitis.
This patient has signs and symptoms of acute pancreatitis, including non-colicky
abdominal pain that radiates to the back and fever. An elevated amylase, an elevated
serum lipase, and hypocalcemia are all also consistent with pancreatitis. The most
frequent underlying cause of pancreatitis is alcoholism or biliary disease
A 35 year old man presents after several episodes of vomiting in the last 24 hours; there
is loose Stoll and strong pain localized in the upper middle region of the abdomen.
Physical examination indicates a temperature of 101F and a tender epigastric. Lab tests
reveal an initial WBC count of 18x10^9/L. C- reactive protein level is 325mg/L, and
amylase is 130 U/L. There is lactate dehydrogenase level of 816 U/L. The patient has
no history of pancreatic disease and denies alcohol use. He is overweight. He has a
history of Type 2 diabetes and hypertension. He takes medicine to control his high
blood pressure and obesity.
What is the most appropriate next step in establishing the diagnosis? - Answer-
Abdominal computed tomography scanning
The symptoms and lab results are consistent with an acute episode of pancreatitis, but
extra tests are necessary to confirm the diagnosis. The CT scan provides the most
accurate way to see the pancreas. A CT study is useful when other diagnostic studies
are inconclusive when the patient has severe symptoms, or if fever or secondary
infection is present.
A 42 year old man presents with acute abdominal pain. He describes the pain as
constant and severe. Upon further questioning, he affirms that the pain radiates to his
back. He leans forward in an attempt to alleviate the pain. On physical examination, his
temperature is 101 F and his pulse is 94. His abdomen is tender, but there is no
guarding or rigidity. There is discoloration in the flanks and discoloration around his
, umbilicus. His nose is bulbous and red, and he appears malnourished. He states that he
does not use recreational drugs. His labs are a s follows.
What is the most probably underlying cause for his condition? - Answer-Alcohol abuse
This patient has signs and symptoms of acute pancreatitis, including non-colicky
abdominal pain that radiates to the back and fever. An elevated amylase, an elevated
serum lipase, and hypocalcemia are all also consistent with pancreatitis. The most
frequent underlying cause of pancreatitis is alcoholism or biliary disease.
Which of the following is the most rare complication of acute pancreatitis? - Answer-
Retinopathy.
Due to black age of the posterior retinal artery by aggregated granulocytes, hemorrhage
and cotton-wool spots are seen in the optic disk and macula in a patient who has acute
pancreatitis. This unusual complication of acute pancreatitis is known as Purtschers
retinopathy. It is characterized by sudden and severe loss of vision.
Hypertriglyceridemia is seen in 15% of the patients with acute pancreatitis.
Chronic pancreatitis is characterized by irregularly distributed fibrosis and relative
sparing of the islets of Langerhans. A patient was diagnosed with chronic pancreatitis
and biopsy tissue sample is shown in the image. Which of the following complications
can this painter develops. - Answer-Pseudocyst
Chronic pancreatitis is a disease characterized by repeated bouts of mild to. Moderate
pancreatic inflammation with continued loss of pancreatitis parenchyma and
replacement with fibrous tissue. The pain difference between an acute and chronic
attack is the state of the pancreas a prior to the attack. Acute pancreatitis refers to the
first attack whereas chronic pancreatitis occurs in already damaged pancreases.
Causes of chronic pancreatitis include:
Ductal obstructions by concretions
secreted proteins
oxidative stress
Interstitial fibrosis
Sequelae of chronic pancreatitis include
Pseudocyst formation
Duct obstruction
Malabsorption
Secondary diabetes
Exocrine secretion of the pancreatic acinar cells may be inhibited by which hormone? -
Answer-Somatostatin
Several hormones act upon the pancreatic acinar cell to regulate the secretion of the
zymogen granules. Vasoactive intestinal peptide (VIP), CCK, and insulin will each
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