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Category: Critical Care Medicine-Gastrointestinal, Nutrition and Genitourinary Disorders--->Pancreas
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Question 1# Print Question

A 30-year-old female with no past medical history presents to the emergency department complaining of severe abdominal pain after a night of binge drinking. She is noted to have a low-grade temperature of 100.4°F with the following vital signs:

  • heart rate 115/min
  • blood pressure 95/60 mm Hg
  • respiratory rate 18/min
  • oxygen saturation 99% on room air

On examination, she has focal moderate to severe tenderness in her mid-epigastrium without peritoneal signs. Her laboratory test results are notable for

  • a WBC 15 000/mm3
  • lipase 5000 U/L
  • creatinine 1.3 mg/dL from a baseline of 0.6 mg/dL

An abdominal ultrasound shows no evidence of cholelithiasis. She is diagnosed with acute alcoholic pancreatitis and admitted to the hospital. All of the following are important initial steps in the management of moderate-severe acute pancreatitis EXCEPT:

A. Admission to a monitored hospital bed
B. Initial resuscitation with lactated ringers at a rate of 5 to 10 mL/kg/h with close monitoring for markers of end organ perfusion
C. Initiation of broad spectrum antibiotics
D. Pain control with multimodal pain therapy
E. Early initiation of oral feeding as tolerated

Question 2# Print Question

All of the following statements are true regarding nutrition in patients with moderate to severe acute pancreatitis EXCEPT:

A. Oral feeding can be initiated early in the setting of improving abdominal pain and decreasing inflammatory markers
B. If oral feeding cannot be tolerated, it is recommended to start enteral nutrition by day 5 to 7
C. Enteral nutrition is preferred over total parenteral nutrition if it can be tolerated
D. Enteral nutrition likely helps to maintain the intestinal mucosal barrier, thereby reducing bacterial translocation and infectious complications of acute pancreatitis
E. Nasojejunal feeding is preferred over nasogastric feeding because of deceased pancreatic stimulation

Question 3# Print Question

A 45-year-old male was admitted to the intensive care unit (ICU) 2 days ago with a diagnosis of acute pancreatitis secondary to alcohol abuse. After initial resuscitation with large volume isotonic crystalloid solution for persistent hypotension, he developed worsening pulmonary edema with an increased oxygen requirement ultimately requiring intubation. In addition to Acute Respiratory Distress Syndrome, another potential complication seen in severe pancreatitis requiring large volume resuscitation is abdominal compartment syndrome. All of the following are signs/symptoms of abdominal compartment syndrome EXCEPT:

A. Intra-abdominal pressure = 10 mm Hg
B. Tense, distended abdomen
C. Progressive oliguria
D. Hypotension that is temporarily relieved with volume administration
E. Increased peak inspiratory and mean airway pressures

Question 4# Print Question

A 35-year-old male is hospitalized following a first episode of acute severe gallstone pancreatitis. Initially, he presented to the emergency department with tachycardia, hypotension, and signs of end organ dysfunction. After aggressive resuscitation and supportive management in the ICU he showed signs of improvement. On hospital day 18 he develops new fevers and an associated leukocytosis. A computed tomography (CT) abdomen/pelvis is obtained that showed new air in areas of previously noted pancreatic necrosis.

Which of the following statements is true regarding this patient’s condition?

A. Use of prophylactic antibiotics has been shown to decrease the rate of infection in necrotizing pancreatitis
B. Primary management is urgent surgical debridement to attain source control
C. Mortality associated with infected pancreatic necrosis ranges from 70% to 80%
D. Current management involves initiation of antibiotic therapy and a step-up approach utilizing minimally invasive and endoscopic techniques
E. Diagnostic Fine Needle Aspiration is required for a diagnosis of infected pancreatic necrosis

Question 5# Print Question

A 30-year-old obese female with a past medical history of cholelithiasis presents to the emergency room with progressive abdominal pain, nausea, and emesis for 2 days. While in the emergency department, she was noted to be afebrile with the following vital signs:

  • heart rate 85/min
  • blood pressure 120/70 mm Hg
  • respiratory rate 18/min
  • oxygen saturation 99% in room air

Her laboratory evaluation was notable for:

  • WBC 14 000/ mm3
  • lipase 2000 U/L
  • otal bilirubin 1 mg/dL

An abdominal ultrasound shows cholelithiasis without secondary signs of cholecystitis and a common bile duct measuring 5 mm. She is admitted for supportive management and the following day her total bilirubin is 0.6 mg/dL, lipase is 500 U/L, and her pain and nausea are significantly improved.

What is the best next step in management?

A. Endoscopic Retrograde Cholangiopancreatography (ERCP)
B. Laparoscopic cholecystectomy during this admission
C. IV antibiotics alone
D. No further intervention necessary
E. Magnetic Resonance Cholangiopancreatography (MRCP)

Category: Critical Care Medicine-Gastrointestinal, Nutrition and Genitourinary Disorders--->Pancreas
Page: 1 of 2