Multiple Choice Questions (MCQ)

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

Question 6# Print Question

A 55-year-old male with pancreatic adenocarcinoma is now 3 weeks status post an uncomplicated pancreaticoduodenectomy (Whipple procedure). He was discharged home 7 days following his procedure and has been feeling well until yesterday morning when he developed gradually worsening abdominal discomfort and recent onset of nausea. Although in the emergency department he is noted to be:

  • afebrile
  • tachycardic with heart rate 105/min
  • and a blood pressure of 110/70 mm Hg

His laboratory evaluation is notable for:

  • a white blood cell count of 8000/mm3
  • and a hemoglobin (Hgb) of 6.0 g/dL

His Hgb at discharge was 9 g/dL. While in the emergency department, he vomits a small amount of bloody emesis. He is admitted to the ICU, has large bore peripheral intravenous access established, is transfused 2 U PRBC, and his Hgb increases to 8.0 g/dL. A CT scan is ordered for further evaluation. That night, before the CT scan is done, he starts vomiting large amounts of bright red blood and becomes hypotensive.

What is the most likely cause for his presentation?

A. Gastroduodenal artery pseudoaneurysm
B. Bleeding esophageal varices
C. Aortoenteric fistula
D. Bleeding gastric ulcer
E. Mallory-Weiss Syndrome

Question 7# Print Question

Choose the correct statement regarding acute pancreatitis from the list below:

A. The diagnosis of gallstone pancreatitis is made by a combination of laboratory test results, imaging, and ERCP
B. Alcohol is responsible for 70% of cases of acute pancreatitis in the United States
C. Routine evaluation for all patients presenting with a first episode of pancreatitis includes a social history with specific inquiry about ethanol consumption, serum triglyceride levels, serum calcium, liver biochemical tests, and an abdominal ultrasound
D. A diagnosis of post-ERCP pancreatitis is made by checking serum amylase and lipase levels the day following the procedure
E. Hypertriglyceridemia-induced pancreatitis is treated with initiation of statin therapy

Question 8# Print Question

A 50-year-old male with a past medical history of hypertension and recent hospitalization for acute pancreatitis presents to the emergency department with complaints of increasing abdominal discomfort, anorexia, and intermittent emesis. He reports that he had been feeling well since his discharge from the hospital 3 weeks ago but has noticed the gradual onset of symptoms that have now increased in severity. All of the following are true regarding the diagnosis and management of a suspected pancreatic pseudocyst EXCEPT:

A. Pancreatic pseudocysts are fluid-filled cavities that lack a true epithelial layer and most commonly arise in the setting of pancreatitis or trauma
B. CT and MRI cross-sectional imaging are the best modalities for diagnosis and routine evaluation of pseudocysts
C. Nutritional assessment and initiation of nasoenteric feeding may be beneficial in symptomatic patients
D. Modalities for intervention include endoscopic drainage, percutaneous catheter drainage, and surgical drainage
E. Most pancreatic pseudocysts eventually require invasive intervention to achieve resolution

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