Question 1

A 65-year-old man complains of vague upper abdominal pain, weight loss, and loose fatty stools. Radiographs show visible calcifications within the pancreas. These findings are most consistent with a diagnosis of which of the following disorders?

A) Ductal carcinoma of the pancreas
B) Acinar cell carcinoma of the pancreas
C) Islet cell carcinoma
D) Chronic pancreatitis
E) Pancreatic pseudocyst

Chronic pancreatitis

Accepted Answer

Upper abdominal pain, weight loss due to malabsorption that is associated with fatty stools (steatorrhea), and calcifications in the pancreas are typical signs and symptoms of chronic pancreatitis.

Question 2

Which of the following is the most common cause of acute pancreatitis?&#10;A) Alcohol&#10;B) Thiazide diuretics&#10;C) Viruses&#10;D) Trauma&#10;E) Vascular thrombosis

Accepted Answer

Alcohol and biliary disease are the cause of acute pancreatitis in most clinically diagnosed cases. Although the exact pathogenesis of alcohol-induced pancreatitis is not known, it is presumed that it acts by provoking a contraction of the sphincter of Oddi, causing a reflux of bile into the pancreas. Alcohol may also provoke pancreatitis by its direct toxic effect on acinar cells of the pancreas or by affecting the intracellular trafficking of enzymes.

Question 3

Which of the following genes is the most frequently mutated oncogene in ductal adenocarcinoma of the pancreas?&#10;A) p53&#10;B) K-RAS&#10;C) MYC&#10;D) RB1&#10;E) SMAD4

Accepted Answer

The K-RAS gene is activated by point mutation in 80%-90% of all pancreatic carcinomas and thus the most often mutated oncogene in this tumor. The MYC oncogene mutations are found in patients with pancreatic carcinoma. Other genes listed in this question (p53, RB1, and SMAD4) mutate less often than the K-RAS gene. Test-smart students will also eliminate them from consideration, because they are tumor suppressor genes and not oncogenes!

Question 4

Hereditary pancreatitis is most likely to be found in persons harboring the mutation of which of the following genes? A) α₁-Antitrypsin B) Amylase C) Cationic trypsinogen D) Enterokinase E) Alkaline phosphatase

Accepted Answer

Mutation of the gene encoding cationic trypsinogen results in the synthesis of an enzyme that is resistant to inactivation. The abnormally active trypsin acts on other digestive enzymes, causing autodigestion of the pancreas and pancreatitis.

Deck 16: Pancreas