Q. Large cystic mass in the body and tail of pancreas in a young female, What is it? ( NEET 2018)
a) Serous cystic neoplasm
b) Mucinous cystic neoplasm
c) IPMN, Intraductal pancreas mucinous tumor
d) SPEN - Solid pseudopapillary Epithelial Neoplasm of pancreas
Q. All of the following predisposing syndromes for pancreatic adenocarcinoma are AD except? ( # Pancreas Q 21-25)
A. PJS (Peutz Jeghers)
B. CFTR (Cystic fibrosis)
C. HNPCC
D. FAMMM
Points : Several hereditary cancer syndromes (e.g., Peutz-Jeghers syndrome, familial atypical mole and multiple melanoma syndrome, hereditary breast and ovarian cancer syndrome) are known to be associated with increased risk of pancreatic cancer
Q . All are true regarding enzyme supplementation in chronic pancreatitis except
a) Lipase to be given 30000U before or after meal
b) H2 blocker is mandatory with enteric coated tablets
c) Main cause of failure is inadequate dosage
d) In cases of failure of enzyme replacement feeding of medium chain Triglycerides are helpful
Ans
Indications of enzyme supplementation are -
Q Regarding islet cell of pancreas true is (AIIMS, JIPMER)
a) Cells in descending order of frequency is B,D,A,F
b) B cells are more common in the periphery of islets
c ) Peri islet acinar cells same as acinar cells else where
d) Portal flow from islet to acinar cell helps to control secretions
Q) All are true about ERCP in pancreatitis except
a) Not useful in patient with multiple strictures and stones
b) Ductal stenting associated with changes of c/c pancreatitis in 50%
c) In pts with pancreas divisum minor duct sphincterotomy causes significant pain relief irrespective of size of duct
d) Pain relief with endoscopic intervention occurs irrespective of relief of ductal pressure/ decrease in duct size
Answer for premium members ( Please log in to see)
Pancreatic ductal obstruction by fibrotic stenoses and/or calculi are the most frequent indications for endoscopic therapy.
Multiple strictures and stones are not amenable for endoscopic therapy ....................
Q) All are true about tropical pancreatitis except?
a. Associated with Tapioca.
b. Patients have large stones with fibrosis.
c. It is Pre Cancerous
d) Onset of disease at 50 years
Free.
Answer -d )Onset of disease is at young age
Tropical pancreatitisis an idiopathic disease which begins in teens. It has a high association with diabetes and Pancreatic duct calculi. It is common in South India, Asia, Africa and central America.
Etiology of tropical pancreatitis includes
Malnutrition
Cassava
Hydrocarbons exposure
It is associated with SPINK 1 mutation
It is pre cancerous
IPSG data shows the cumulative risk of Pancreatic Cancer in patients with Chronic Pancreatitis (predominantly of alcoholic aetiology) was reported as 1.8 % and 4 % at 10 and 20 years respectively. This risk was reported to be independent of age, sex and type of pancreatitis.
The link between CP and PC is clearer in certain subtypes of CP like tropical pancreatitis and hereditary pancreatitis.
Augustine et al. reported a 8.3 % incidence of pancreatic cancer in patients with tropical pancreatitis, which is much higher than western figures.
Ref
Pancreatic Cancer in Chronic Pancreatitis
Clinical Picture of tropical pancreatitis
a child, adolescent or young adult , recurrent upper abdominal pain, diabetes mellitus, malnutrition, nutrient deficiencies, nutritional edema, cyanotic hue of the lips, parotid enlargement and pancreatic calculi on plain abdominal X ray
Ref https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742869/pdf/v079p00606.pdf
Q ) True about heterotropic pancreas is
a) Most common site for heterotropic pancreas is stomach.
Q) Median survival after surgery and chemotherapy in Ca Head of Pancreas
a) 12 months
b) 22 months
c) 32 months
d) 44 months
This is an interesting question because this is one tumor in which breakthrough has not been achieved in the last 70 years. Pancreatic cancer remains one of the deadliest cancers of the GI tract and whipple's surgery continues to have high morbidity.
We discuss the role and response of chemotherapy also
