1. PGY 101: Chapters 53 & 54 Lisa Spiguel, MD

2. True or False: The most common cause of chronic pancreatitis in the US is related to gallstones.

3. Which of the below proteins have been shown to be involved in the etiology of chronic pancreatitis? 1.SPINK-1 – Pancreatic secretory trypsin inhibitor 2.CFTR – Cystic fibrosis transmembrane conductance regulator 3.C-Kit – Tyrosine kinase inhibitor 4.A & B 5.All of the above

5. True or False: Only 30% of acinar function must be lost prior to symptoms of steatorrhea appear.

6. Which of the following below is the most common complication of chronic pancreatitis? 1.Pain 2.Pseudocyst 3.Pseudoaneurysm 4.Mesenteric Venous Thrombosis

7. A 55 yo man with a PMH of chronic pancreatitis presents to your clinic with complaints of abdominal discomfort, increased abdominal girth, and decreased appetite. On physical exam you not a non-pulsatile fullness in his epigastrium without signs of peritonitis. His CT scan is shown to the right. What is his diagnosis? 1.Splenic artery aneurysm 2.Splenic vein Thrombosis 3.Pancreatic adenocarcinoma 4.Pancreatic pseudocyst

8. True or False: Chronic pancreatitis is a risk factor for pancreatic adenocarcinoma, being proportionate with duration of diagnosis.

10. A 62 yo male with chronic alcoholic pancreatitis presents to your clinic. He has been suffering with abdominal pain, steatorrhea, and weight loss for almost 3 years. He has seen multiple physicians with no help. He is on an extensive narcotic regimen and pancreatic enzyme replacement without success. You order a CT pancreatic protocol which is demonstrated below. Which surgical procedure would you offer this man? 1.Whipple 2.Distal pancreatectomy 3.Central pancreatectomy 4.Peustow procedure

11. A 62 yo male with chronic alcoholic pancreatitis presents to your clinic. He has been suffering with abdominal pain, steatorrhea, and weight loss for almost 3 years. He has seen multiple physicians with no help. He is on an extensive narcotic regimen and pancreatic enzyme replacement without success. You order a CT pancreatic protocol which is demonstrated below. However it also demonstrates excessive chronic pancreatitic changes in the pancreatic head. Which surgical procedure would you offer this man? 1.Whipple 2.Distal pancreatectomy 3.Frey procedure 4.Peustow procedure

13. Puestow Frey

14. Whipple Frye Beger

15. Distal Pancreatectomy

17. 55 yo male presents to his PCP with a 2 month history of some mild upper abdominal pain, and new onset yellowing of the skin. His PCP orders a CT abdomen and pelvis below. What is your diagnosis? 1.Choledocholithiasis 2.Pseudoaneurysm 3.Pancreatic adenocarcinoma 4.Chronic Pancreatitis

18. Which of the following below is not a risk factor for pancreatic cancer? 1.Tobacco 2.Age 3.BRCA 2+ carrier 4.High fiber diet

20. True of False: 20 % of pancreatic cancer are caused by Familial predisposition syndromes.

21. Which of the below genes is not associated with pancreatic cancer? 1.BRCA 2 2.PRSSl 3.STKll 4.VEGF

23. Which of the below Oncogenes has be found to be altered in patients with pancreatic adenocarcinoma? 1.P53 2.DPC4 3.BRCA 2 4.K-ras

25. Which of the tumor markers below is elevated in pancreatic adenocarcinoma? 1.CA 125 2.CA 19-9 3.CEA 4.AFP

26. 55 yo male presents to his PCP with a 2 month history of some mild upper abdominal pain, his PCP orders a CT abdomen pelvis as demonstrated below. What is the best surgical treatment option? 1.Pancreaticoduodenectomy 2.Splenectomy 3.Central pancreatectomy 4.Distal pancreatectomy

27. 55 yo male presents to his PCP with a 2 month history of some mild upper abdominal pain, his PCP orders a CT abdomen pelvis as demonstrated below. What is the best surgical treatment option? 1.Pancreaticoduodenectomy 2.Splenectomy 3.Central pancreatectomy 4.Distal pancreatectomy

28. Distal Pancreatectomy Whipple

29. A 64 yo male is recently diagnosed with pancreatic adenocarcinoma after a work up of back pain and new onset jaundice. His CT is demonstrated below. What is your definitive plan? 1.Pancreaticoduodenectomy followed by Adjuvant chemo- XRT 2.Neoadjuvant chemo-XRT followed by plan for pancreaticoduodenectomy if clinical response 3.This patient is a non-surgical candidate 4.Pancreaticoduodenectomy alone without adjuvant therapy

30. Which of the below is not a contraindication to pancreatic resection? 1.Encroachment of the celiac plexus 2.Encasement of superior mesenteric vessels 3.Abutting the portal vein 4.All of the above are contraindications

31. 5 yr survival rates for resectable pancreatic adenocarcinoma are? 1.5-10% 2.10-15% 3.15-20% 4.20-25%

32. 57 yo male underwent an EGD for chronic abdominal pain that was not alleviated by antacids. Once the gastroenterologist entered the 2 nd portion of the duodenum, he encountered the image below. What is your most likely diagnosis? 1.Mucinous cystadenoma 2.Serous cystadenoma 3.Intraductal papillary mucinous neoplasm 4.Ampullary adenocarcinoma

33. True or False: Intraductal papillary mucinous neoplasms contain ovarian-type stroma, unlike mucinous cystadenomas

35. Which of the following is not an indication for Branch-duct type IPMN resection? 1.Connection with main duct 2.Mural nodule 3.Greater than 3 cm 4.Location in the distal body

36. True of False: All Serous Cystadenomas are benign and do not require resection.