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Q1. Which of the following is least associated with development of cancer of pancreas?
a) Smoking
b) BRCA 2 gene mutation
c) Lynch Syndrome
d) Diabetes Mellitus
Ans
1.d
In adenocarcinoma of pancreas both environmental and genetic factors play a causative role. The most commonly associated risk factor for adenocarcinoma of the pancreas is smoking. The incidence of adenocarcinoma of the pancreas is directly related to the number of pack years smoked. Diabetes Mellitus and Chronic pancreatitis are somewhat doubtful etiological factors.
Somatic genetic drivers of PDAC
mutations of
a) KRAS (90%)
b) TP53 (75%)
c) SMAD4 (55%)
d) CDKN2A (80%)
Hereditary cases of PDAC are associated with several, wellestablished susceptibility genes, including BRCA2, ATM, BRCA1, PALB2, CDKN2A, STK11, PRSS1, and SPINK1
Diabetes does not have a direct causative role in carcinoma pancreas
Blumgart New 7th edition page 845
Q2. Not true regarding blood supply of pancreas?
a) Pancreas receives blood supply from coeliac trunk and superior mesenteric artery.
b) Body and tail of pancreas is supplied by Splenic artery
c) Posterior superior pancreaticoduodenal artery is a branch of Superior mesenteric artery.
d) All major pancreatic arteries lie posterior to pancreatic ducts
Ans 2. c
Anterior and Posterior Superior Pancreaticoduodenal artery & vessels are derived from coeliac artery.
Anteior and Posterior Inferior pancreaticoduodenal artery & vessels are derived from Superior Mesenteric artery.
Splenic artery supplies the body and tail of pancreas. Dorsal pancreatic artery usually arises from the splenic artery, near its origin from the celiac trunk. A right branch of the dorsal pancreatic artery supplies the head of the pancreas and usually joins the posterior arcade.
The gastroduodenal artery gives origin to the supraduodenal, retroduodenal, and posterior superior pancreaticoduodenal (PSPD) arteries. The gastroduodenal artery ends by dividing into the right gastroepiploic and anterior Superior pancreaticoduodenal (ASPD) arteries.
PSPD (Postero Superior Pancreaticodeuocenal Artery) is a branch of gastroduodenal and not Superior mesenteric artery
The anterior inferior pancreaticoduodenal artery arises from the SMA at or above the inferior margin of the pancreatic neck
Q3. Most Common Cause of death in early acute Pancreatitis is
a) Renal Failure
b) Cardiac failure
c) Respiratory Failure
d) Uncontrolled Coagulopathy
Ans3. c
Respiratory failure is the cause of death in the early phase (7 days). The pulmonary manifestations of pancreatitis include atelectasis and acute lung injury where as infective complications are the cause of death in late phase.
Q4. All of the following have been used in management of Acute Pancreatitis except
a) Interleukin-10
b) Gabexate
c) Somatostatin
d) Peritoneal dialysis
Ans4. a
Peritoneal dialysis, Gabexate, lexipafant (Anti PAF factor) Somatostatin all have been used in management of acute pancreatitis but have been found to be of no proven value .
IL 10 is raised in pancreatitis and has no role as treatment modality
Q5. Which of the following is not true for ectopic pancreas
a) Stomach and duodenum are the most common site
b) Ectopic pancreas appears as a submucosal irregular nodule in the wall
c) Islet tissue is present in all the organs where ectopic pancreas is present.
d) Ulceration, bleeding and obstruction are the most common symptoms
Ans5. c
Ectopic pancreas is most commonly seen as a submucosal nodule in the wall of stomach, duodenum, ileum, colon, gall bladder, meckel's diverticulum and mesentary.
Islet tissue is present only in the wall of stomach and duodenum not in other organs.
Ulceration , bleeding and obstruction (Ectopic pancreas can form a lead point of intussusception).
Sabiston Surgery 21st edition page 1531
Q6. Nealon's classification is used for
a) Acute pancreatitis
b) chronic pancreatitis
c) pseudocyst pancreas
d) alcoholic pancreatitis
Ans
6.c
Nealon classification describes the relationship of pseudocyst pancreas with the pancreatic duct
Nealon and Walser ] classified pancreatic pseudocysts according to the duct anatomy and the presence or absence of communication with the pseudocyst cavity. The aim of this classification system was to propose guidelines for an appropriate treatment of pancreatic pseudocysts.
Type I: normal duct/no communication with the cyst.
Type II: normal duct with duct-cyst communication.
Type III: otherwise normal duct with stricture and no duct-cyst communication.
Type IV: otherwise normal duct with stricture and duct-cyst communication.
Type V: otherwise normal duct with complete cut-off.
Type VI: chronic pancreatitis, no duct-cyst communication.
Type VII: chronic pancreatitis with duct-cyst communication
