KMU Past Paper Practice
Pancreatic Disorders: Pancreatitis, Pseudocyst and Pancreatic Carcinoma
4th Year MBBS • 20 A-type Single Best Answer MCQs
MCQ 1
A 28-year-old man has recurrent episodes of otherwise unexplained pancreatitis. MRCP demonstrates separate dorsal and ventral pancreatic duct systems. Which functional consequence best explains his predisposition to recurrent inflammation?
Options:
Restricted drainage of most secretions through the minor papilla
In pancreas divisum, failure of duct fusion leaves most pancreatic secretion draining through the smaller minor papilla, creating relative outflow difficulty in susceptible patients.
MCQ 2
A 52-year-old woman develops severe epigastric pain and vomiting several hours after ERCP. Serum pancreatic enzymes are markedly elevated. Which mechanism most likely initiated her pancreatic inflammation?
Options:
Procedure-related injury to pancreatic drainage pathways
ERCP can injure or transiently obstruct the pancreatic papilla and ducts, promoting premature intrapancreatic enzyme activation and acute pancreatitis.
MCQ 3
A 48-year-old woman with recurrent renal stones and hyperparathyroidism develops acute epigastric pain radiating to the back. Which biochemical abnormality could have contributed to the pancreatic attack?
Options:
Elevated serum calcium
Hypercalcemia is a recognized metabolic cause of acute pancreatitis and should be considered when pancreatitis occurs in a patient with hyperparathyroidism.
MCQ 4
A patient admitted with acute pancreatitis develops increasing abdominal distension. Bowel sounds are markedly reduced, but imaging shows no mechanical transition point. Which complication best explains this finding?
Options:
Paralytic ileus
Inflammation from acute pancreatitis can suppress intestinal motility, producing abdominal distension and reduced bowel sounds without a mechanical obstruction.
MCQ 5
A 57-year-old man with severe acute pancreatitis develops flank discoloration, tachycardia and a falling hemoglobin concentration. Which pathological event most directly accounts for this deterioration?
Options:
Enzymatic destruction of vessels with retroperitoneal bleeding
Activated pancreatic enzymes can damage vascular walls, causing hemorrhage into retroperitoneal tissues and producing ecchymosis with falling hemoglobin.
MCQ 6
A patient with severe acute pancreatitis remains hypotensive for several hours and subsequently develops oliguria with a rising serum creatinine. Which complication has most likely developed?
Options:
Acute kidney injury
Severe pancreatitis can cause circulatory failure and systemic inflammation, reducing renal perfusion and producing acute kidney injury.
MCQ 7
A patient with severe pancreatitis develops oozing from intravenous cannula sites. Platelet count is low and clotting times are prolonged. Which systemic complication best accounts for these findings?
Options:
Disseminated intravascular coagulation
Severe systemic inflammation can trigger widespread coagulation activation, consuming platelets and clotting factors and producing DIC.
MCQ 8
A 44-year-old woman recovers from an episode of gallstone pancreatitis. No persistent biliary obstruction remains. Which subsequent management principle is most important for reducing the risk of another pancreatic attack?
Options:
Definitive treatment of the underlying gallstone disease
Removing the underlying biliary source prevents recurrent transient obstruction at the pancreaticobiliary junction and reduces recurrence of gallstone pancreatitis.
MCQ 9
A 50-year-old man with recurrent upper abdominal pain and suspected chronic pancreatitis requires non-invasive assessment of pancreatic duct anatomy. Which investigation is most suitable for demonstrating ductal irregularity and dilatation?
Options:
Magnetic resonance cholangiopancreatography
MRCP provides non-invasive visualization of the pancreatic ductal system and can demonstrate irregularity, strictures and dilatation in chronic pancreatitis.
MCQ 10
Histology from a patient with established chronic pancreatitis shows extensive fibrosis and loss of exocrine tissue. Which additional finding would be most consistent with an earlier stage of this disease?
Options:
Relative preservation of pancreatic islets
Chronic pancreatitis initially causes prominent acinar destruction and fibrosis, while pancreatic islets may remain relatively preserved until later stages.
MCQ 11
A man with long-standing chronic pancreatitis develops jaundice. Imaging shows marked fibrosis in the pancreatic head and dilatation of the extrahepatic biliary tree, but no discrete tumor is identified. What is the most likely explanation?
Options:
Compression of the bile duct by pancreatic fibrosis
Fibrosis and inflammatory enlargement in chronic pancreatitis can compress the distal common bile duct and produce obstructive jaundice even without carcinoma.
MCQ 12
A patient with chronic pancreatitis develops persistent postprandial vomiting. Imaging demonstrates narrowing of the adjacent duodenum caused by inflammatory fibrosis around the pancreatic head. Which complication has developed?
Options:
Duodenal obstruction
Chronic inflammation and fibrosis around the pancreatic head may narrow the adjacent duodenum and produce obstructive vomiting.
MCQ 13
A 58-year-old man with chronic pancreatitis continues to lose weight despite adequate food intake. Stool analysis shows excessive fat. Which process best explains his nutritional deterioration?
Options:
Maldigestion from pancreatic exocrine insufficiency
Loss of pancreatic acinar tissue reduces digestive enzyme delivery, particularly fat digestion, causing maldigestion, steatorrhea and weight loss.
MCQ 14
Six weeks after acute pancreatitis, a patient with a known pancreatic fluid collection develops sudden generalized abdominal pain, guarding and free fluid in the peritoneal cavity. Which complication is most likely?
Options:
Rupture of a pancreatic pseudocyst
A mature pseudocyst may rupture into the peritoneal cavity, releasing enzyme-rich fluid and causing sudden abdominal pain and peritoneal irritation.
MCQ 15
A 46-year-old man with chronic pancreatitis notices progressive fullness in the upper abdomen. Imaging shows a well-defined pancreatic fluid collection that has enlarged over several weeks. Which diagnosis best fits this complication?
Options:
Pancreatic pseudocyst
Persistent enzyme-rich collections can occur in chronic pancreatitis and may enlarge sufficiently to present as abdominal fullness or a palpable mass.
MCQ 16
A 67-year-old man develops progressive weight loss and deep back pain. Imaging shows a pancreatic tail mass without biliary dilatation. Why can tumors in this location remain clinically silent until relatively advanced disease?
Options:
They do not cause early distal bile duct obstruction
Body and tail tumors are remote from the distal common bile duct, so jaundice may be absent and diagnosis may occur only after pain, weight loss or spread develops.
MCQ 17
A 70-year-old man with pancreatic adenocarcinoma develops painful thrombosis in one superficial vein, followed weeks later by thrombosis at another site. Which cancer-related process best explains this pattern?
Options:
Malignancy-associated hypercoagulability
Pancreatic adenocarcinoma can produce a hypercoagulable state, leading to recurrent migratory superficial thrombophlebitis.
MCQ 18
A 64-year-old man with a 15-year history of chronic pancreatitis develops new progressive weight loss and a pancreatic mass. Which aspect of his history is a recognized risk factor for pancreatic ductal adenocarcinoma?
Options:
Long-standing chronic pancreatic inflammation
Chronic pancreatitis is associated with an increased risk of pancreatic ductal adenocarcinoma, particularly when inflammation persists for many years.
MCQ 19
Staging imaging in a patient with pancreatic ductal adenocarcinoma shows no distant metastases, but the primary tumor extensively involves a major adjacent artery. How should this finding be interpreted?
Options:
It represents advanced local tumor extension
Major arterial involvement reflects extensive local invasion of the primary pancreatic tumor and therefore advanced local disease rather than distant metastasis.
MCQ 20
Molecular analysis of an invasive pancreatic ductal adenocarcinoma demonstrates several accumulated genetic abnormalities. Which finding represents loss of a tumor-suppressor pathway rather than activation of an oncogene?
Options:
Loss of SMAD4 function
SMAD4 is a tumor-suppressor gene whose loss contributes to pancreatic carcinogenesis; this differs from activation of oncogenic signaling such as KRAS.