Pancreatic Disease Board Review Questions

Pancreatic Disease is the focus of this week's free CME Quick Quiz, courtesy of Med-Challenger online medical education. Below is a free CME quick quiz question that provides a better understanding of the diagnosis and treatment of pancreatic disease.

By playing the full online quiz, you can earn CME credit every week for free. Players sign up, create an anonymous game "alias," and rank on player leaderboards as part of the fun knowledge review challenge. You can play every quiz over time and claim your AMA Category 1 CME earning anytime. It's just one of the many benefits of Med-Challenger.

Let's evaluate a pancreatic disease patient case.

Try this free case then earn CME from the full quiz online.

Question:

A 70-year-old man presents to you with recurrent episodes of mild abdominal pain located in the epigastric region that radiates to his back.

Over time, he states that the pain has become more continuous and is associated with nausea and intermittent vomiting.

He notes diarrhea with foul-smelling stools, and he has lost about 10 pounds in the past 6 months.

He is jaundiced with a bilirubin level of 3.2 mg/dL.

Abdominal ultrasonography is performed and reveals a diffusely enlarged and hypoechoic pancreas.

Computed tomography (CT) with intravenous contrast shows a diffusely enlarged, sausage-shaped pancreas with delayed rim-like enhancement.

What laboratory marker would be helpful in establishing a diagnosis for this patient?

Answer Options:

Amylase and lipase levels

Immunoglobulin (Ig) G4 level

C-reactive protein (CRP)

Triglyceride level

See the answer...

The correct answer is:

Immunoglobulin (Ig) G4 level

Educational Objective:

Evaluate patients with suspected type 1 autoimmune pancreatitis.

Key Point:

Type 1 autoimmune pancreatitis is distinguished by an elevated IgG4 level.

Explanation:

This patient likely has type 1 autoimmune pancreatitis, which is seen more commonly in men who are middle aged or older. The most common presentation is painless obstructive jaundice due to obstruction of the intrapancreatic bile duct. Less commonly, however, patients can have episodes of acute pancreatitis. Other symptoms include weight loss, vomiting, and glucose intolerance.

Imaging studies show diffuse or local pancreatic enlargement. CT often shows a diffusely enlarged, sausage-shaped pancreas in which enhancement with the intravenous contrast agent is delayed and then prolonged.

Most patients have an elevated IgG4 level in serum with positive staining of involved tissues. CRP, amylase, lipase, and triglyceride levels would not help make the diagnosis of autoimmune pancreatitis.

References:

Forsmark CE. Chronic pancreatitis. In: Feldman M, et al. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed., 2016:994-1026.e10.

Madhani D, Farrell JJ. Autoimmune pancreatitis. Gastroenterol Clin North Am. 2016;45:29-

This pancreatic disease question is just a sample from this week's free online medical education Quick Quiz.

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