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WorksheetsAcute Pancreatitis
Total questions: 15
Worksheet time: 11mins
A 45-year-old man presents with acute epigastric pain radiating to the back. Serum amylase is 850 IU/L. What is the most appropriate next step in imaging to confirm the diagnosis and rule out complications?
Abdominal ultrasound to evaluate peripancreatic oedema
CT abdomen immediately to confirm pancreatic necrosis
MRI to evaluate for autoimmune pancreatitis
Contrast-enhanced CT after 48–72 hours if severity or complications suspected
A 60-year-old woman with known gallstones presents with upper abdominal pain and jaundice. She is febrile and hypotensive. Ultrasound urgent: dilated common bile duct with choledocholithiasis. What is the most appropriate immediate intervention?
Administer broad-spectrum antibiotics and observe
Emergency laparotomy
Urgent ERCP with stenting
Delay intervention until biliary inflammation subsides
A 35-year-old man with severe acute pancreatitis develops new-onset organ dysfunction and persistent fever two weeks after admission. CT shows a heterogeneous collection with internal gas bubbles. What is the most likely diagnosis?
Walled-off pancreatic necrosis
Infected acute necrotic collection
Pancreatic pseudocyst
Retroperitoneal abscess
A 50-year-old man is admitted with suspected acute pancreatitis. He is haemodynamically unstable, with respiratory distress and reduced urine output. What finding best correlates with severe disease and poor prognosis?
Serum amylase > 1000 IU/L
ALT > 80 IU/L
CRP > 150 mg/L after 48 hours
Leukocytosis on admission
A patient with acute pancreatitis is improving symptomatically but remains unable to resume oral intake by day 3. What is the best method of nutritional support?
Total parenteral nutrition (TPN)
Nasojejunal feeding
Oral high-fat diet
Intravenous glucose and saline only
A 40-year-old man presents with acute pancreatitis. On the third day of admission, he develops increasing abdominal distension and a falling oxygen saturation. What is the most likely cause?
Pancreatic pseudocyst formation
Acute respiratory distress syndrome
Gastrointestinal perforation
Mesenteric ischemia
A patient with a history of chronic alcohol use presents with acute pancreatitis. His APACHE II score is 10 and CRP is 180 mg/L at 48 hours. What is the most appropriate setting for ongoing care?
Discharge with outpatient follow-up
Admit to general medical ward with observation
High-dependency or intensive care unit
Transfer to surgical ward for exploratory laparotomy
A 58-year-old man presents with acute pancreatitis and is found to have gallstones. What is the most appropriate timing for cholecystectomy?
During the initial admission once inflammation settles
Elective surgery 3 months later
Immediately upon diagnosis
Only if recurrent pancreatitis occurs
A 35-year-old woman with acute pancreatitis develops a fluid-filled cavity adjacent to the pancreas six weeks after discharge. It is non-infected and asymptomatic. What is the best management strategy?
Surgical drainage
Percutaneous aspiration
Endoscopic drainage
Observation and follow-up
A patient presents with acute pancreatitis and has a raised serum lipase level. Which of the following best explains the higher diagnostic accuracy of lipase over amylase?
Lipase rises earlier than amylase
Lipase is specific for gallstone pancreatitis
Lipase remains elevated longer than amylase
Lipase is unaffected by renal function
A 56-year-old man presents with acute upper abdominal pain radiating to the back, nausea, and vomiting. His serum amylase is 960 IU/L (normal <110 IU/L). Which of the following is the best next step to confirm the diagnosis and evaluate severity?
Abdominal ultrasound scan
Serum calcium and glucose levels
Contrast-enhanced CT abdomen
Serum lipase level
A 45-year-old man with alcoholic pancreatitis develops hypotension, tachycardia, and confusion 3 days after admission. CT shows extensive pancreatic necrosis without gas formation. What is the best initial management?
Broad-spectrum antibiotics
Percutaneous drainage
Emergency laparotomy
Supportive care in ICU
In a patient with severe acute pancreatitis, enteral nutrition is preferred over parenteral nutrition. What is the main reason for this?
Faster improvement in pancreatic function
Reduced length of hospital stay
Lower complication and mortality rates
Better patient tolerance
A 50-year-old man presents with acute pancreatitis. After 72 hours, he is still febrile with rising CRP and leukocytosis. CT reveals pancreatic necrosis with gas bubbles. What is the most likely diagnosis?
Walled-off necrosis
Pancreatic pseudocyst
Infected necrotic collection
Chronic pancreatitis flare
A 38-year-old woman presents with severe epigastric pain radiating to the back, nausea, and vomiting. Her serum amylase is 800 IU/L. She is tachycardic but normotensive. An abdominal ultrasound shows gallstones without ductal dilation. What is the most appropriate management during this admission?
Immediate ERCP
Elective cholecystectomy after discharge
Laparoscopic cholecystectomy during same admission
Conservative management with follow-up in outpatient clinic
