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Pancreatitis

Total questions: 60

Worksheet time: 30mins

Name
Class
Date
1.

Which combination BEST defines acute pancreatitis?

a)

Chronic inflammation with endocrine loss only

b)

Pain + elevated pancreatic enzymes

c)

Inflammation with loss of function without pain

d)

Malabsorption with steatorrhea only

2.

Acute pancreatitis ends up with:

a)

Bile acid–induced membrane rupture

b)

Activation of trypsin and other enzymes → autodigestion and necrosis

c)

Autoimmune attack on alpha cells

d)

Loss of lactate clearance leading to acidosis

3.

Which option is a cause of acute pancreatitis?

a)

Idiopathy

b)

Diabetes

c)

Smoking

d)

Hypertriglyceridemia

4.

Which is a cause of chronic pancreatitis?

a)

Idiopathic

b)

Gall stone

c)

IBD

d)

Diabetes

5.

Chronic pancreatitis is:

a)

Necrosis of endocrine tissue only

b)

Inflammation and loss of function (both exocrine and endocrine)

c)

Increased insulin secretion leading to hypoglycemia

d)

Only elevated pancreatic enzymes with pain

6.

Which is NOT a pancreatitis treatment option?

a)

Pancreatic enzymes

b)

Fluid replacement

c)

Acid reducing agents

d)

Beta blockers

7.

Pancreatic enzyme products consist of:

a)

Lactase, pepsin, bile salts

b)

Amylase, lipase, protease

c)

Lipase only

d)

Protease only

8.

Pancreatic enzymes are prescribed based on:

a)

Amylase content

b)

Lipase content

c)

Protease content only

d)

Carbohydrate digestion units

9.

Which is an indication for pancreatic enzymes?

a)

Hypoglycemia

b)

Steatorrhea

c)

Hypertension

d)

Gastric ulcer prevention

10.

How do pancreatic enzymes reduce pancreatitis-related pain?

a)

Lipase blocks COX-1

b)

Proteases degrade CCK

c)

Amylase increases bicarbonate secretion

d)

Protease increases CCK release to stimulate digestion

11.

Which substance is the secretagogue of pancreatic enzymes?

a)

Secretin

b)

Motilin

c)

CCK

d)

Ghrelin

12.

The preferred formulation of pancreatic enzyme therapy is:

a)

IV solution

b)

Enteric coated form

c)

Immediate release capsule without coating

d)

Sublingual tablet

13.

Which of the following is a ADR for pancreatic enzymes?

a)

Hypoglycemia

b)

Flatulence

c)

QT prolongation

d)

Pulmonary fibrosis

14.

Pancreatic enzyme hypersensitivity may occur because products are:

a)

Derived from bovine collagen

b)

Derived from porcine sources

c)

Synthetic peptides only

d)

Derived from fungi

15.

Vomiting and _______ from inflammation as reasons for fluid replacement in pancreatitis?

a)

vasodilation

b)

bronchoconstriction

c)

hypothermia

d)

platelet aggregation

16.

NSAIDs carry a boxed warning for:

a)

irreversible alopecia

b)

serious cardiovascular thrombotic events

c)

hepatotoxicity due to CYP inhibition

d)

respiratory depression

17.

NSAIDs are contraindicated specifically in the setting of:

a)

asthma exacerbation

b)

CABG surgery

c)

chronic kidney disease stage 1

d)

Headache

18.

Acetaminophen boxed warnings highlight risk of:

a)

infection

b)

errors and hepatotoxicity

c)

QT prolongation

d)

dysphoria

19.

Acetaminophen combo products should not exceed:

a)

500 mg APAP per dose

b)

325 mg APAP per dose

c)

1000 mg APAP per dose

d)

650 mg APAP per dose

20.

Which term is defined as a natural compound present in opium?

a)

Narcotic

b)

Opioid

c)

Opiate

d)

Withdrawal syndrome

21.

The term preferred for “any drug, natural or synthetic, with morphine-like actions” is:

a)

Opiate

b)

Narcotic

c)

Opioid

d)

NSAID

22.

Withdrawal syndrome is defined as:

a)

hallucinations after first dose

b)

signs/symptoms when drug use is discontinued by a physically dependent person

c)

liver enzyme elevation after NSAIDs

d)

mood improvement after SSRI

23.

Which drug is specifically described as having opioid and non-opioid mechanisms (inhibits NE + serotonin uptake)?

a)

Hydromorphone

b)

Codeine

c)

Tramadol

d)

Oxycodone

24.

Which opioid receptor is listed as “most important”?

a)

Delta

b)

Mu

c)

Kappa

d)

Sigma

25.

Which effect is associated with Mu (μ) receptor activation?

a)

Increased GI motility

b)

Respiratory depression

c)

Bronchodilation

d)

Hypertension

26.

What symptom is associated with Kappa receptors?

a)

Euphoria

b)

Dysphoria

c)

Hepatotoxicity

d)

Tendon rupture

27.

If untreated, hypoglycemia may progress to:

a)

tendon rupture

b)

convulsions and coma

c)

GI bleeding and perforation

d)

colonic stricture

28.

Which is listed as an ADR of insulin therapy?

a)

tendon rupture

b)

lipodystrophy of the injection site

c)

fibrosing colonopathy

d)

GI bleeding

29.

Acid reducing agents increase the amount of:

a)

opioid receptors

b)

pancreatic enzymes

c)

bile salts

d)

folate

30.

Beta-lactam antibiotics work by:

a)

Bacterial cell wall synthesis inhibitor

b)

Reactive nitro radical anion damages DNA and other macromolecules

c)

RNA transcription at ZBD

d)

Inhibits DNA gyrase and topoisomerase

31.

Which list contains ONLY hormones secreted into the bloodstream as part of pancreatic endocrine function?

a)

Amylase, lipase, trypsin

b)

Insulin, glucagon, somatostatin

c)

Bicarbonate, electrolytes, waste products

d)

Cholecystokinin, secretin, gastrin

32.

Which statement matches the definition of chronic pancreatitis?

a)

Self-limiting pancreatitis that resolves in 24 hours

b)

Long-standing inflammation → loss of pancreatic exocrine and endocrine function

c)

Severe pain + enzyme elevation in blood with spontaneous resolution in majority

d)

Acute onset abdominal pain with lipase >3× ULN

33.

Acute pancreatitis is described as:

a)

The leading cardiac cause of hospitalization in the U.S.

b)

The leading GI cause of hospitalization in the U.S.

c)

The leading endocrine cause of hospitalization in the U.S.

d)

The leading cause of outpatient GI visits

34.

Mild acute pancreatitis is described as usually self-limiting over:

a)

12–24 hours

b)

2 days

c)

3–5 days

d)

>7 days

35.

Which is listed as an etiology of acute pancreatitis?

a)

Chronic alcohol abuse

b)

Hyperparathyroidism

c)

Obstructive disease only

d)

Idiopathic only

36.

Which is specifically listed under chronic pancreatitis etiologies?

a)

Hypercalcemia

b)

Infections

c)

Genetic

d)

Tumor

37.

Which medication is listed as Class Ia trigger for acute pancreatitis?

a)

Omeprazole

b)

Codeine

c)

Atorvastatin

d)

Cisplatin

38.

Which medication is listed in Class Ib?

a)

Losartan

b)

Ceftriaxone

c)

Octreotide

d)

Gemfibrozil

39.

Drug-induced pancreatitis may occur:

a)

Only within 72 hours of initiation

b)

Only within the first month

c)

Within a few months to several years of initiation

d)

Only after >10 years of use

40.

Which symptom is listed for acute pancreatitis?

a)

Steatorrhea

b)

Diabetes mellitus

c)

Epigastric pain

d)

Malabsorption only

41.

Which finding is specifically listed for chronic pancreatitis?

a)

Hypovolemia

b)

Respiratory distress

c)

Malabsorption and steatorrhea

d)

Tender, distended abdomen

42.

Diagnosis of acute pancreatitis requires at least 2 of the following

a)

Abdominal pain + triglycerides >500 + WBC >12,000

b)

Abdominal pain + amylase/lipase >3× ULN + abdominal imaging

c)

Imaging only

d)

Lipase > ULN only

43.

The gold standard for chronic pancreatitis diagnosis is:

a)

CT abdomen

b)

MRI

c)

Histological exam

d)

Serum lipase >3× ULN

44.

Under “Initial insult,” acute pancreatitis includes:

a)

Duct obstruction and ischemia

b)

Hypoglycemia and anemia

c)

Increased insulin release

d)

Viral replication only

45.

“Mild” acute pancreatitis is:

a)

Organ failure >48 hours

b)

Organ failure lasting <48 hours

c)

No organ failure or other complications

d)

Local complications mandatory

46.

Severe acute pancreatitis is defined by:

a)

Elevated lipase

b)

Pain + vomiting

c)

Organ failure >48 hours

d)

CT severity index <5

47.

Which age range is a risk factor?

a)

Age >35–45 years

b)

Age >55–75 years

c)

Age >18 years

d)

Age >90 years

48.

Obesity risk factor is specified as:

a)

BMI >25 kg/m²

b)

BMI >30 kg/m²

c)

BMI >40 kg/m²

d)

Any overweight

49.

In regards to pancreatitis APACHE II has:

a)

Poor negative predictive value and high positive predictive value

b)

Good negative predictive value and modest positive predictive value

c)

Only positive predictive value

d)

No predictive value

50.

Which trend suggests a mild attack?

a)

Increasing APACHE in first 48 hours

b)

Decreasing APACHE in first 48 hours

c)

Stable APACHE after 7 days

d)

APACHE measured once only

51.

Which is listed as a goal of acute pancreatitis treatment?

a)

Prevent necrosis and infection

b)

Start GLP-1 analogue therapy

c)

Avoid fluids

d)

Surgery for all patients

52.

Which opioid is described as often preferred due to longer duration of action?

a)

Hydrocodone

b)

Morphine

c)

Tramadol

d)

Fentanyl

53.

In pancreatitis when is it preferred to start with opioid treatment for pain?

a)

Acute

b)

Chronic

54.

Nausea treatment for acute pancreatitis includes:

a)

Dopamine antagonists and serotonin antagonists

b)

Anticholinergics only

c)

GLP-1 analogues only

d)

DPP4 inhibitors

55.

In acute pancreatitis antibiotics are indicated for:

a)

Any pancreatitis diagnosis automatically

b)

Extrapancreatic infections or infected pancreatic necrosis

c)

Mild pancreatitis always

d)

All gallstone pancreatitis

56.

Diet recommendation for mild AP is:

a)

High-fat liquid diet

b)

Low fat soft diet

c)

Nothing by mouth for 7 days

d)

High-protein ketogenic diet

57.

Infected pancreatic necrosis requires:

a)

Surgical debridement

b)

PPI only

c)

Metformin only

d)

Nasal feeding only

58.

Chronic pancreatitis is:

a)

Acute and fully reversible

b)

Progressive, irreversible with loss of endocrine and exocrine function

c)

Only endocrine loss

d)

Only exocrine loss

59.

Pancreatic enzyme replacement therapy uses pancrelipase products such as:

a)

Humalog, Novolog, Lantus

b)

Creon, Viokace, Zenpep

c)

Pepcid, Zantac, Nexium

d)

Reglan, Zofran, Compazine

60.

For diabetes in chronic pancreatitis:

a)

GLP-1 analogues preferred

b)

Metformin preferred

c)

DPP-4 inhibitors preferred

d)

SGLT2 inhibitors preferred

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