19 The Pancreas
1 A 73-year-old woman has noticed a 10-kg weight loss in the past 3 months. She is becoming increasingly icteric and has constant vague epigastric pain, nausea, and episodes of bloating and diarrhea. On physical examination, she is afebrile. There is mild tenderness to palpation in the upper abdomen, but bowel sounds are present. Her stool is negative for occult blood. Laboratory findings include a total serum bilirubin concentration of 11.6 mg/dL and a direct bilirubin level of 10.5 mg/dL. Which of the following conditions involving the pancreas is most likely to be present?
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(B) 
(C) 
(D) 
(E) 2 A 52-year-old man has had severe abdominal pain for the past 2 days. Physical examination shows boardlike rigidity of the abdominal muscles, making further examination difficult. There is no observable abdominal distention. The representative gross appearance of the disease process is shown in the figure. Which of the following is the mechanism most likely to produce this appearance?
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(B) 
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(D) 
(E) 
(F) 
(G) 3 The patient described in Question 2 is admitted to the hospital. With supportive care, his acute condition subsides within 7 days. Which of the following complications is most likely to occur in this patient?
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(B) 
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(D) 
(E) 
(F) 4 A 38-year-old woman with a long history of gallbladder disease has a sudden onset of severe midabdominal pain. On physical examination, she has marked abdominal tenderness, particularly in the upper abdomen, and bowel sounds are reduced. An abdominal radiograph shows no free air, but there is marked soft tissue edema. Abdominal CT scan shows decreased attenuation with fluid density along with many small, bright foci of calcification involving the pancreas. She is given intravenous fluids and nasogastric suction and recovers gradually. Which of the following serum laboratory findings is most likely to be reported in this disease process?
(A) 
(B) 
(C) 
(D) 
(E) 5 For the past 35 years, a 39-year-old man has had numerous bouts of pneumonia caused by Pseudomonas aeruginosa and Burkholderia cepacia. He now has diarrhea of mild-to-moderate volume. On physical examination, he has decreased breath sounds and dullness to percussion in both lungs. His stool guaiac test is negative. Laboratory studies show the ΔF508 mutation. His quantitative stool fat is 7.5 g/day. Which of the following pathologic findings is most likely to be present in the pancreas of this patient?
(A) 
(B) 
(C) 
(D) 
(E) 6 A 63-year-old man who had worsening congestive heart failure with cardiac dysrhythmias in the last year of his life died of pneumonia. At autopsy, his pancreas is grossly small and densely fibrotic. Microscopic examination shows extensive atrophy of the acini with abundant collagenous interstitial fibrosis, but the islets of Langerhans appear normal. Inspissated proteinaceous secretions are present in branches of the pancreatic duct. The heart weighs 500 g, and all four chambers are dilated. What condition is most likely to account for these findings?
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(B) 
(C) 
(D) 
(E) 7 A 24-year-old, G2, P1001 woman has a screening ultrasound that shows polyhydramnios. She gives birth at term to a boy who on examination has no abnormal findings. Since birth, he has often vomited after feedings. A radiograph with contrast enhancement shows the findings in the figure. Laboratory studies show sodium, 130 mmol/L; potassium, 3.4 mmol/L; chloride, 85 mmol/L; CO2, 32 mmol/L; glucose, 65 mg/dL; and amylase, 15 U/L. What is the most likely diagnosis?
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(B) 
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(D) 
(E) 
(F) 8 An 11-year-old boy has experienced multiple bouts of severe abdominal pain for the past 6 years, but no other medical problems. His father and grandfather have been similarly affected. On examination during the last episode, bowel sounds were absent, and he exhibited marked diffuse abdominal pain with abdominal wall rigidity. A radiograph of the abdomen showed dilated loops of bowel with air-fluid levels. Laboratory studies showed serum amylase of 3320 U/L. This boy is most likely to have an inherited mutation involving which of the following genes?
(A) 
(B) Stay updated, free articles. Join our Telegram channel
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