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SELF-ASSESSMENT QUESTIONS

1. Which one of the following is not a commonly encountered cause for acute pancreatitis?

A. Ethanol abuse

B. Gallstones

C. Hypertriglyceridemia

D. Hypercholesterolemia

The correct answer is D. In addition to the first three choices above, which are well-known causes of acute pancreatitis, other causes include hypercalcemia, selected infections, obstructing pancreatic tumors, and trauma to the pancreas. Hypercholesterolemia is not known to be causative for acute pancreatitis.

2. Which one of the following choices is least likely to be contributory to a diagnosis of acute pancreatitis?

A. Serum amylase elevation

B. Serum lipase elevation

C. Serum calcium elevation

D. Amylase/creatinine clearance

The correct answer is C. The calcium may be altered in acute pancreatitis, but when it is, it generally is lower than normal rather than elevated. The two primary markers for acute pancreatitis are serum amylase and serum lipase. In acute pancreatitis, the clearance of amylase into the urine may be higher than the clearance of creatinine into the urine. This creates an increase in the (amylase/creatinine clearance) ratio.

3. Which of the following is not a clinical or laboratory manifestation of chronic pancreatitis?

A. Recurrence of an earlier bout of acute pancreatitis

B. Impaired glucose tolerance or, in severe cases, diabetes mellitus

C. A serum amylase level that is significantly higher than in cases of acute pancreatitis

D. Abdominal x-ray films showing calcifications within the pancreas

The correct answer is C. In about 50% of patients with chronic pancreatitis, the serum amylase level is normal. In patients who do have an increased amylase level, the value may be borderline or only slightly elevated. The amylase level is far more important diagnostically for acute pancreatitis than it is for chronic pancreatitis.

4. Which of the following is not true about the pancreatic tumor marker, CA 19-9 antigen?

A. The sensitivity of the marker for diagnosis of pancreatic neoplasm is proportional to the size of the tumor.

B. The marker is of little value as a screening test because patients with early-stage tumors have normal levels of CA 19-9.

C. CA 19-9 is most useful to monitor patient response to therapy.

D. CA 19-9 is specific for the diagnosis of pancreatic cancer ...

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