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Author: Laurence Scott Bailen, M.D.

1. Question 1

A 25 year old woman with Crohn’s disease is taking azathioprine for maintenance therapy. She comes to the office complaining of 1 week of periumbilical abdominal pain. Amylase is 2,555 and lipase is 3,435. She is admitted to the hospital.

Which of the following tests are most important to follow during her hospitalization?

  1. Serum magnesium level

  2. Serum phosphorus level

  3. Serum calcium level

  4. Serum cholesterol level

  5. Platelet count

2. Question 2

A 42 year old woman has had intermittent episodes of right upper quadrant abdominal pain that begin 1-2 hours after eating. The pain resolves after 3-4 hours. She comes to the emergency room with severe peri-umbilical pain. Her amylase and lipase are elevated and a right upper quadrant ultrasound shows sludge.

Which of the following best explains the pathogenesis of her condition?

  1. Activation of pancreatic enzymes within the duodenal lumen

  2. Temporary blockage of the exit of enzyme granules from acinar cells

  3. Proteinaceous plugs in pancreatic ducts

  4. Activation of pancreatic enzymes within the bile duct

  5. Pancreatic duct stricture

3. Question 3

A 68 year old man complains of chronic peri-umbilical abdominal discomfort. He has had diarrhea for many years of unclear cause. He has lost 15 lbs in the past year unintentionally. He used to drink alcohol heavily up until 5 years ago. His blood sugar is normal.

Which of the following will most likely help you diagnosis chronic pancreatitis?

  1. Serum amylase level

  2. Serum calcium level

  3. Low vitamin B12

  4. Abdominal CT scan

  5. Lactose tolerance test