Pathology EMQ template.

Name:

Candidate number:

Theme: Pancreatic pathology

 

OPTION LIST

 

A	Acute pancreatitis	I	Pancreas divisum
B	Annular pancreas	J	Pancreas head carcinoma
C	Chronic pancreatitis	K	Pancreas tail carcinoma
D	Diabetes mellitus, type 1	L	Pancreatic insufficiency
E	Diabetes mellitus, type 2	M	VIPoma
F	Ectopic pancreas	N	Zollinger-Ellison syndrome
G	Insulinoma	O
H	Mucinous cystic neoplasm	P

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. Steve is an 35 year old international athlete undergoing review by the IOC for a drug administered by SC injection. His doctor says if he cannot take this, his life is at grave risk, so the IOC allow him to compete. Which condition does he have?

 

2. Tarquin is a 22-year old Eton boy on his 4th consecutive gap year. He presents to A+E severely drunk and with intense upper abdominal pain and a rigid abdomen. Between cries of pain and ‘Banter’, he vomits everywhere but he can’t really tell you anything else about his problem.

 

3. Dr Greg is looking at an ERCP. One of his colleagues comments that the patient appears to have two pancreases (or perhaps pancreaii?). After calling him an idiot, Dr Greg informs him of the correct medical name for this.

 

4. Laura is a 54 year old lady who has multiple masses in her tail of pancreas shown on CT that do not communicate with the main ducts of the organ. She is intensely worried since she has heard that pancreatic cancer is very lethal, but her doctor reassures her that her type of lesions are almost always benign.

 

5. Chris is a 23 year old man who has just been to India and presents to Charing Cross Hospital. The endocrine FY1 notes the tremendous quantities of faeces he produces, and its watery nature, and suggests a diagnosis of cholera. However, the medical student notes in the history that this diarrhoea has been present for more than a year already and busts out two rare double-barrelled eponymous conditions that also fit the symptoms. Gastroscopy is normal, so what is it?

 

 

ANSWERS

1.

2.

3.

4.

5.

 

SEE PAGE 2 FOR ANSWERS:

 

 

 

 

 

 

 

 

D – Steve has type 1 diabetes, the drug is insulin which is on the IOC’s banned list because they believe it may help recovery of athletes by helping them stuff their muscles with glycogen post-training.

 

A – Tarquin has acute pancreatitis. The severity of the symptoms suggest acute rather than chronic. An extreme alcohol binge (sometimes euphemised as ‘turbo-lash’) has caused this, as well as making him a poor historian.

 

I – It’s pancreas divisum, differentiated from ectopic pancreas because the latter is less likely to be seen on ERCP.

 

H – Mucinous cystic neoplasms are mostly benign, but some aren’t. Better to have this than head of pancreas cancer though.

 

M – VIPoma is also Verner-Morrison syndrome. Zollinger-Ellison fits the symptoms much less well but it can give people diarrhea – often melaena like. The key is that the gastroscopy is normal, so VIPoma is even more likely.