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Pancreatitis Part 1:: MSRA MCQs

  1. A 46-year-old woman presents with epigastric pain, vomiting, jaundice, and a lipase level 1,200 IU/L. LFTs show ALT 320 IU/L, ALP 420, and bilirubin 110 µmol/L. She is afebrile. Ultrasound reveals gallstones and a dilated CBD.

    What is the most appropriate next step?

Choose the correct answer

  • A. Start antibiotics and observe

  • B. MRCP to evaluate ductal stones

  • C. Urgent laparoscopic cholecystectomy

  • D. ERCP within 72 hours


✅ Answer: D. ERCP within 72 hours 

Rationale: Gallstone pancreatitis with biliary obstruction (↑ bilirubin and dilated CBD) — ERCP is indicated even without cholangitis.



  1. A 63-year-old man develops fever and hypotension 5 days into an acute pancreatitis admission. CT shows pancreatic necrosis with gas bubbles in a non-enhancing area.

    What is the most likely diagnosis?

Choose the correct answer

  • A. Sterile necrosis

  • B. Chronic pancreatitis with calcification

  • C. Pancreatic pseudocyst

  • D. Infected pancreatic necrosis



✅ Answer: D. Infected pancreatic necrosis 

Rationale: Gas on CT within necrotic tissue is virtually diagnostic of infection, typically requiring antibiotics and drainage.


  1. A 43-year-old woman presents with severe epigastric pain, fever, jaundice, and vomiting. US shows gallstones and CBD dilation. What is the most likely diagnosis?

Choose the correct answer

  • A. Acute pancreatitis

  • B. Acute cholangitis

  • C. Pancreatic cancer

  • D. Biliary colic


✅ Answer: B. Acute cholangitis 

Rationale: Charcot’s triad (pain + jaundice + fever) = cholangitis. Gallstones + CBD dilation confirms obstructive biliary sepsis.



  1. Which of the following lab results strongly supports gallstone pancreatitis over alcohol-induced pancreatitis?


Choose the correct answer

  • A. AST > ALT

  • B. ALT >150 IU/L within 48 hours

  • C. Lipase <3× ULN

  • D. CRP >200


✅ Answer: B. ALT >150 IU/L within 48 hours 

Rationale: Highly specific marker for biliary (gallstone) pancreatitis; sensitivity ~80–90%.



  1. A patient with gallstone pancreatitis improves with conservative management. No fever, jaundice, or signs of cholangitis. What is the next best step?

Choose the correct answer

  • A. Schedule ERCP

  • B. Repeat ultrasound in 1 week

  • C. Discharge and follow up in 6 months

  • D. Plan early laparoscopic cholecystectomy



✅ Answer: D. Plan early laparoscopic cholecystectomy

 Rationale: Once patient recovers from mild gallstone pancreatitis, cholecystectomy during same admission is advised to prevent recurrence.


  1. A 49-year-old man has persistent upper abdominal pain 4 weeks after recovering from acute pancreatitis. CT shows a 5 cm fluid-filled, well-defined structure with a thin wall and no enhancement. He is afebrile with normal inflammatory markers.

    What is the most likely diagnosis?

Choose the correct answer

  • A. Infected necrosis

  • B. Sterile pancreatic necrosis

  • C. Pancreatic pseudocyst

  • D. Pancreatic abscess


✅ Answer: C. Pancreatic pseudocyst

 A pseudocyst typically forms ≥4 weeks post-acute attack, has a thin wall, and no enhancement or signs of infection.



  1. Which of the following best explains why necrosis occurs in severe acute pancreatitis?

Choose the correct answer

  • A. Immune suppression leading to bacterial overgrowth

  • B. Overproduction of insulin causing ischemia

  • C. Autodigestion and microvascular thrombosis

  • D. Chronic enzyme depletion


✅ Answer: C. Autodigestion and microvascular thrombosis

 Trypsin activation + ischemia leads to necrosis.



  1. A 43-year-old woman with acute pancreatitis is stable and improving. When should a contrast CT be arranged?

Choose the correct answer

  • A. Immediately to check for necrosis

  • B. Only if there is clinical deterioration after 72 hours

  • C. On admission as baseline imaging

  • D. At 1-week follow-up regardless of symptoms


✅ Answer: B. Only if there is clinical deterioration after 72 hours

 Early CT is avoided unless worsening or unclear diagnosis.



  1. In a known case of chronic pancreatitis, what is the most likely lab finding during an acute flare?

Choose the correct answer

  • A. Normal lipase

  • B. Lipase < 3x ULN

  • C. Lipase > 3x ULN

  • D. Low faecal elastase



✅ Answer: B. Lipase < 3x ULN

 Chronic damage limits enzyme production → lipase may be only mildly raised during an acute flare.



  1. Which of the following drugs is most strongly associated with causing pancreatitis?

Choose the correct answer

  • A. Metformin

  • B. Tetracycline

  • C. Atorvastatin

  • D. Paracetamol



✅ Answer: B. Tetracycline

 Others include: thiazides, azathioprine, valproate, oestrogens, DPP-4 inhibitors.


  1. Why does hypocalcaemia occur in severe acute pancreatitis?

Choose the correct answer

  • A. Vitamin D deficiency from malabsorption

  • B. Renal wasting of calcium

  • C. Hypoalbuminemia causing pseudo-hypocalcaemia

  • D. Saponification due to fat necrosis


✅ Answer: D. Saponification due to fat necrosis

 Fatty acids released bind calcium → soap formation → real hypocalcaemia.

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