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Pancreatitis Part 2:: MSRA MCQs

Updated: Aug 9

  1. A 45-year-old man presents with sudden severe epigastric pain radiating to the back. He admits to a weekend alcohol binge. On examination, he is tachycardic and has epigastric tenderness.

    Which of the following is the most appropriate first investigation?

Choose the correct answer

  • A. Contrast-enhanced CT abdomen

  • B. Serum lipase

  • C. Erect chest X-ray

  • D. MRCP


✅ Answer: B. Serum lipase 

Lipase ≥3× ULN confirms diagnosis early. CT is for complications or unclear diagnosis after 72h.


  1. A 50-year-old man with known chronic pancreatitis presents with acute worsening of epigastric pain after a heavy meal. He has steatorrhoea and poorly controlled diabetes. Lipase is mildly elevated.

    What is the most appropriate initial management?

Choose the correct answer

  • A. Start broad-spectrum IV antibiotics

  • B. CT abdomen immediately

  • C. Start IV fluids, analgesia, and NPO

  • D. Refer for surgical necrosectomy


✅ Answer: C. Start IV fluids, analgesia, and NPO 

This is a classic acute-on-chronic flare. Treat as acute first unless signs of infection or deterioration.



  1. Which combination of findings is most suggestive of chronic pancreatitis?

Choose the correct answer

  • A. Jaundice, anaemia, hepatomegaly

  • B. Sudden severe pain, hyperamylasaemia, shock

  • C. Recurrent epigastric pain, steatorrhoea, diabetes

  • D. Fluctuating RUQ pain, fever, positive Murphy's sign


✅ Answer: C. Recurrent epigastric pain, steatorrhoea, diabetes 

This is the classic chronic pancreatitis triad (pain + exocrine + endocrine insufficiency).


  1. A patient with acute pancreatitis is not improving after 4 days. He becomes febrile and hypotensive. CT shows non-enhancing areas in the pancreas. What does this suggest?

Choose the correct answer

  • A. Pancreatic cancer

  • B. Pseudocyst

  • C. Necrotic pancreatitis

  • D. Sterile pancreatitis


✅ Answer: C. Necrotic pancreatitis 

“Non-enhancing” = necrotic (no contrast uptake = tissue death).



  1. A 62-year-old man develops fever and sepsis 5 days into acute pancreatitis. CT reveals gas bubbles in a non-enhancing region of the pancreas. What is the next best step?

Choose the correct answer

  • A. Start IV fluids and observe

  • B. Emergency laparotomy

  • C. IV antibiotics and percutaneous drainage

  • D. Perform ERCP


✅ Answer: C. Start broad-spectrum IV antibiotics and plan for percutaneous drainage 

Classic step-up approach: antibiotics → drainage → surgery if no improvement.


  1. A 65-year-old man presents with painless jaundice, weight loss, and a palpable non-tender gallbladder. What is the most likely diagnosis?

Choose the correct answer

  • A. Gallstones

  • B. Autoimmune hepatitis

  • C. Pancreatic cancer

  • D. Chronic pancreatitis


✅ Answer: C. Pancreatic cancer 

Courvoisier sign = palpable gallbladder + painless jaundice → malignancy.


  1. A 48-year-old man has chronic epigastric pain, steatorrhoea, and weight loss. Lipase is normal. What test would best confirm pancreatic exocrine insufficiency?

Choose the correct answer

  • A. Serum lipase

  • B. Faecal elastase-1

  • C. CT pancreas

  • D. HbA1c


✅ Answer: B. Faecal elastase-1

 Low faecal elastase confirms exocrine dysfunction (especially in chronic pancreatitis).



  1. A 58-year-old man presents with painless jaundice and weight loss. CT shows diffuse pancreatic swelling. IgG4 is elevated. Which condition is most likely?

Choose the correct answer

  • A. Chronic pancreatitis

  • B. Pancreatic cancer

  • C. Autoimmune pancreatitis

  • D. Acute pancreatitis


✅ Answer: C. Autoimmune pancreatitis 

IgG4 + imaging + systemic signs (often steroid-responsive).



  1. A 35-year-old woman presents with gallstone pancreatitis. LFTs show bilirubin 120 and ALP 400. She is febrile and jaundiced. When should ERCP be performed?

Choose the correct answer

  • A. Immediately

  • B. Within 72 hours

  • C. After 7 days

  • D. Not indicated


✅ Answer: B. Within 72 hours 

Gallstone pancreatitis + cholangitis = ERCP within 72 hrs is guideline-based.



  1. When is contrast-enhanced CT most appropriate in acute pancreatitis?

Choose the correct answer

  • A. At the time of diagnosis

  • B. Immediately if pain is severe

  • C. If patient worsens or fails to improve after 3–5 days

  • D. In all cases to rule out cancer



✅ Answer: C. If patient worsens or fails to improve after 3–5 days 

CT too early may miss necrosis; it’s used to evaluate complications.

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