WBR0805: Difference between revisions

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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{YD}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Embryology
|MainCategory=Embryology
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|MainCategory=Embryology
|MainCategory=Embryology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|MainCategory=Embryology
|MainCategory=Embryology
|MainCategory=Embryology
|MainCategory=Embryology
|MainCategory=Embryology
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|MainCategory=Embryology
|MainCategory=Embryology
|SubCategory=Gastrointestinal
|SubCategory=Gastrointestinal
|Prompt=A 36 year old man with no significant past medical history presents to the emergency department for right upper quadrant abdominal pain and jaundice.  On physical examination, his vital signs show a temperature of 38.5 degrees C (101.3 degrees F), heart rate of 96 bpm, and a blood pressure measuring 118/78 mmHg. Following appropriate work-up, the diagnosis of acute cholangitis is made.  During endoscopic retrograde cholangiopancreatography (ERCP), he is found to have 2 distinct dorsal and ventral pancreatic ducts. Which of the following embryologic processes failed to occur in this patient's incidental finding?
|Prompt=A 36-year-old man presents to the emergency department for right upper quadrant abdominal pain and jaundice.  His temperature is 38.5 °C (101.3 °F), heart rate is 96/min, and a blood pressure is 118/78 mmHg. Following initial work-up, the diagnosis of acute cholangitis is made.  During endoscopic retrograde cholangiopancreatography (ERCP), the patient is found to have 2 distinct dorsal and ventral pancreatic ducts. Which of the following embryologic processes likely failed to occur in this patient?
|Explanation=Pancreatic divisum is considered the most common variant of pancreatic ductal configuration that occurs in approximately 10% of the population.  It is caused by failure of fusion of the dorsal and the ventral pancreatic ducts.  Most patients with pancreatic divisum are asymptomatic and the diagnosis is based on incidental findings during ERCP.  Only the minority of patients with pancreatic divisum are symptomatic and generally complain of non-specific recurrent abdominal pain and episodes of pancreatitis.  Although no definitive cause for the symptoms has been confirmed, it is believed that the partial obstruction of pancreatic fluid at the level of the minor papilla causes an elevated pressure within the ducts and leads to pancreatitis. Symptomatic treatment for such patients is endoscopic sphincterotomy.
|Explanation=Pancreatic divisum is considered the most common variant of pancreatic ductal configuration that occurs in approximately 10% of the population.  It is caused by failure of fusion of the dorsal and the ventral pancreatic ducts.  Most patients with pancreatic divisum are asymptomatic and the diagnosis is based on incidental findings during ERCP.  Only the minority of patients with pancreatic divisum are symptomatic and generally complain of non-specific recurrent abdominal pain and episodes of pancreatitis.  Although no definitive cause for the symptoms has been confirmed, it is believed that the partial obstruction of pancreatic fluid at the level of the minor papilla causes an elevated pressure within the ducts and leads to pancreatitis. Symptomatic treatment for such patients is endoscopic sphincterotomy.


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|AnswerEExp=Pancreatic divisum is not due to failed recanalization.
|AnswerEExp=Pancreatic divisum is not due to failed recanalization.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=pancreatic, divisum, fusion, fuse, ventral, dorsal, duct, ducts, failure of fusion, failed fusion, pancreas, recanalization, differentiation, apoptosis, failure, failed, cholangitis, incidental, finding, fever, jaundice, abdominal, pain
|WBRKeyword=Pancreatic divisum, Pancreas divisum, Pancreas, Differentiation, Failure, Cholangitis, Jaundice, Abdominal pain
|Approved=No
|Approved=Yes
}}
}}

Revision as of 18:41, 4 March 2015
Author [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Embryology
Sub Category SubCategory::Gastrointestinal
Prompt [[Prompt::A 36-year-old man presents to the emergency department for right upper quadrant abdominal pain and jaundice. His temperature is 38.5 °C (101.3 °F), heart rate is 96/min, and a blood pressure is 118/78 mmHg. Following initial work-up, the diagnosis of acute cholangitis is made. During endoscopic retrograde cholangiopancreatography (ERCP), the patient is found to have 2 distinct dorsal and ventral pancreatic ducts. Which of the following embryologic processes likely failed to occur in this patient?]]
Answer A AnswerA::Failed fusion
Answer A Explanation AnswerAExp::Pancreatic divisum is caused by failure of fusion of the dorsal and ventral ducts.
Answer B AnswerB::Failed apoptosis
Answer B Explanation AnswerBExp::Pancreatic divisum is not due to failed apoptosis.
Answer C AnswerC::Failed differentiation
Answer C Explanation AnswerCExp::Pancreatic divisum is not due to failed differentiation.
Answer D AnswerD::Failed proliferation
Answer D Explanation AnswerDExp::Pancreatic divisum is not due to failed proliferation.
Answer E AnswerE::Failed recanalization
Answer E Explanation AnswerEExp::Pancreatic divisum is not due to failed recanalization.
Right Answer RightAnswer::A
Explanation [[Explanation::Pancreatic divisum is considered the most common variant of pancreatic ductal configuration that occurs in approximately 10% of the population. It is caused by failure of fusion of the dorsal and the ventral pancreatic ducts. Most patients with pancreatic divisum are asymptomatic and the diagnosis is based on incidental findings during ERCP. Only the minority of patients with pancreatic divisum are symptomatic and generally complain of non-specific recurrent abdominal pain and episodes of pancreatitis. Although no definitive cause for the symptoms has been confirmed, it is believed that the partial obstruction of pancreatic fluid at the level of the minor papilla causes an elevated pressure within the ducts and leads to pancreatitis. Symptomatic treatment for such patients is endoscopic sphincterotomy.

Educational Objective: Pancreatic divisum is the most common congenital variant of pancreatic ductal configuration. It is caused by the failure of fusion of the distal and ventral pancreatic ducts leading to 2 distinct ducts.

Reference: Manfrendi R, Costamagna G, Brizi MG, et al. Pancreas divisum and "santorinicele": diagnosis with dynamic MR cholangiopancreatography with secretin stimulation. Radiology. 2000;217:403-408.
Educational Objective:
References: ]]

Approved Approved::Yes
Keyword WBRKeyword::Pancreatic divisum, WBRKeyword::Pancreas divisum, WBRKeyword::Pancreas, WBRKeyword::Differentiation, WBRKeyword::Failure, WBRKeyword::Cholangitis, WBRKeyword::Jaundice, WBRKeyword::Abdominal pain
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Order in Linked Questions LinkedOrder::
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