Acute Pancreatitis Management Quiz
Question 1: Initial Resuscitation Priority
A 45-year-old patient presents with acute pancreatitis. What is the MOST critical initial intervention within the first 12-24 hours?
A) Immediate CT scan with IV contrast to assess necrosis
B) Prophylactic broad-spectrum antibiotics
C) Aggressive fluid resuscitation and oxygen supplementation
D) Urgent ERCP regardless of etiology
Question 2: Oxygen and Fluid Targets
What are the appropriate oxygen saturation and urine output targets in acute pancreatitis management?
A) O2 sat >90%, urine output >0.3 ml/kg/hr
B) O2 sat >95%, urine output >0.5 ml/kg/hr
C) O2 sat >92%, urine output >1.0 ml/kg/hr
D) O2 sat >98%, urine output >0.2 ml/kg/hr
Question 3: Prophylactic Antibiotics in Mild Pancreatitis
A patient with mild acute pancreatitis (no necrosis, stable vitals) asks about antibiotics. What is the correct approach?
A) Start IV cefuroxime immediately for 14 days
B) Start oral ciprofloxacin for 7 days
C) Do NOT give prophylactic antibiotics; only treat specific infections
D) Start IV imipenem for all cases
Question 4: Timing of CT Imaging in Severe Pancreatitis
When should dynamic CT with IV contrast be obtained in severe acute pancreatitis?
A) Immediately upon admission
B) Within 3-10 days of admission
C) Only if patient deteriorates after 2 weeks
D) CT is not indicated in severe pancreatitis
Question 5: Nutritional Support Strategy
What is the preferred nutritional approach in acute pancreatitis, including severe cases?
A) NPO for at least 7 days, then TPN
B) Total parenteral nutrition (TPN) from day 1
C) Early enteral nutrition (gastric or jejunal feeding)
D) Clear liquids only until complete resolution
Question 6: Urgent ERCP Indication
A patient with severe gallstone pancreatitis develops fever, rigors, and worsening liver function tests 36 hours after admission. What is the next step?
A) Continue conservative management and reassess in 48 hours
B) Immediate therapeutic ERCP with sphincterotomy
C) Schedule elective ERCP in 2 weeks
D) Proceed directly to cholecystectomy
Question 7: ICU/HDU Admission Criteria
Which patients with acute pancreatitis MUST be managed in an ICU or HDU setting?
A) All patients with acute pancreatitis
B) Only patients with infected necrosis
C) All patients with severe acute pancreatitis
D) Only patients requiring mechanical ventilation
Question 8: Mortality Expectations and Timing
What is the expected mortality pattern in acute pancreatitis?
A) Most deaths occur uniformly throughout hospitalization
B) One-third of deaths in first week from organ failure; two-thirds after first week from infected necrosis
C) All deaths occur in first 48 hours
D) Most deaths occur after hospital discharge
Correct Answer: B 1
Question 9: Pain Management Approach
What is the recommended pain management strategy in acute pancreatitis?
A) Avoid all opioids due to sphincter of Oddi spasm
B) NSAIDs only to avoid opioid dependence
C) Multimodal approach with PCA; consider epidural analgesia; Dilaudid preferred over morphine
D) Acetaminophen only until severity is determined
Question 10: Cholecystectomy Timing in Gallstone Pancreatitis
When should cholecystectomy be performed in mild gallstone pancreatitis?
A) Wait 6 months after complete resolution
B) During the same hospital admission or within 2-4 weeks
C) Only if recurrent pancreatitis occurs
D) After 3 months of conservative management