Surgery MCQs Q34

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SURGERY • PANCREAS

A 60-year-old man presents with severe epigastric pain radiating to the back after alcohol intake. On admission, he is dehydrated, tachypneic, and hypotensive. Examination reveals generalized abdominal tenderness. A diagnosis of acute pancreatitis is made.

Which of the following is NOT included in Ranson’s criteria?

A Age

B WBC count

C Serum potassium

D Serum calcium

E Blood glucose level

The correct statement is Serum potassium.

Decoding the Stem

1

CLUE "Acute pancreatitis + Ranson’s criteria"

TRANSLATION Recall prognostic scoring system parameters.

Explanation

C. Serum potassium: ✅ Correct. Ranson’s criteria do not include serum potassium. It focuses on markers that indicate systemic inflammation and metabolic derangement specific to pancreatitis.

Ranson’s Criteria Checklist:

At Admission: Age > 55, WBC > 16k, Glucose > 200, LDH > 350, AST > 250

At 48 Hours: Hct ↓ > 10%, BUN ↑ > 5, Ca < 8, PaO2 < 60, Base deficit > 4, Fluid > 6L

A, B, D, E: ❌ Incorrect options because they are all valid components of the score at either admission or the 48-hour mark.

🧠 High-Yield Pearls

✔ Ranson's = severity scoring (Score ≥ 3 indicates severe pancreatitis).

✔ Hypocalcemia = poor prognostic sign (caused by saponification).

✔ Other scores: APACHE II (can be used daily), Glasgow score.

Integrated Clinical Questions

1. Most common cause of acute pancreatitis?

Answer: Gallstones.

2. Most common cause in alcoholics?

Answer: Alcohol consumption.

3. Why does hypocalcemia occur?

Answer: Fat necrosis → saponification → calcium consumption.

4. Serious complication of acute pancreatitis?

Answer: Pancreatic necrosis or ARDS (Acute Respiratory Distress Syndrome).

5. Initial management priority?

Answer: Aggressive IV fluids + analgesia + NPO status.

⚡ Exam Pearls

• Potassium is NOT in Ranson’s (common trap).
• Calcium ↓ indicates a poor prognosis.
• Classic presentation: Alcohol + epigastric pain radiating to back.

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