Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 64-year-old man with abdominal bloating and epigastric discomfort

mksap
Conditions
August 13, 2011
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 64-year-old man is evaluated for a 3-month history of abdominal bloating and mid-epigastric discomfort associated with a 6.8-kg (15-lb) weight loss. The patient has no significant medical history and takes no medications.

On physical examination, vital signs are normal, and the only significant finding is mild epigastric tenderness.

Laboratory studies:

Complete blood count Normal
Aspartate aminotransferase 55 U/L
Alanine aminotransferase 67 U/L
Amylase 184 U/L
Lipase 382 U/L

(A mobile quick reference of normal lab values is available for download online.)

Helical CT scan of the abdomen shows a 2.8-cm pancreatic body mass. There are no liver lesions and no invasion into surrounding major vessels. Endoscopic ultrasonography confirms the presence of an approximately 3-cm lesion without vascular invasion. A fine-needle aspiration specimen is positive for adenocarcinoma.

Which of the following is the most appropriate next step in the management of this patient?

A) Combined radiation therapy and chemotherapy
B) Distal pancreatectomy
C) Palliative care consultation
D) Pancreatic enzyme supplementation

MKSAP Answer and Critique

The correct answer is B) Distal pancreatectomy. This item is available to MKSAP 15 subscribers as item 34 in the Gastroenterology and Hepatology section.

At the time of diagnosis, about 80% to 85% of pancreatic cancers are unresectable because of distant metastases or invasion or encasement of the major blood vessels. Treatment of pancreatic cancer that has not metastasized nor spread to the local vasculature is surgical resection, with distal pancreatectomy being the preferred procedure for lesions of the pancreatic body. Evaluation of whether the tumor is resectable preoperatively is performed with a combination of helical CT of the abdomen and endoscopic ultrasonography. Even with surgery and complete resection of the tumor, the 5-year survival rate is only 10% to 30%.

Concurrent radiation therapy and chemotherapy alone delay disease progression and may improve survival in patients with localized unresectable pancreatic cancer but will not provide a cure in patients with localized resectable pancreatic cancer. Pancreatic enzymes are used in patients with chronic pancreatitis or after pancreatic surgery to treat pancreatic malabsorption. In this otherwise healthy patient with a localized lesion and a potential for curative resection, palliative care is not indicated.

Key Point

  • Surgery is the only treatment that provides a potential cure in patients with localized pancreatic cancer, with a 5-year survival rate of 10% to 30%.

Learn more about ACP’s MKSAP 15.

This content is excerpted from MKSAP 15 with permission from the American College of Physicians(ACP). Use is restricted in the same manner as that defined in the MKSAP 15 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

How early closure can cause doctors to misdiagnose

August 12, 2011 Kevin 3
…
Next

Why is the iPad be revolutionary for doctors and nurses?

August 13, 2011 Kevin 2
…

ADVERTISEMENT

Post navigation

< Previous Post
How early closure can cause doctors to misdiagnose
Next Post >
Why is the iPad be revolutionary for doctors and nurses?

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

More in Conditions

  • Extreme weight cutting harms health and resilience in youth wrestling

    Sarah White, APRN
  • Institutional reporting systems discourage clinical honesty

    Jenny Shields, PhD
  • How doctors can turn criticism into collaboration

    Mary Remón, LCPC
  • Nurse-initiated protocols for sepsis: a strategic imperative for patient care and hospital operations

    Rhonda Collins, DNP, RN
  • How molecular discoveries are transforming preeclampsia prediction and care

    Thomas McElrath, MD, PhD and Kara Rood, MD
  • How neuroplasticity offers hope for complex PTSD

    Hannah Holmes
  • Most Popular

  • Past Week

    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why rigorous training is vital for today’s surgeons

      Philip Alford, MD | Physician
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why hospital jobs are failing physicians: burnout, pay, and lost autonomy

      Justin Nabity, CFP | Finance
    • The cost of ending shadowing in medical education

      Matthew Ryan, MD, PhD | Education
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Extreme weight cutting harms health and resilience in youth wrestling

      Sarah White, APRN | Conditions
    • The case for a standard pre-med major in U.S. universities

      Devin Behjatnia | Education
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why patients and doctors are fleeing flagship hospitals

      Anonymous | Physician
    • The hidden reason your vacations never feel like enough

      Kent DeLay, MD | Physician
    • Confronting the return of measles and vaccine misinformation [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why so many doctors secretly feel like imposters

      Ryan Nadelson, MD | Physician
    • Why rigorous training is vital for today’s surgeons

      Philip Alford, MD | Physician
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why hospital jobs are failing physicians: burnout, pay, and lost autonomy

      Justin Nabity, CFP | Finance
    • The cost of ending shadowing in medical education

      Matthew Ryan, MD, PhD | Education
    • Why enterprise risk management is key to value-based health care success

      Olumuyiwa Bamgbade, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Extreme weight cutting harms health and resilience in youth wrestling

      Sarah White, APRN | Conditions
    • The case for a standard pre-med major in U.S. universities

      Devin Behjatnia | Education
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why patients and doctors are fleeing flagship hospitals

      Anonymous | Physician
    • The hidden reason your vacations never feel like enough

      Kent DeLay, MD | Physician
    • Confronting the return of measles and vaccine misinformation [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

MKSAP: 64-year-old man with abdominal bloating and epigastric discomfort
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...