October 13, 2010

USMLE 2 Question 9

A 70 year old man presents to his general practitioner complaining of dull and boring pain which radiates to the back. He has found that the pain intensifies by lying down and tends to be relieved by crouching forward. On questioning he admits to smoking 25 cigarettes daily,and to losing 12 pounds(5 kg) over the last 2 months.

On examination he is found to be cachexic, he was afebrile, and appears jaundiced. Abdominal palpation reveals a mass in the upper abdomen under the right costal margin.

The most likely cause for this man's jaundice is

a) a malignant lesion of the head of the pancreas
b) stones in the common bile duct
c) hepatocellular carcinoma
d) hepatitis B
e) gall bladder carcinoma

The correct answer is B

Pancreatic cancer is the 4th most common cancer causing death in the U.S. The disease is more common in men especially those between 60 and 70 years. The cause is unknown, but the incidence is greater in smokers. In fact Cigarette smoking is one of the greatest risk factors for the development of cancer of the pancreas.

Rapid spread. Most of the carcinomas of the pancreas are advanced by the time they cause symptoms. Pain in the back and upper abdomen occurs when a pancreatic tumor presses against the nerves in those areas. The disease is not only common, but it is also extremely difficult to treat.

The most commonly occurring cancers of the pancreas tend to grow rapidly. More than 90 percent of them arise in the ductal cells, which transport digestive enzymes to the duodenum. Two- thirds of ductal cell tumors grow in the head of the pancreas; the other third develop in the gland's body and tail.

A large firm liver eventually develops due to seeding

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