Hepatobiliary and pancreatic surgery: CT severity index: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hepatobiliary and pancreatic surgery: CT severity index

Sample item

A radiologist reports the CT severity index in a patient with acute pancreatitis. Which two CT findings are combined to calculate it?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Grade of pancreatic inflammation and extent of pancreatic necrosis

The CT severity index of Balthazar adds points for the grade of pancreatic and peripancreatic inflammation (A to E) and for the percentage of pancreatic necrosis. Higher scores predict more complications, longer hospital stay and higher mortality.

Option by option

  • A. Diameter of the main pancreatic duct and thickness of the gland

    Duct diameter and gland thickness are features of chronic pancreatitis and are not used in the index.

  • B. Size of any pseudocyst and presence of gallstones

    Pseudocysts form after the acute phase, and gallstone presence is an aetiological finding rather than a severity score element.

  • C. Grade of pancreatic inflammation and extent of pancreatic necrosis (correct)

    Correct. The index sums the inflammation grade and the necrosis score.

  • D. Splenic vein thrombosis and gastric varices

    Splenic vein thrombosis and varices are late vascular complications and are not scored.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Grade of pancreatic inflammation and extent of pancreatic necrosis. The CT severity index of Balthazar adds points for the grade of pancreatic and peripancreatic inflammation (A to E) and for the percentage of pancreatic necrosis.

Why is "Diameter of the main pancreatic duct and thickness of the gland" not the answer?

Duct diameter and gland thickness are features of chronic pancreatitis and are not used in the index.

Why is "Size of any pseudocyst and presence of gallstones" not the answer?

Pseudocysts form after the acute phase, and gallstone presence is an aetiological finding rather than a severity score element.

Why is "Splenic vein thrombosis and gastric varices" not the answer?

Splenic vein thrombosis and varices are late vascular complications and are not scored.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: CT severity index in General Surgery. Higher scores predict more complications, longer hospital stay and higher mortality.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary and pancreatic surgery: CT severity index?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.