Try it
General Medicine · Gastroenterology: pancreatic head carcinoma
Sample itemA 65-year-old man has painless progressive jaundice, weight loss and a palpable non-tender gallbladder. Which is the best initial imaging?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Pancreas protocol contrast-enhanced CT
A non-tender distended gallbladder with jaundice is Courvoisier sign and suggests malignant obstruction of the distal bile duct, most often pancreatic head cancer. Contrast CT assesses the mass, vascular involvement and metastasis. CA 19-9 supports diagnosis and monitoring but is not diagnostic alone.
Option by option
A. HIDA scan
A HIDA scan assesses gallbladder function and cystic duct patency, not pancreatic masses.
B. Barium meal
Barium meal may show duodenal widening only late and is not diagnostic.
C. Pancreas protocol contrast-enhanced CT (correct)
Correct. A pancreatic protocol CT defines the mass and staging.
D. Plain abdominal X-ray
A plain film cannot show a pancreatic tumour.
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.
More General Medicine questions
- EndocrinologyA 19-year-old with type 1 diabetes presents with vomiting, deep rapid breathing, fruity…
- ElectrolytesWhich is the earliest ECG change in hyperkalaemia?
- Infectious diseaseWhat is the drug of choice for Pneumocystis jirovecii pneumonia in a patient with advanc…
- NeurologyA chronic alcohol user is brought in confused, with nystagmus and an unsteady gait. What…