Archive Of Standardized Exam Questions: Acute Pancreatitis


This page is dedicated to organizing various examples of standardized exam questions whose answer is acute pancreatitis. While this may seem a odd practice, it is useful to see multiple examples of how acute pancreatitis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.


When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for acute pancreatitis.

  • Past history of alcohol abuse/alcoholism
  • Abdominal pain: epigastric pain that radiates to the back is very specific to this condition!
  • Nausea/vomiting are common symptoms
  • Fever is a common finding on vitals
  • Lab results:
    • Elevated serum amylase
    • Elevated serum lipase 
    • Hypocalcemia 
  • Calcium deposition around pancreas: can be seen radiographically/during a laparotomy (chalky white appearance), or histologically.

Question # 1

A 50 year old man comes to the emergency room with complaints of abdominal pain, nausea, and vomiting for the past couple of days. His past medical history is notable for longstanding alcoholism and a 60 pack year smoking history. His temperate is 102.1°F, pulse is 120/min, respirations are 16/min, and blood pressure is 90/55 mm Hg. A physical exam is notable for coarse breath sounds, and left upper quadrant abdominal tenderness/guarding. The patient’s stool is positive for occult blood, his serum calcium concentration is 7.5 mg/dL, and serum albumin concentration is 3.5 g/dL. What is a possible diagnosis in this patient?

Explanation #1

Alcoholism + acute abdominal pain + fever + hypocalcemia = acute pancreatitis

Question # 2

A 48 year old man with chronic alcoholism comes to the hospital because he has been experiencing nausea, vomiting, and abodminla pain. He explains that his pain is in the mid abdominal region and radiates to the back. His pulse is 115/min, respirations are 21/min, and his blood pressure is 110/65 mm Hg. An abdominal exam reveals tenderness to palpation over the upper quadrants. Labs are collected and reported below:

  • Hemoglobin: 10.5 g/dL
  • Leukocyte count: 25,000/mm3
  • Platelet count: 350,000/mm3
  • Serum amylase: 1900 U/L***
  • Albumin: 4.0 g/dL

What is the diagnosis in this patient?

Explanation #2

 Abdominal pain (radiating to back) + elevated serum amylase = acute pancreatitis

Question # 3

A 45 year old alcoholic male presents with severe epigastric pain. This began shortly after a heavy episode of alcoholic intake, and reached maximum intensity over the course of 2 hours.. The pain is constant, radiates straight through to the back and is accompanied by nausea and vomiting. He had a similar episode two years ago, for which he required hospitalization.

Explanation# 3

Abdominal pain (radiating to back) + history of alcoholism = acute pancreatitis

Question # 4

A 60 year old woman comes to the ER because she is experiencing the acute onset of a midepigastric pain that radiates to her back. She also complains of nausea nd vomiting. Her past medical history is significant for hypertension, and she takes amlodipine to control it. She denies using tobacco, alcohol, or any illicit drugs. Her temperature is 98.4°F, blood pressure is 120/80 mm Hg, push is 105/min, and respirations are 18/min. A physical exam shows tenderness present when the epigastrum is palpated. The rest of the physical exam is unremarkable. Lab test results are listed below:


  • Albumin: 4.0 g/dL
  • ALP: 150 U/L
  • AST: 110 U/L
  • ALT: 180 U/L


  • Hemoglobin: 13.1 g/dL
  • Platelets: 240,000/mm³
  • WBCs: 14,000//mm³


  • Amylase: 980 U/L **
  • Lipase: 2055 U/L **

An abdominal ultrasound is performed and several gallstones are present. There is no gall bladder wall checking. What is the likely diagnosis in this patient?

Explanation #4 

Abdominal pain (radiating to back) + elevated amylase/lipase + gallstones = acute pancreatitis (secondary to cholelithiasis)

Question # 5

A 45 year old male comes to the hospital with epigastric abdominal pain. He has a past history of alcoholism. He explains that he had the gradual onset of abdominal pain, and that it has reached its peak intensity now. The pain started after his most recent drinking binge, and it has been constant. The pain radiates to the back, and the patine that nausea and vomiting. Vital signs are within normal limits except for some tachycardia. A physical exam reveals epigastric tenderness, but there is no rebound or guarding. What is the likely diagnosis?

Explanation #5

Abdominal pain (radiating to back) + history of alcoholism = acute pancreatitis

Question # 6

A 35 year old male is hospitalized because of nausea, vomiting, and severe abdominal pain. His past history is notable for heavy alcohol usage which is ongoing. Last weekend he went to a party where he drank an entire bottle of tequila. His temperature is 101.1°F, blood pressure is 115/80 mm Hg, pulse is 105/min, and respirations are 18/min. His physical exam reveals marked tenderness in the epigastric region. Labs are drawn and this patient’s serum lipase is 2200 U/L. What might this patient’s diagnosis be?

Explanation #6

Nausea/vomiting + epigastric abdominal pain + history of alcoholism + fever + elevated lipase = acute pancreatitis

Question # 7

Laparotomy is performed on a 40 year old male who suffers from abdominal pain. During the procedure there is chalky white lesions in the mesentery. Histological analysis of these lesions reveasl the presence of fat cell dust ruction and calcium deposition. What is a possible diagnosis in this patient?

Explanation #7

Abdominal pain + chalky white lesions + histological evidence of calcium deposition = acute pancreatitis

Question # 8

A 50 year old male has a 3 day history of very severe abdominal pain. The patient explains that he drank a large amount of alcohol during the past week. His serum studies show an amylase activity of 750 U/L and a serum lipase activity of 900 U/L. His serum calcium level is 6.9 mg/dL. What is the diagnosis in this patient?

Explanation #8

Abdominal pain + alcohol abuse + elevated serum amylase/lipase + hypocalcemia = acute pancreatitis

Question # 9

A 35 year old woman is brought to he emergency department because she is suffering from abdominal pain, nausea, and vomiting. These symptoms began about 8 hours ago. She underwent a cholecystectomy 3 years ago, but does not have any other surgical history. Her menses occur regularly at 28 day intervals, and her last period ended 2 weeks ago. She denies smoking or drinking. She appears acutely ill in the ED. Her temperature is 99.6°F, respirations are 16/min, pulse is 105 bpm, and her blood pressure is 130/65 mm Hg. An abdominal exam is remarkable for guarding and rebound tenderness over the epigastric area. The rest of the physical exam is non-contributory. Labs are draw and shown below:

  • Sodium: 145 mEq/L
  • Potassium: 3.5 mEq/L
  • Calcium: 8.5 mg/dL
  • Total bilirubin: 1.1 mg/dL
  • ALT: 75 U/L
  • AST: 60 U/L
  • Amylase: 1050 U/L***

What is the likely diagnosis in this patient?

Explanation #9

Abdominal pain (epigastric) + nausea/vomiting + elevated amylase = acute pancreatitis (not caused by stones/alcohol because of patient history. Could be caused by elevated triglycerides)

Question # 10

A 27 year old woman, G3P2 is at 22 weeks gestation. She complains of severe epigastric pain that radiates to her back and is sent to the ER. Since arriving she has vomited one time. Her temperature is 100.7°F, pulse is 90 bpm, and blood pressure is 125/75 mm Hg. Her abdominal exam reveals a funds that is non tender, however epigastric tenderness is noted. A fetal heart rate is 135 bpm. Labs are drawn and her heamtocrit is 43%, leukocyte count is 9200/mm³, and platelet count is 250,000/mm³. What diagnosis should be considered in this patient?

Explanation #10

Abdominal pain (epigastric radiating to back) + fever = acute pancreatitis (must be considered, order amylase to rule out) 

Question # 11

A 65 year old hospitalized female has a 1 day history of nausea and abdominal distention. She has vomited 3 times over the past 24 hours, has continued to have flatus, and has had 1 bowel movement. A week ago she underwent surgical repair of a AAA. She has been able to tolerate a clear liquid diet since her operation. Currently her temperature is 100.8°F, heart rate is 96 bpm, and her blood pressure is 120/85 mm Hg. Her lung fields are clear to auscultation bilaterally. Her cardiovascular exam is unremarkable. Her abdomen is distended and tympanic to percussion. She has epigastric tenderness but does not have any guarding or rebound tenderness. Her surgical incision sites are clean/dry/intact without any inflammation. Labs are drawn and listed below:

  • Hemoglobin: 10.3 g/dL
  • WBC count: 11,200/mm³
  • Potassium: 3.8 mEq/L
  • Calcium: 9.1 mg/dL
  • AST: 55 U/L
  • Amylase: 1050 U/L***
  • LDH: 75 U/L

What is the likely diagnosis in this patient?

Explanation #11

Vomiting + fever + epigastric tenderness + elevated serum amylase = acute pancreatitis

Question # 12


Explanation #12


Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:

  • Causes:
    • Alcohol use/abuse: very common
    • Gallstones: very common
    • Highly elevated triglyceride levels: much less common (only consider if gallstones/alcohol abuse is not likely)
  • Management:
    • Nasogastric tube placement/decompression 
    • Diet switched to NPO
    • Aggressive fluid hydration 
  • Histological appearance:
    • Fat/adipocyte destruction
    • Calcium deposition
  • Complications:
    • ARDS: characterized by shortness of breath, hypoxemia, and bilateral opacities on chest X-ray
Page Updated: 01.22.2017