DIFFERENTIAL DIAGNOSIS AND PRIMARY CARE
PRACTICUM MIDTERM CERTIFICATION
EVALUATION SCRIPT 2026 TESTED QUESTIONS
AND CORRECT ANSWERS
◉ What is trypsinogen? How, when, and to what is it converted?
Answer: Trypsinogen is a zymogen made by the pancreas. It is
activated by enteropepidase which is produced in the duodenum.
The active form of the enzyme is called trypsin.
◉ What is the results of trypsinogen and other zymogens becoming
active prematurely? Answer: Acute Pancreatitis
◉ Acute pancreatitis may be a result from what two physical
circumstances? Answer: 1. Injury to the acinar cells
2. Impaired secretion of proenzymes
◉ What are the leading causes of impaired secretion of proenzymes
from the pancreas? Answer: 1. Alcohol abuse
2. Gallstones
◉ How does alcohol induce acute pancreatitis? Answer: 1. Alcohol
increases zymogen secretion from acinar cells. Simultaneously, it
,decreases fluid and bicarbonate in the ducts of the pancreas. This
results in thick pancreatic juices that can form a protein plug in the
pancreatic ducts and therefore cause a blockage.
2. Backed up pancreatic juices increase pressure and may distend
ducts. Membrane trafficking* becomes chaotic. Zymogen granules
may fuse with lysosomes. This brings trypsinogen into contact with
lysosomal digestive enzymes. Trypsinogen then converts to
trypsinogen which starts a cascade of enzyme activation resulting in
AUTODIGESTION of the pancreas = acute pancreatic.
3. It stimulates release of cytokines which attracts a strong immune
reaction. Neutrophils arrive and release superoxide and proteases
which contributes to the problem.
4. High alcohol consumption and oxidative metabolism of alcohol
produces reactive oxygen species which may overwhelm cellular
defenses.
*Membrane trafficking is the process by which proteins and other
macromolecules are distributed throughout the cell, and released to
or internalised from the extracellular space. Membrane trafficking
uses membrane-bound vesicles as transport intermediaries.
◉ How do gallstones cause acute pancreatitis? Answer: They can
become lodged in the Sphincter of Oddi which is the opening of the
,of the common bile duct into the duodenum. This results in much
the same results as alcohol induced acute pancreatitis (because of
the plug)
◉ Fill out the acronym "I GET SMASHED" in order to show the varied
causes of acute pancreatitis. Answer: I: idiopathic
G: gallstones
E: ethanol abuse
T: trauma (i.e. knife wound, not just a punch)
S: steroids
M: mumps virus
A: autoimmune diseases
S: scorpion stings
H: hypertriglyceridemia and hypercalcemia
E: endoscopic retrogrande cholangiopancreatography (ERCP).
D: drugs --> sulfa, reverse transcriptase inhibitors and protease
inhibitors.
◉ What happens to the pancreas as a whole after the inflammatory
response and proteases ravaging the tissues? Answer: This causes
blood vessels to leak and rupture causing edema which results in the
swelling of the capsule of the pancreas.
, ◉ What happens when lipases are activated in the pancreas as a
result of the inflammatory process? Answer: They can destroy the
fat surrounding the pancreas known as the peripancreatic fat.
◉ As the autodigestion and bleeding occur in the pancreas, what is
the end result? Answer: Liquification of pancreatic tissues known as:
liquefactive hemorrhagic necrosis.
◉ One complication of acute pancreatitis is a pseudocyst. How does
this occur and what are the symptoms? How is it best diagnosed?
How is this problematic? Answer: This occurs when fibrous tissue
surrounds liquefactive necrotic tissue which fills with pancreatic
juice. Symptoms: abdominal pain, loss of appetite, palpable mass,
serum amylase/lipase/bilirubin elevation.
CT scan for imaging
As pseudocysts grow they may rupture releasing enzymes into the
abdominal cavity causing massive inflammation. They can become
infected, often by E. coli, which turns the pseudocyst into an abscess.
◉ How is a pancreatic pseudocyst distinguished from a pancreatic
abscess since they present similarly in symptoms and imaging?
Answer: 1. High fever and WBC count since it is an infection
PRACTICUM MIDTERM CERTIFICATION
EVALUATION SCRIPT 2026 TESTED QUESTIONS
AND CORRECT ANSWERS
◉ What is trypsinogen? How, when, and to what is it converted?
Answer: Trypsinogen is a zymogen made by the pancreas. It is
activated by enteropepidase which is produced in the duodenum.
The active form of the enzyme is called trypsin.
◉ What is the results of trypsinogen and other zymogens becoming
active prematurely? Answer: Acute Pancreatitis
◉ Acute pancreatitis may be a result from what two physical
circumstances? Answer: 1. Injury to the acinar cells
2. Impaired secretion of proenzymes
◉ What are the leading causes of impaired secretion of proenzymes
from the pancreas? Answer: 1. Alcohol abuse
2. Gallstones
◉ How does alcohol induce acute pancreatitis? Answer: 1. Alcohol
increases zymogen secretion from acinar cells. Simultaneously, it
,decreases fluid and bicarbonate in the ducts of the pancreas. This
results in thick pancreatic juices that can form a protein plug in the
pancreatic ducts and therefore cause a blockage.
2. Backed up pancreatic juices increase pressure and may distend
ducts. Membrane trafficking* becomes chaotic. Zymogen granules
may fuse with lysosomes. This brings trypsinogen into contact with
lysosomal digestive enzymes. Trypsinogen then converts to
trypsinogen which starts a cascade of enzyme activation resulting in
AUTODIGESTION of the pancreas = acute pancreatic.
3. It stimulates release of cytokines which attracts a strong immune
reaction. Neutrophils arrive and release superoxide and proteases
which contributes to the problem.
4. High alcohol consumption and oxidative metabolism of alcohol
produces reactive oxygen species which may overwhelm cellular
defenses.
*Membrane trafficking is the process by which proteins and other
macromolecules are distributed throughout the cell, and released to
or internalised from the extracellular space. Membrane trafficking
uses membrane-bound vesicles as transport intermediaries.
◉ How do gallstones cause acute pancreatitis? Answer: They can
become lodged in the Sphincter of Oddi which is the opening of the
,of the common bile duct into the duodenum. This results in much
the same results as alcohol induced acute pancreatitis (because of
the plug)
◉ Fill out the acronym "I GET SMASHED" in order to show the varied
causes of acute pancreatitis. Answer: I: idiopathic
G: gallstones
E: ethanol abuse
T: trauma (i.e. knife wound, not just a punch)
S: steroids
M: mumps virus
A: autoimmune diseases
S: scorpion stings
H: hypertriglyceridemia and hypercalcemia
E: endoscopic retrogrande cholangiopancreatography (ERCP).
D: drugs --> sulfa, reverse transcriptase inhibitors and protease
inhibitors.
◉ What happens to the pancreas as a whole after the inflammatory
response and proteases ravaging the tissues? Answer: This causes
blood vessels to leak and rupture causing edema which results in the
swelling of the capsule of the pancreas.
, ◉ What happens when lipases are activated in the pancreas as a
result of the inflammatory process? Answer: They can destroy the
fat surrounding the pancreas known as the peripancreatic fat.
◉ As the autodigestion and bleeding occur in the pancreas, what is
the end result? Answer: Liquification of pancreatic tissues known as:
liquefactive hemorrhagic necrosis.
◉ One complication of acute pancreatitis is a pseudocyst. How does
this occur and what are the symptoms? How is it best diagnosed?
How is this problematic? Answer: This occurs when fibrous tissue
surrounds liquefactive necrotic tissue which fills with pancreatic
juice. Symptoms: abdominal pain, loss of appetite, palpable mass,
serum amylase/lipase/bilirubin elevation.
CT scan for imaging
As pseudocysts grow they may rupture releasing enzymes into the
abdominal cavity causing massive inflammation. They can become
infected, often by E. coli, which turns the pseudocyst into an abscess.
◉ How is a pancreatic pseudocyst distinguished from a pancreatic
abscess since they present similarly in symptoms and imaging?
Answer: 1. High fever and WBC count since it is an infection
