Abdomen: pancreatic head relations: practice question

A Anatomy 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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Anatomy · Abdomen: pancreatic head relations

Sample item

A 62-year-old man has progressive painless jaundice, weight loss and a palpable, non-tender gallbladder. Which anatomical relation explains the obstructive jaundice from a pancreatic head carcinoma?

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

The answer and the reasoning

B. The lower common bile duct lies in a groove on the back of the pancreatic head

The distal common bile duct lies in a groove on the posterior surface of the pancreatic head, or is partly embedded in it, before joining the main pancreatic duct at the hepatopancreatic ampulla. A tumour there compresses it, causing jaundice with a distended gallbladder (Courvoisier sign). The gallbladder is distended because the cystic duct is above the obstruction.

Option by option

  • A. The lower common bile duct runs behind the pancreatic neck and below the uncinate process

    The duct does not pass behind the neck or below the uncinate process, which is a different region.

  • B. The lower common bile duct lies in a groove on the back of the pancreatic head (correct)

    Correct. A head tumour compresses the intrapancreatic or retropancreatic bile duct.

  • C. The common bile duct lies in front of the pancreatic head, touching the stomach

    The bile duct lies behind, not in front of, the head, and the stomach is separated from it by the lesser sac.

  • D. The cystic duct runs through the pancreatic head before joining the bile duct

    The cystic duct runs from the gallbladder to the common hepatic duct and does not pass through the pancreas.

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 Anatomy question

What is the answer to this Anatomy question?

The best answer is B, The lower common bile duct lies in a groove on the back of the pancreatic head. The distal common bile duct lies in a groove on the posterior surface of the pancreatic head, or is partly embedded in it, before joining the main pancreatic duct at the hepatopancreatic ampulla.

Why is "The lower common bile duct runs behind the pancreatic neck and below…" not the answer?

The duct does not pass behind the neck or below the uncinate process, which is a different region.

Why is "The common bile duct lies in front of the pancreatic head, touching t…" not the answer?

The bile duct lies behind, not in front of, the head, and the stomach is separated from it by the lesser sac.

Why is "The cystic duct runs through the pancreatic head before joining the b…" not the answer?

The cystic duct runs from the gallbladder to the common hepatic duct and does not pass through the pancreas.

What concept does this question test?

It tests Abdomen: pancreatic head relations in Anatomy. A tumour there compresses it, causing jaundice with a distended gallbladder (Courvoisier sign). The gallbladder is distended because the cystic duct is above the obstruction.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Abdomen: pancreatic head relations?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy 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.