Gastroenterology and hepatology: pancreatic pseudocyst: practice question

A General Medicine 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.

Try it

General Medicine · Gastroenterology and hepatology: pancreatic pseudocyst

Sample item

Six weeks after severe acute pancreatitis, a 40-year-old man has persistent epigastric pain, early satiety and vomiting. CT shows a 9 cm thin-walled fluid collection abutting the stomach, with no solid debris. What is the best management?

AImmediate laparotomy and pancreatectomyBOctreotide infusion and observationCRepeated weekly percutaneous aspiration aloneDEndoscopic transmural cystogastrostomy drainage

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

The answer and the reasoning

D. Endoscopic transmural cystogastrostomy drainage

A mature encapsulated collection persisting beyond 4 weeks is a pseudocyst. Observation is enough when it is asymptomatic, but a symptomatic one causing gastric outlet obstruction needs drainage, and endoscopic transmural drainage into the stomach is preferred when it abuts the stomach wall.

Option by option

A. Immediate laparotomy and pancreatectomy
Pancreatectomy is excessive for a simple fluid collection.
B. Octreotide infusion and observation
Octreotide and observation do not relieve a symptomatic obstructing collection.
C. Repeated weekly percutaneous aspiration alone
Aspiration alone usually recurs and carries a risk of infection.
D. Endoscopic transmural cystogastrostomy drainage (correct)
Correct. Endoscopic cystogastrostomy drains a symptomatic pseudocyst adherent to the stomach.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Endoscopic transmural cystogastrostomy drainage. A mature encapsulated collection persisting beyond 4 weeks is a pseudocyst.

Why is "Immediate laparotomy and pancreatectomy" not the answer?

Pancreatectomy is excessive for a simple fluid collection.

Why is "Octreotide infusion and observation" not the answer?

Octreotide and observation do not relieve a symptomatic obstructing collection.

Why is "Repeated weekly percutaneous aspiration alone" not the answer?

Aspiration alone usually recurs and carries a risk of infection.

What concept does this question test?

It tests Gastroenterology and hepatology: pancreatic pseudocyst in General Medicine. Observation is enough when it is asymptomatic, but a symptomatic one causing gastric outlet obstruction needs drainage, and endoscopic transmural drainage into the stomach is preferred when it abuts the stomach wall.

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 Gastroenterology and hepatology: pancreatic pseudocyst?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.