Continuing Medical Education Questions: January 2020: Chronic Pancreatitis: Managing a Difficult Disease
Bibliographic record
Abstract
LEARNING OBJECTIVE After this activity, the participant will demonstrate a comprehensive understanding of epidemiology, etiology and management of chronic pancreatitis. QUESTION 1 A 56-year-old man with a 12-year history of consuming 5 alcoholic drinks every day and a diagnosis of chronic pancreatitis 2 years ago complains of constant epigastric abdominal pain radiating to the back. He denies diarrhea or jaundice. His past medical history is significant for hypertension and fatty liver. He takes amlodipine 5 mg PO daily and denies any known allergy to medications. He has not had any alcohol or smoked since the diagnosis. There is no family history of chronic pancreatitis or pancreatic cancer. Upper endoscopy was unremarkable. Magnetic resonance cholangiopancreatography showed a 12-mm obstructing stone in the pancreatic duct in the body leading to dilation of duct in the tail of the pancreas. Which of the following interventions is best to perform next to manage his abdominal pain? A. Endoscopic retrograde cholangiopancreatography B. Endoscopic ultrasound-assisted celiac plexus block C. Total pancreatectomy with islet autotransplantation D. Extracorporeal shock wave lithotripsy QUESTION 2 A 45-year-old woman with idiopathic chronic pancreatitis presented with steatorrhea and was started on pancreatic enzyme replacement therapy (PERT with lipase 25,000 units per meal). This resulted in partial symptom improvement, but increasing the dose of lipase to 50,000 units and adding pantoprazole 40 mg PO twice daily did not result in greater symptom improvement. She does not complain of abdominal pain or jaundice. Her past medical history is significant for appendectomy and cesarean section and she does not take any other medications. She has no known drug allergy. Family history is significant for chronic pancreatitis in her father but negative for pancreatic cancer. She does not smoke or drink alcohol. Stool examinations for ova and parasite, culture and sensitivity, and Clostridium difficile were negative. Which of the following diagnostic modalities should be used next? A. Hydrogen breath test B. 72-hours stool quantitative fat test C. Fecal elastase-1 D. Magnetic resonance cholangiopancreatography QUESTION 3 Which of the following statements is true regarding chronic pancreatitis? A. Clinical severity is worse in black patients than in white patients B. It is more prevalent in women than in men C. Alcohol consumption accounts for the majority of cases D. The role of cigarette smoking in its etiology is unclear
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.013 | 0.006 |
| Insufficient payload (model declined to judge) | 0.186 | 0.091 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".