146) A 65 year old Hispanic man presents to your office for intermittent abdominal discomfort. He is afebrile and his he physical examination is benign.
A plain x-ray of his abdomen is obtained , the film is shown below :
The most likely complication that this patient is likely to develop:
A) Inflammatory bowel disease
B) Colon cancer
C) Diabetes Mellitus
D) Chronic Renal Insufficiency
E) Hyperparthyroidism.
Archer USMLE Step 3 Blog 
146-c
must be D
100%
A
b
bbb
E
Chronic Pancreatitis ——> DM answer C
Answer C
Patient shows extensive pancreatic calcifications, although not very clear. The patient has intermittent abdominal pain, so it’s definitely not a colicky picture showing a renal colic or some so renal insufficiency is ruled out. There’s no this is IBD, Colon cancer or hyperparathyroidism. The etiology is mostly hypertriglyceridemia or alcohol. The most common cause of acute pancreatitis in USA is gallstones and not alcohol so keep that in mind AND 9/10 times epigastric tenderness is acute pancreatitis!
The answer is Diabetes mellitus. Chronic pancreatitis leads to B cell depletion and production of insulin depletes leading to DM.
A 65 year old man with no findings except intermittent abdominal discomfort may have pancreatic cancer. Pancreatic calcifications is a rare secondary diagnostic clue. Diabetes can be a complication sometimes rather than a cause. Colon metastasis is less common than DM as a complication of pancreatic ca. Finally, experts note that when diabetes occurs suddenly in an over 60 year old man, it can be among the early signs of pancreatic cancer. In this case, abdominal discomfort is already the red herring or harbinger of the tumor and so DM may be a complication.
(Option D)