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Category: Gastrointestinal, Nutrition and Genitourinary Disorders--->Gallbladder and Biliary Tract
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Question 1#Print Question

A 71-year-old male with past medical history of hypertension, hyperlipidemia, congestive heart failure with 20% ejection fraction, and chronic obstructive pulmonary disease on 3 L home oxygen presents to the emergency department from his nursing home with complaints of: 5 days of fever, nausea, and right upper quadrant abdominal pain. His vital signs are as follows:

  • temperature 101°F
  • heart rate 115/min
  • blood pressure 90/60 mm Hg
  • respiratory rate 18/min
  • oxygen saturation 95% of 3 L oxygen via nasal canula

He undergoes an ultrasound that shows cholelithiasis, gallbladder wall thickening with pericholecystic fluid, and a positive sonographic Murphy sign, consistent with a diagnosis of acute calculous cholecystitis.

What is the most appropriate management?

A. IV antibiotics alone
B. Endoscopic Retrograde Cholangiopancreatography
C. Laparoscopic Cholecystectomy
D. Open Cholecystectomy
E. Percutaneous Cholecystostomy Tube


Question 2#Print Question

A 65-year-old male is now 10 days status post coronary artery bypass grafting with a postoperative course complicated by bleedingrequiring reoperation, and ventilator-associated pneumonia. After being afebrile for 2 days he spikes a temperature to 102°F and his laboratory test results demonstrate a new leukocytosis. An abdominal ultrasound is obtained that shows a distended gallbladder with wall thickening and pericholecystic fluid. A computed tomography scan of his abdomen confirms the aforementioned findings and is otherwise unremarkable.

From the following choose the correct diagnosis and treatment. 

A. Acalculous cholecystitis—laparoscopic cholecystectomy
B. Acalculous cholecystitis—percutaneous cholecystostomy tube
C. Acalculous cholecystitis—endoscopic retrograde cholangiopancreatography
D. Acute calculous cholecystitis—laparoscopic cholecystectomy
E. Acute calculous cholecystitis—percutaneous cholecystostomy tube


Question 3#Print Question

A 45-year-old female with a past medical history of obesity and cholelithiasis presents to the emergency department with 2 days of right upper quadrant abdominal pain, fevers, and emesis. She is febrile to 102°F and her systolic blood pressure in the 80s mm Hg. Her systolic blood pressure improves to the 100s with 2 L lactated ringers. Her laboratory test results are notable for a WBC count of 19,000/mm3 (85% neutrophils), total bilirubin 6 mg/dL, and amylase 130 U/L. An abdominal ultrasound is obtained in the emergency department that shows cholelithiasis, a common bile duct measuring 8 mm and an otherwise normal gallbladder. In addition to continued resuscitation with IV fluids, what is the most appropriate next step in management?

A. Laparoscopic cholecystectomy
B. IV antibiotics alone
C. Percutaneous cholecystostomy tube
D. Endoscopic Retrograde Cholangiopancreatography
E. Percutaneous Transhepatic Cholangiography


Question 4#Print Question

A 50-year-old male with a past medical history of hypertension presents to the emergency department with right upper quadrant abdominal pain, nausea, and fevers. He is noted to have an elevated white blood cell count and total bilirubin of 5 mg/dL. Further evaluation with an abdominal ultrasound shows a dilated common bile duct to 8 mm with a visualized obstructing gallstone within the lumen. All of the following are appropriate antibiotic choices EXCEPT:

A. Pipercillin-Tazobactam 3.375 g IV every 6 hours
B. Ertapenem 1 g IV once daily
C. Cefazolin 1 to 2 g IV every 8 hours and Metronidazole 500 mg IV every 8 hours
D. Ceftriaxone 2 g IV once daily




Category: Gastrointestinal, Nutrition and Genitourinary Disorders--->Gallbladder and Biliary Tract
Page: 1 of 1