ABSITE – BILIARY QUESTIONS WITH
CORRECT ANSWERS 2025
AM37-year-
oldMwomanMwithMBMIM30kg/m2MpresentsMwithMunremittingMRUQMpainMlastingMseveralMdays.MSheMhasMex
periencedMnauseaMandMvomitingMforMtheMlastMtwoMdays.MVitalMsignsMareMTM37.9°C,MHRM105Mbpm,MBPM110
/80MmmHg,MRRM20Mbreaths/min,M100%MonMRA.MLabsMrevealMWBCM13,000MandMtotalMbilirubinM3Mmg/dL.M
OnMphysicalMexam,MthereMisMnoMjaundiceMorMscleralMicterus,MandMpalpationMofMtheMRUQMproducesMguardi
ngMandMrebound.MUltrasoundMofMtheMRUQMshowsMgallbladderMwallMthicknessMofM5MmmMandMmildMperich
olecysticMfluid.MWhatMisMtheMdiagnosis?M
M
A.MAcuteMcholecystitisM
B.MCholelithiasisM
C.MAcuteMcholangitisM
D.MChronicMcholecystitisM
E.MBiliaryMdyskinesiaM-MCORRECTMANSWERM-AcuteMcholecystitis
Correct.
A)MAcuteMcholecystitisMisMdefinedMbyMpericholecysticMfluidMandMgallbladderMwallMthickeningM>M4mm.
B)MTheMultrasoundMdidMnotMspecifyMtheMpresenceMofMstonesMinMtheMgallbladder.
C)MAcuteMcholangitisMrequiresMtheMclassicMtriadMjaundiceMofMtheMskinMorMsclera,MfeverMandMRUQMpain.
D)MChronicMcholecystitisMusuallyMlastsMlongerMthanMseveralMdaysMorMhasMoccurredMonMandMoffMforMsomeM
time.
E)MBiliaryMdyskinesiaMdoesMnotMcauseMaMSIRSMresponseMorMpericholecysticMfluidMandMgallbladderMwallMthi
ckening.
AnM81-year-
oldMwomanMonMPODM#6MfromMopenMsplenectomyMforMaMgradeM4MsplenicMlacerationMresultingMfromManM
MVCMdevelopsMaMsevereMpneumonia,MwithMpersistentMfeverMofM39°C,MWBCM18,000,MandMhighMresidualsM
,onMtubeMfeedings.MSheMhasMbeenMunableMtoMweanMfromMtheMventilator,MandMisMonMmultipleMinotropicMa
gentsMtoMsupportMherMbloodMpressureMwhichMisMcurrentlyM80/60MmmHg.MOnMexam,MsheMwincesMinMpainM
withMpalpationMofMtheMRUQ.MRUQMUSMshowsMnoMstonesMinMtheMgallbladder,MpericholecysticMfluidMandMaM
wallMthicknessMofM6Mmm.MWhichMofMtheMfollowingMisMtheMnextMbestMstepMinMmanagement?M
M
A.MCTMscanMofMabdomenMandMpelvisM
B.MPercutaneousMcholecystostomyMtubeMplacementM
C.MERCPM
D.MLaparoscopicMcholecystectomyM
E.MOpenMcholecystectomyM-MCORRECTMANSWERM-PercutaneousMcholecystostomyMtubeMplacement
Correct.
ThisMpatientMhasMacalculousMcholecystitis.MSheMisMnotMhealthyMenoughMforManMelectiveMcholecystectomyM
atMthisMtime,MsoMtheMappropriateMtreatmentMisMpercutaneousMcholecystostomyMtubeMplacement.MERCPM
wouldMnotMhelpMtreatMacalculousMcholecystitis.
AM65-year-
oldMmanMpresentsMtoMtheMERMwithMcomplaintsMofMstabbingMRUQMpainMoccurringMforMseveralMdays,MandMa
ccordingMtoMhisMfamily,MhasMbecomeMincreasinglyMaggravatedMandMconfused.MHisMvitalsMareMTM39°C,MHRM
115Mbpm,MBPM94/71MmmHg,MRRM20Mbreaths/min,M100%MonMRA.MHeMisMjaundicedMandMexhibitsMaMpositiv
eMMurphy'sMsign.MLabsMrevealMelevatedMbilirubin,MalkalineMphosphatase,MandMWBC.MHisMtroponinsMareMn
egativeMandMEKGMdemonstratesMnormalMsinusMrhythm.MHisMdiseaseMprocessMisMmostMlikelyMcausedMbyMw
hichMorganism?M
M
A.MStaphylococcusMaureusM
B.MStaphylococcusMepididymisM
C.MStreptococcusMpneumoniaM
D.MClostridiumMperfringensM
E.MKlebsiellaMpneumoniaM-MCORRECTMANSWERM-E.MKlebsiellaMpneumoniae
Correct.
TheMpatientMisMsufferingMfromMacuteMcholangitis,MwhichMisMmostMcommonlyMcausedMbyME.Mcoli,MKlebsiell
aMpneumoniae,Menterococci,MandMBacteroidesMfragilis.
,AM42-year-
oldMwomanMwithMBMIM42Mkg/m2MpresentsMwithMstabbingMRUQMpainMoccurringMafterMmealsMforMtheMlastM
3Mdays,MsometimesMwakingMherMfromMsleep.MSheMhadMaMmyocardialMinfarctionM2MmonthsMagoMtreatedMw
ithMaMstent.MSheMisMonMclopidogrel.MHerMvitalsMareMTM36.5°C,MHRM75Mbpm,MBPM135/74MmmHg,MRRM16Mbre
aths/min,M100%MonMRA.MSheMisMjaundicedMandMhasMRUQMtendernessMtoMdeepMpalpation.MHerMtotalMbilir
ubinMisM4.0Mmg/dL,MdirectMbilirubinM3.2Mmg/dL,MandMalkalineMphosphataseM200MIU/L.MHerMWBCMisMnorm
alMandMserumMtroponinsMareMnotMelevated.MEKGMdemonstratesMnormalMsinusMrhythm.MAnMultrasoundMof
MtheMRUQMrevealsMstonesMinMtheMgallbladder.MWhatMimagingMstudyMwouldMyouMconsiderMnext?M
M
A.MCTMscanMwithoutMcontrastM
B.MHIDAMscanMwithMadministrationMofMcholecystokininM
C.MPlainMradiographMofMtheMabdomenM
D.MMagneticMresonanceMcholangiopancreatographyM(MRCP)M
E.MEndoscopicMretrogradeMcholangiopancreatographyM(ERCP)M-MCORRECTMANSWERM-
D.MMagneticMresonanceMcholangiopancreatographyM(MRCP)
Correct.
ThisMpatientMlikelyMhasMcholedocholithiasisMgivenMherMelevatedMbilirubinMandMalkalineMphosphatase.MUSM
canMonlyMshowMstonesMinMtheMCBDM10-
15%MofMtheMtime.MIfMclinicallyMsuspiciousMofMcholedocholithiasis,MtheMnextMimagingMstudyMcouldMbeMend
oscopicMretrogradeMcholangiogram/endoscopicMUSM(ERC/EUS)MorMMRCP.MSinceMthisMpatientMrecentlyMha
dManMMIMandMisManticoagulated,MsheMshouldMundergoMtheMleastMinvasiveMprocedure,ManMMRCP,MandMrule
MoutMotherMcausesMofMincreasedMhepaticMfunctionMpanelMbeforeMundergoingManMinvasiveMprocedureMsuc
hMasMERC/EUS.
MRCPMcanMdiagnoseMCBDMstonesMwithMaMsensitivityMofM90%,MaMspecificityMofM100%,MandManMoverallMdiag
nosticMaccuracyMofM97%.
A)MCTMscanMwithoutMcontrastMhasMgreatMsensitivityMandMspecificityMforMstonesMinMtheMrenalMsystem.MForM
theMgallbladder,McalcifiedMstonesMcanMonlyMbeMvisualizedM50%MofMtheMtime.
B)M99mTechnetium-labeledMiminodiaceticMacidMderivativesM(hepaticM2,6-dimethyl-
iminodiaceticMacidM[HIDA],Mdiisopropyl-acetanilidoiminodiaceticMacid,MP-isopropylacetanilido-
imidodiaceticMacid)MscansMwithMcholecystokininMadministrationMshouldMbeMusedMtoMidentifyMbiliaryMdyski
nesia.
, C)MPlainMx-
raysMofMtheMabdomenMidentifyMstonesMonlyM15%MofMtheMtimeMandMitMwouldMbeMimpossibleMtoMdifferenti
ateMaMCBDMstoneMfromMaMgallbladderMstoneMonMx-ray.
D)MSinceMthisMpatientMrecentlyMhadManMMI,MsheMshouldMundergoMtheMleastMinvasiveMprocedure,ManMMRC
P,MandMruleMoutMotherMcausesMofMincreasedMhepaticMfunctionMpanelMbeforeMundergoingManMinvasiveMpro
cedureMsuchMasMERC/EUS.
E)MEndoscopicMretrogradeMcholangiogram/endoscopicMUSM(ERC/EUS)MisMmoreMinvasiveMthanMMRCP;Mthis
MpatientMwouldMbeMhighMriskMforManMinvasiveMprocedure.
AM55-year-
oldMmaleMpresentsMwithMRUQMpainMoverMtheMlastM24Mhours.MUltrasoundMconfirmsMacuteMcholecystitis,Mw
ithMgallbladderMwallMthickening,MpericholecysticMfluid,MandMmultipleMstones.MTheMCBDMisMnotMvisualizedM
becauseMofMoverlyingMbowelMgas.MHisMlaboratoryMworkupMisMasMfollows:MWBCM17,000,MtotalMbilirubinM2.5
,MAST/ALTM150/170,MalkalineMphosphataseM138.MHeMisMnotMfebrile.MHisMpastMsurgicalMhistoryMincludesMaM
Roux-en-
YMgastricMbypassMandMaMcerebralManeurysmMrepair.MWhatMisMtheMbestMnextMstepMinMhisMmanagement?M
M
A.MOpenMcholecystectomyM
B.MLaparoscopicMcholecystectomyMwithMintraoperativeMcholangiogramM
C.MCTMabdomen/pelvisM
D.MMRCPM
E.MERCPM-MCORRECTMANSWERM-B.MLaparoscopicMcholecystectomyMwithMintraoperativeMcholangiogram
Correct.
ThisMpatientMhasMcholecystitisMwithMabnormalMliverMfunctionMtests.MHisMCBDMneedsMtoMbeMvisualizedMpre
operativelyMorMintraoperatively.MOptionsMgenerallyMincludeMMRCP,MERCP,Mand/orMintraoperativeMcholangi
ogramM(IOC).MRoux-en-
YMgastricMbypassMdoesMnotMprecludeMlaparoscopicMcholecystectomy.MContraindicationsMtoMMRCPMinclude
MolderMheartMpacemakers,MimplantedMmetallicMdevicesM(insulinMpumps,MhearingMaids,Mneurostimulators),
MintracranialMmetalMclips,MandMmetallicMbodiesMinMtheMeye.
CORRECT ANSWERS 2025
AM37-year-
oldMwomanMwithMBMIM30kg/m2MpresentsMwithMunremittingMRUQMpainMlastingMseveralMdays.MSheMhasMex
periencedMnauseaMandMvomitingMforMtheMlastMtwoMdays.MVitalMsignsMareMTM37.9°C,MHRM105Mbpm,MBPM110
/80MmmHg,MRRM20Mbreaths/min,M100%MonMRA.MLabsMrevealMWBCM13,000MandMtotalMbilirubinM3Mmg/dL.M
OnMphysicalMexam,MthereMisMnoMjaundiceMorMscleralMicterus,MandMpalpationMofMtheMRUQMproducesMguardi
ngMandMrebound.MUltrasoundMofMtheMRUQMshowsMgallbladderMwallMthicknessMofM5MmmMandMmildMperich
olecysticMfluid.MWhatMisMtheMdiagnosis?M
M
A.MAcuteMcholecystitisM
B.MCholelithiasisM
C.MAcuteMcholangitisM
D.MChronicMcholecystitisM
E.MBiliaryMdyskinesiaM-MCORRECTMANSWERM-AcuteMcholecystitis
Correct.
A)MAcuteMcholecystitisMisMdefinedMbyMpericholecysticMfluidMandMgallbladderMwallMthickeningM>M4mm.
B)MTheMultrasoundMdidMnotMspecifyMtheMpresenceMofMstonesMinMtheMgallbladder.
C)MAcuteMcholangitisMrequiresMtheMclassicMtriadMjaundiceMofMtheMskinMorMsclera,MfeverMandMRUQMpain.
D)MChronicMcholecystitisMusuallyMlastsMlongerMthanMseveralMdaysMorMhasMoccurredMonMandMoffMforMsomeM
time.
E)MBiliaryMdyskinesiaMdoesMnotMcauseMaMSIRSMresponseMorMpericholecysticMfluidMandMgallbladderMwallMthi
ckening.
AnM81-year-
oldMwomanMonMPODM#6MfromMopenMsplenectomyMforMaMgradeM4MsplenicMlacerationMresultingMfromManM
MVCMdevelopsMaMsevereMpneumonia,MwithMpersistentMfeverMofM39°C,MWBCM18,000,MandMhighMresidualsM
,onMtubeMfeedings.MSheMhasMbeenMunableMtoMweanMfromMtheMventilator,MandMisMonMmultipleMinotropicMa
gentsMtoMsupportMherMbloodMpressureMwhichMisMcurrentlyM80/60MmmHg.MOnMexam,MsheMwincesMinMpainM
withMpalpationMofMtheMRUQ.MRUQMUSMshowsMnoMstonesMinMtheMgallbladder,MpericholecysticMfluidMandMaM
wallMthicknessMofM6Mmm.MWhichMofMtheMfollowingMisMtheMnextMbestMstepMinMmanagement?M
M
A.MCTMscanMofMabdomenMandMpelvisM
B.MPercutaneousMcholecystostomyMtubeMplacementM
C.MERCPM
D.MLaparoscopicMcholecystectomyM
E.MOpenMcholecystectomyM-MCORRECTMANSWERM-PercutaneousMcholecystostomyMtubeMplacement
Correct.
ThisMpatientMhasMacalculousMcholecystitis.MSheMisMnotMhealthyMenoughMforManMelectiveMcholecystectomyM
atMthisMtime,MsoMtheMappropriateMtreatmentMisMpercutaneousMcholecystostomyMtubeMplacement.MERCPM
wouldMnotMhelpMtreatMacalculousMcholecystitis.
AM65-year-
oldMmanMpresentsMtoMtheMERMwithMcomplaintsMofMstabbingMRUQMpainMoccurringMforMseveralMdays,MandMa
ccordingMtoMhisMfamily,MhasMbecomeMincreasinglyMaggravatedMandMconfused.MHisMvitalsMareMTM39°C,MHRM
115Mbpm,MBPM94/71MmmHg,MRRM20Mbreaths/min,M100%MonMRA.MHeMisMjaundicedMandMexhibitsMaMpositiv
eMMurphy'sMsign.MLabsMrevealMelevatedMbilirubin,MalkalineMphosphatase,MandMWBC.MHisMtroponinsMareMn
egativeMandMEKGMdemonstratesMnormalMsinusMrhythm.MHisMdiseaseMprocessMisMmostMlikelyMcausedMbyMw
hichMorganism?M
M
A.MStaphylococcusMaureusM
B.MStaphylococcusMepididymisM
C.MStreptococcusMpneumoniaM
D.MClostridiumMperfringensM
E.MKlebsiellaMpneumoniaM-MCORRECTMANSWERM-E.MKlebsiellaMpneumoniae
Correct.
TheMpatientMisMsufferingMfromMacuteMcholangitis,MwhichMisMmostMcommonlyMcausedMbyME.Mcoli,MKlebsiell
aMpneumoniae,Menterococci,MandMBacteroidesMfragilis.
,AM42-year-
oldMwomanMwithMBMIM42Mkg/m2MpresentsMwithMstabbingMRUQMpainMoccurringMafterMmealsMforMtheMlastM
3Mdays,MsometimesMwakingMherMfromMsleep.MSheMhadMaMmyocardialMinfarctionM2MmonthsMagoMtreatedMw
ithMaMstent.MSheMisMonMclopidogrel.MHerMvitalsMareMTM36.5°C,MHRM75Mbpm,MBPM135/74MmmHg,MRRM16Mbre
aths/min,M100%MonMRA.MSheMisMjaundicedMandMhasMRUQMtendernessMtoMdeepMpalpation.MHerMtotalMbilir
ubinMisM4.0Mmg/dL,MdirectMbilirubinM3.2Mmg/dL,MandMalkalineMphosphataseM200MIU/L.MHerMWBCMisMnorm
alMandMserumMtroponinsMareMnotMelevated.MEKGMdemonstratesMnormalMsinusMrhythm.MAnMultrasoundMof
MtheMRUQMrevealsMstonesMinMtheMgallbladder.MWhatMimagingMstudyMwouldMyouMconsiderMnext?M
M
A.MCTMscanMwithoutMcontrastM
B.MHIDAMscanMwithMadministrationMofMcholecystokininM
C.MPlainMradiographMofMtheMabdomenM
D.MMagneticMresonanceMcholangiopancreatographyM(MRCP)M
E.MEndoscopicMretrogradeMcholangiopancreatographyM(ERCP)M-MCORRECTMANSWERM-
D.MMagneticMresonanceMcholangiopancreatographyM(MRCP)
Correct.
ThisMpatientMlikelyMhasMcholedocholithiasisMgivenMherMelevatedMbilirubinMandMalkalineMphosphatase.MUSM
canMonlyMshowMstonesMinMtheMCBDM10-
15%MofMtheMtime.MIfMclinicallyMsuspiciousMofMcholedocholithiasis,MtheMnextMimagingMstudyMcouldMbeMend
oscopicMretrogradeMcholangiogram/endoscopicMUSM(ERC/EUS)MorMMRCP.MSinceMthisMpatientMrecentlyMha
dManMMIMandMisManticoagulated,MsheMshouldMundergoMtheMleastMinvasiveMprocedure,ManMMRCP,MandMrule
MoutMotherMcausesMofMincreasedMhepaticMfunctionMpanelMbeforeMundergoingManMinvasiveMprocedureMsuc
hMasMERC/EUS.
MRCPMcanMdiagnoseMCBDMstonesMwithMaMsensitivityMofM90%,MaMspecificityMofM100%,MandManMoverallMdiag
nosticMaccuracyMofM97%.
A)MCTMscanMwithoutMcontrastMhasMgreatMsensitivityMandMspecificityMforMstonesMinMtheMrenalMsystem.MForM
theMgallbladder,McalcifiedMstonesMcanMonlyMbeMvisualizedM50%MofMtheMtime.
B)M99mTechnetium-labeledMiminodiaceticMacidMderivativesM(hepaticM2,6-dimethyl-
iminodiaceticMacidM[HIDA],Mdiisopropyl-acetanilidoiminodiaceticMacid,MP-isopropylacetanilido-
imidodiaceticMacid)MscansMwithMcholecystokininMadministrationMshouldMbeMusedMtoMidentifyMbiliaryMdyski
nesia.
, C)MPlainMx-
raysMofMtheMabdomenMidentifyMstonesMonlyM15%MofMtheMtimeMandMitMwouldMbeMimpossibleMtoMdifferenti
ateMaMCBDMstoneMfromMaMgallbladderMstoneMonMx-ray.
D)MSinceMthisMpatientMrecentlyMhadManMMI,MsheMshouldMundergoMtheMleastMinvasiveMprocedure,ManMMRC
P,MandMruleMoutMotherMcausesMofMincreasedMhepaticMfunctionMpanelMbeforeMundergoingManMinvasiveMpro
cedureMsuchMasMERC/EUS.
E)MEndoscopicMretrogradeMcholangiogram/endoscopicMUSM(ERC/EUS)MisMmoreMinvasiveMthanMMRCP;Mthis
MpatientMwouldMbeMhighMriskMforManMinvasiveMprocedure.
AM55-year-
oldMmaleMpresentsMwithMRUQMpainMoverMtheMlastM24Mhours.MUltrasoundMconfirmsMacuteMcholecystitis,Mw
ithMgallbladderMwallMthickening,MpericholecysticMfluid,MandMmultipleMstones.MTheMCBDMisMnotMvisualizedM
becauseMofMoverlyingMbowelMgas.MHisMlaboratoryMworkupMisMasMfollows:MWBCM17,000,MtotalMbilirubinM2.5
,MAST/ALTM150/170,MalkalineMphosphataseM138.MHeMisMnotMfebrile.MHisMpastMsurgicalMhistoryMincludesMaM
Roux-en-
YMgastricMbypassMandMaMcerebralManeurysmMrepair.MWhatMisMtheMbestMnextMstepMinMhisMmanagement?M
M
A.MOpenMcholecystectomyM
B.MLaparoscopicMcholecystectomyMwithMintraoperativeMcholangiogramM
C.MCTMabdomen/pelvisM
D.MMRCPM
E.MERCPM-MCORRECTMANSWERM-B.MLaparoscopicMcholecystectomyMwithMintraoperativeMcholangiogram
Correct.
ThisMpatientMhasMcholecystitisMwithMabnormalMliverMfunctionMtests.MHisMCBDMneedsMtoMbeMvisualizedMpre
operativelyMorMintraoperatively.MOptionsMgenerallyMincludeMMRCP,MERCP,Mand/orMintraoperativeMcholangi
ogramM(IOC).MRoux-en-
YMgastricMbypassMdoesMnotMprecludeMlaparoscopicMcholecystectomy.MContraindicationsMtoMMRCPMinclude
MolderMheartMpacemakers,MimplantedMmetallicMdevicesM(insulinMpumps,MhearingMaids,Mneurostimulators),
MintracranialMmetalMclips,MandMmetallicMbodiesMinMtheMeye.
