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1. What is the underlying pathophysiology of gallstone (cholelithiasis) formation?
A. Bile becomes diluted, preventing cholesterol crystallization
B. Bile becomes saturated with cholesterol, cholesterol crystals aggregate, and bile stasis/slow
secretion allows bile to remain in the gallbladder
C. Excess bile acid production dissolves existing stones
D. Increased gallbladder motility prevents stone formation
Rationale: Stone formation results from cholesterol supersaturation in bile combined with poor
gallbladder emptying, allowing crystals time to aggregate into stones.
2. Which of the following are recognized causes/risk factors for gallstone formation? (Select all
that apply)
A. Spinal cord injuries
B. Total parenteral nutrition (TPN)
C. Rapid weight loss
D. Pregnancy
Rationale: These conditions all promote bile stasis or altered cholesterol metabolism, increasing
gallstone risk through different mechanisms (immobility, bypassing normal GI stimulation, rapid
cholesterol mobilization, and hormonal changes, respectively).
3. What are the clinical manifestations of gallstones?
A. Left lower quadrant pain relieved by eating
B. Severe RUQ pain, fever, and biliary colic (especially after a high-fat meal)
C. Painless jaundice with no other symptoms
D. Diarrhea and hypoactive bowel sounds
,Rationale: Fatty meals stimulate gallbladder contraction against an obstructing stone, producing
the classic biliary colic pain pattern in the right upper quadrant.
4. What laboratory findings are expected with gallstones/cholelithiasis?
A. Decreased ALT, decreased bilirubin, leukopenia
B. Elevated ALT, elevated bilirubin, leukocytosis
C. Normal liver enzymes with elevated glucose
D. Decreased WBC count with normal bilirubin
Rationale: Biliary obstruction and inflammation elevate liver enzymes and bilirubin, while the
inflammatory/infectious component raises WBC count.
5. What diagnostic test and patient profile ("Four F's") is associated with gallstones?
A. CT scan; Fasting, Febrile, Female, Fatigued
B. Ultrasound; Forty, Fat, Female, Fertile
C. MRI; Frail, Female, Febrile, Fasting
D. X-ray; Forty, Fasting, Febrile, Female
Rationale: This classic mnemonic describes the demographic risk profile most associated with
gallstone disease, diagnosed via ultrasound as the primary imaging modality.
6. What are common treatments for gallstones/cholelithiasis?
A. Oral antibiotics only
B. ERCP (endoscopic retrograde cholangiopancreatography) and lithotripsy
C. High-fat diet to dissolve stones
D. Strict bed rest only
Rationale: These procedures either remove/break down stones (lithotripsy) or allow direct
visualization and stone extraction from the bile duct (ERCP).
7. What is the pathophysiology of cholecystitis?
A. Complete absence of bile production
B. Inflammation of the gallbladder wall, which can be acute or chronic
, C. Excessive bile acid synthesis
D. Gallbladder atrophy due to disuse
Rationale: Cholecystitis specifically involves inflammatory changes to the gallbladder wall, often
secondary to obstruction by gallstones.
8. What clinical manifestations distinguish acute versus chronic cholecystitis?
A. Acute: asymptomatic; Chronic: severe pain and fever
B. Acute: elevated temperature, severe RUQ pain, leukocytosis; Chronic: often asymptomatic
C. Both presentations are identical
D. Acute: jaundice only; Chronic: fever only
Rationale: Acute inflammation produces the classic inflammatory triad, while chronic
cholecystitis may present with minimal or no symptoms despite ongoing gallbladder pathology.
9. What diagnostic tools are used for cholecystitis?
A. Only blood cultures
B. MRI, CT, and ultrasound
C. Only a physical exam
D. Colonoscopy
Rationale: These imaging modalities allow visualization of gallbladder wall inflammation,
thickening, and associated complications.
10. What dietary modifications should be included in cholecystitis treatment?
A. High fat, low protein, alcohol permitted in moderation
B. Low fat, increased protein, avoid gas-forming foods, no alcohol
C. High fat, high protein, unrestricted alcohol
D. No dietary restrictions are necessary
Rationale: Reducing fat intake decreases gallbladder stimulation/contraction, while avoiding
gas-forming foods and alcohol reduces additional GI irritation.