ABSITE – BILIARY QUESTIONS WITH CORRECT ANSWERS 2025

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.