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Exam Questions with 100%
Correct Answers 2025 A+
An 81-year-old woman on POD #6 from open splenectomy for a grade 4 splenic laceration 1
resulting from an MVC develops a severe pneumonia, with persistent fever of 39°C, WBC 18,000,
and high residuals on tube feedings. She has been unable to wean from the ventilator, and is on
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multiple inotropic agents to support her blood pressure which is currently 80/60 mmHg. On
exam, she winces in pain with palpation of the RUQ. RUQ US shows no stones in the gallbladder,
pericholecystic fluid and a wall thickness of 6 mm. Which of the following is the next best step in
management?
A. CT scan of abdomen and pelvis
B. Percutaneous cholecystostomy tube placement
C. ERCP
D. Laparoscopic cholecystectomy
E. Open cholecystectomy
- Correct Answer :Percutaneous cholecystostomy tube placement
Correct.
This patient has acalculous cholecystitis. She is not healthy enough for an elective
cholecystectomy at this time, so the appropriate treatment is percutaneous cholecystostomy
tube placement. ERCP would not help treat acalculous cholecystitis.
A 37-year-old woman with BMI 30kg/m2 presents with unremitting RUQ pain lasting several
days. She has experienced nausea and vomiting for the last two days. Vital signs are T 37.9°C, HR
105 bpm, BP 110/80 mmHg, RR 20 breaths/min, 100% on RA. Labs reveal WBC 13,000 and total
bilirubin 3 mg/dL. On physical exam, there is no jaundice or scleral icterus, and palpation of the
RUQ produces guarding and rebound. Ultrasound of the RUQ shows gallbladder wall thickness of
5 mm and mild pericholecystic fluid. What is the diagnosis?
B. Acute cholecystitis
C. Cholelithiasis
D. Acute cholangitis
E. Chronic cholecystitis
F. Biliary dyskinesia
- Correct Answer :Acute cholecystitis
Correct.
A) Acute cholecystitis is defined by pericholecystic fluid and gallbladder wall thickening > 4mm.
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B) The ultrasound did not specify the presence of stones in the gallbladder.
C) Acute cholangitis requires the classic triad jaundice of the skin or sclera, fever and RUQ pain.
D) Chronic cholecystitis usually lasts longer than several days or has occurred on and off for
some time.
E) Biliary dyskinesia does not cause a SIRS response or pericholecystic fluid and gallbladder wall
thickening.
A 42-year-old woman with BMI 42 kg/m2 presents with stabbing RUQ pain occurring after meals
for the last 3 days, sometimes waking her from sleep. She had a myocardial infarction 2 months
ago treated with a stent. She is on clopidogrel. Her vitals are T 36.5°C, HR 75 bpm, BP 135/74
mmHg, RR 16 breaths/min, 100% on RA. She is jaundiced and has RUQ tenderness to deep
palpation. Her total bilirubin is 4.0 mg/dL, direct bilirubin 3.2 mg/dL, and alkaline phosphatase
200 IU/L. Her WBC is normal and serum troponins are not elevated. EKG demonstrates normal
A+ TEST BANK 2
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sinus rhythm. An ultrasound of the RUQ reveals stones in the gallbladder. What imaging study
would you consider next?
A. CT scan without contrast
B. HIDA scan with administration of cholecystokinin
C. Plain radiograph of the abdomen
D. Magnetic resonance cholangiopancreatography (MRCP)
E. Endoscopic retrograde cholangiopancreatography (ERCP)
- Correct Answer :D. Magnetic resonance cholangiopancreatography (MRCP)
Correct.
This patient likely has choledocholithiasis given her elevated bilirubin and alkaline phosphatase.
US can only show stones in the CBD 10-15% of the time. If clinically suspicious of
choledocholithiasis, the next imaging study could be endoscopic retrograde
cholangiogram/endoscopic US (ERC/EUS) or MRCP. Since this patient recently had an MI and is
anticoagulated, she should undergo the least invasive procedure, an MRCP, and rule out other
causes of increased hepatic function panel before undergoing an invasive procedure such as
ERC/EUS.
MRCP can diagnose CBD stones with a sensitivity of 90%, a specificity of 100%, and an overall
diagnostic accuracy of 97%.
A) CT scan without contrast has great sensitivity and specificity for stones in the renal system.
For the gallbladder, calcified stones can only be visualized 50% of the time.
B) 99mTechnetium-labeled iminodiacetic acid derivatives (hepatic 2,6-dimethyl-iminodiacetic
acid [HIDA], diisopropyl-acetanilidoiminodiacetic acid, P-isopropylacetanilido-imidodiacetic acid)
scans with cholecystokinin administration should be used to identify biliary dyskinesia.
C) Plain x-rays of the abdomen identify stones only 15% of the time and it would be impossible to
differentiate a CBD stone from a gallbladder stone on x-ray.
D) Since this patient recently had an MI, she should undergo the least invasive procedure, an
MRCP, and rule out other causes of increased hepatic function panel before undergoing an
invasive procedure such as ERC/EUS.
E) Endoscopic retrograde cholangiogram/endoscopic US (ERC/EUS) is more invasive than MRCP;
this patient would be high risk for an invasive procedure.
A 55-year-old male presents with RUQ pain over the last 24 hours. Ultrasound confirms acute
cholecystitis, with gallbladder wall thickening, pericholecystic fluid, and multiple stones. The CBD
is not visualized because of overlying bowel gas. His laboratory workup is as follows: WBC
A+ TEST BANK 3
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17,000, total bilirubin 2.5, AST/ALT 150/170, alkaline phosphatase 138. He is not febrile. His past
surgical history includes a Roux-en-Y gastric bypass and a cerebral aneurysm repair. What is the
best next step in his management?
A. Open cholecystectomy
B. Laparoscopic cholecystectomy with intraoperative cholangiogram
C. CT abdomen/pelvis
D. MRCP
E. ERCP
- Correct Answer :B. Laparoscopic cholecystectomy with intraoperative cholangiogram
Correct.
This patient has cholecystitis with abnormal liver function tests. His CBD needs to be visualized
preoperatively or intraoperatively. Options generally include MRCP, ERCP, and/or intraoperative
cholangiogram (IOC). Roux-en-Y gastric bypass does not preclude laparoscopic cholecystectomy.
Contraindications to MRCP include older heart pacemakers, implanted metallic devices (insulin
pumps, hearing aids, neurostimulators), intracranial metal clips, and metallic bodies in the eye.
A 65-year-old man presents to the ER with complaints of stabbing RUQ pain occurring for several
days, and according to his family, has become increasingly aggravated and confused. His vitals
are T 39°C, HR 115 bpm, BP 94/71 mmHg, RR 20 breaths/min, 100% on RA. He is jaundiced and
exhibits a positive Murphy's sign. Labs reveal elevated bilirubin, alkaline phosphatase, and WBC.
His troponins are negative and EKG demonstrates normal sinus rhythm. His disease process is
most likely caused by which organism?
A. Staphylococcus aureus
B. Staphylococcus epididymis
C. Streptococcus pneumonia
D. Clostridium perfringens
E. Klebsiella pneumonia
- Correct Answer :E. Klebsiella pneumoniae
Correct.
The patient is suffering from acute cholangitis, which is most commonly caused by E. coli,
Klebsiella pneumoniae, enterococci, and Bacteroides fragilis.
ERCP is generally considered technically impossible after a Roux-en-Y gastric bypass. CT A/P does
not provide adequate visualization of the CBD, and cannot reliably rule out a CBD stone.
An 83-year-old male with CAD, CHF and COPD is admitted to the MICU with a COPD exacerbation
during which he develops acute, acalculous cholecystitis as confirmed by RUQ US and HIDA scan.
He has a cholecystostomy tube placed. Two weeks after tube placement with resolution of his
cholecystitis and improvement of his COPD, he is ready for discharge to a skilled nursing facility.
Absite Exam Test Bank
Exam Questions with 100%
Correct Answers 2025 A+
An 81-year-old woman on POD #6 from open splenectomy for a grade 4 splenic laceration 1
resulting from an MVC develops a severe pneumonia, with persistent fever of 39°C, WBC 18,000,
and high residuals on tube feedings. She has been unable to wean from the ventilator, and is on
A+ TEST BANK
multiple inotropic agents to support her blood pressure which is currently 80/60 mmHg. On
exam, she winces in pain with palpation of the RUQ. RUQ US shows no stones in the gallbladder,
pericholecystic fluid and a wall thickness of 6 mm. Which of the following is the next best step in
management?
A. CT scan of abdomen and pelvis
B. Percutaneous cholecystostomy tube placement
C. ERCP
D. Laparoscopic cholecystectomy
E. Open cholecystectomy
- Correct Answer :Percutaneous cholecystostomy tube placement
Correct.
This patient has acalculous cholecystitis. She is not healthy enough for an elective
cholecystectomy at this time, so the appropriate treatment is percutaneous cholecystostomy
tube placement. ERCP would not help treat acalculous cholecystitis.
A 37-year-old woman with BMI 30kg/m2 presents with unremitting RUQ pain lasting several
days. She has experienced nausea and vomiting for the last two days. Vital signs are T 37.9°C, HR
105 bpm, BP 110/80 mmHg, RR 20 breaths/min, 100% on RA. Labs reveal WBC 13,000 and total
bilirubin 3 mg/dL. On physical exam, there is no jaundice or scleral icterus, and palpation of the
RUQ produces guarding and rebound. Ultrasound of the RUQ shows gallbladder wall thickness of
5 mm and mild pericholecystic fluid. What is the diagnosis?
B. Acute cholecystitis
C. Cholelithiasis
D. Acute cholangitis
E. Chronic cholecystitis
F. Biliary dyskinesia
- Correct Answer :Acute cholecystitis
Correct.
A) Acute cholecystitis is defined by pericholecystic fluid and gallbladder wall thickening > 4mm.
, Absite Exam Test Bank
B) The ultrasound did not specify the presence of stones in the gallbladder.
C) Acute cholangitis requires the classic triad jaundice of the skin or sclera, fever and RUQ pain.
D) Chronic cholecystitis usually lasts longer than several days or has occurred on and off for
some time.
E) Biliary dyskinesia does not cause a SIRS response or pericholecystic fluid and gallbladder wall
thickening.
A 42-year-old woman with BMI 42 kg/m2 presents with stabbing RUQ pain occurring after meals
for the last 3 days, sometimes waking her from sleep. She had a myocardial infarction 2 months
ago treated with a stent. She is on clopidogrel. Her vitals are T 36.5°C, HR 75 bpm, BP 135/74
mmHg, RR 16 breaths/min, 100% on RA. She is jaundiced and has RUQ tenderness to deep
palpation. Her total bilirubin is 4.0 mg/dL, direct bilirubin 3.2 mg/dL, and alkaline phosphatase
200 IU/L. Her WBC is normal and serum troponins are not elevated. EKG demonstrates normal
A+ TEST BANK 2
, Absite Exam Test Bank
sinus rhythm. An ultrasound of the RUQ reveals stones in the gallbladder. What imaging study
would you consider next?
A. CT scan without contrast
B. HIDA scan with administration of cholecystokinin
C. Plain radiograph of the abdomen
D. Magnetic resonance cholangiopancreatography (MRCP)
E. Endoscopic retrograde cholangiopancreatography (ERCP)
- Correct Answer :D. Magnetic resonance cholangiopancreatography (MRCP)
Correct.
This patient likely has choledocholithiasis given her elevated bilirubin and alkaline phosphatase.
US can only show stones in the CBD 10-15% of the time. If clinically suspicious of
choledocholithiasis, the next imaging study could be endoscopic retrograde
cholangiogram/endoscopic US (ERC/EUS) or MRCP. Since this patient recently had an MI and is
anticoagulated, she should undergo the least invasive procedure, an MRCP, and rule out other
causes of increased hepatic function panel before undergoing an invasive procedure such as
ERC/EUS.
MRCP can diagnose CBD stones with a sensitivity of 90%, a specificity of 100%, and an overall
diagnostic accuracy of 97%.
A) CT scan without contrast has great sensitivity and specificity for stones in the renal system.
For the gallbladder, calcified stones can only be visualized 50% of the time.
B) 99mTechnetium-labeled iminodiacetic acid derivatives (hepatic 2,6-dimethyl-iminodiacetic
acid [HIDA], diisopropyl-acetanilidoiminodiacetic acid, P-isopropylacetanilido-imidodiacetic acid)
scans with cholecystokinin administration should be used to identify biliary dyskinesia.
C) Plain x-rays of the abdomen identify stones only 15% of the time and it would be impossible to
differentiate a CBD stone from a gallbladder stone on x-ray.
D) Since this patient recently had an MI, she should undergo the least invasive procedure, an
MRCP, and rule out other causes of increased hepatic function panel before undergoing an
invasive procedure such as ERC/EUS.
E) Endoscopic retrograde cholangiogram/endoscopic US (ERC/EUS) is more invasive than MRCP;
this patient would be high risk for an invasive procedure.
A 55-year-old male presents with RUQ pain over the last 24 hours. Ultrasound confirms acute
cholecystitis, with gallbladder wall thickening, pericholecystic fluid, and multiple stones. The CBD
is not visualized because of overlying bowel gas. His laboratory workup is as follows: WBC
A+ TEST BANK 3
, Absite Exam Test Bank
17,000, total bilirubin 2.5, AST/ALT 150/170, alkaline phosphatase 138. He is not febrile. His past
surgical history includes a Roux-en-Y gastric bypass and a cerebral aneurysm repair. What is the
best next step in his management?
A. Open cholecystectomy
B. Laparoscopic cholecystectomy with intraoperative cholangiogram
C. CT abdomen/pelvis
D. MRCP
E. ERCP
- Correct Answer :B. Laparoscopic cholecystectomy with intraoperative cholangiogram
Correct.
This patient has cholecystitis with abnormal liver function tests. His CBD needs to be visualized
preoperatively or intraoperatively. Options generally include MRCP, ERCP, and/or intraoperative
cholangiogram (IOC). Roux-en-Y gastric bypass does not preclude laparoscopic cholecystectomy.
Contraindications to MRCP include older heart pacemakers, implanted metallic devices (insulin
pumps, hearing aids, neurostimulators), intracranial metal clips, and metallic bodies in the eye.
A 65-year-old man presents to the ER with complaints of stabbing RUQ pain occurring for several
days, and according to his family, has become increasingly aggravated and confused. His vitals
are T 39°C, HR 115 bpm, BP 94/71 mmHg, RR 20 breaths/min, 100% on RA. He is jaundiced and
exhibits a positive Murphy's sign. Labs reveal elevated bilirubin, alkaline phosphatase, and WBC.
His troponins are negative and EKG demonstrates normal sinus rhythm. His disease process is
most likely caused by which organism?
A. Staphylococcus aureus
B. Staphylococcus epididymis
C. Streptococcus pneumonia
D. Clostridium perfringens
E. Klebsiella pneumonia
- Correct Answer :E. Klebsiella pneumoniae
Correct.
The patient is suffering from acute cholangitis, which is most commonly caused by E. coli,
Klebsiella pneumoniae, enterococci, and Bacteroides fragilis.
ERCP is generally considered technically impossible after a Roux-en-Y gastric bypass. CT A/P does
not provide adequate visualization of the CBD, and cannot reliably rule out a CBD stone.
An 83-year-old male with CAD, CHF and COPD is admitted to the MICU with a COPD exacerbation
during which he develops acute, acalculous cholecystitis as confirmed by RUQ US and HIDA scan.
He has a cholecystostomy tube placed. Two weeks after tube placement with resolution of his
cholecystitis and improvement of his COPD, he is ready for discharge to a skilled nursing facility.
