Gastroenterology & Nutrition
Final Test Review
(Questions & Solutions)
2025
1
,1. A 48-year-old woman with right upper quadrant pain, fever, and
leukocytosis has an ultrasound showing gallbladder wall thickening and a
positive sonographic Murphy’s sign. What is the next best step?
A) Administer ceftriaxone and schedule cholecystectomy within 24–48
hours
B) Oral ursodeoxycholic acid for 6 months
C) Percutaneous cholecystostomy only
D) ERCP to remove gallstones
Correct ANS: A
Rationale: Acute calculous cholecystitis is best managed initially with
broad‐spectrum antibiotics and early laparoscopic cholecystectomy
within 1–2 days in a stable patient.
2. A 65-year-old diabetic man has biliary colic pain and an ultrasound
showing multiple 3–5 mm gallstones without inflammation. Which is the
most appropriate management?
A) Elective laparoscopic cholecystectomy
B) Emergency ERCP
C) Observation only
D) Ursodeoxycholic acid dissolution therapy
Correct ANS: A
Rationale: Symptomatic cholelithiasis warrants elective cholecystectomy;
dissolution therapy is slower and less effective for multiple stones.
3. A 55-year-old woman presents with Charcot’s triad (fever, RUQ pain,
jaundice). Labs show elevated ALP and bilirubin. Ultrasound reveals a
dilated common bile duct. What is the initial intervention?
A) Emergent ERCP with biliary decompression
B) IV fluids only
C) Immediate cholecystectomy
D) Percutaneous transhepatic cholangiography
Correct ANS: A
Rationale: Acute cholangitis requires prompt biliary drainage—preferably
2
, ERCP—to reduce mortality along with antibiotics.
4. A 45-year-old man presents with acute epigastric pain radiating to the
back. Serum lipase is elevated. Ultrasound shows gallstones in the
gallbladder without CBD stones. What is the next step?
A) Conservative management then early cholecystectomy
B) Immediate ERCP
C) Ursodeoxycholic acid
D) Pancreatic resection
Correct ANS: A
Rationale: In gallstone pancreatitis without evidence of ductal
obstruction, initial supportive care followed by cholecystectomy during
the same hospitalization prevents recurrence.
5. An ICU patient on TPN develops unexplained fever and RUQ
tenderness. Ultrasound shows gallbladder distention without stones.
What is most likely and how treat?
A) Acalculous cholecystitis—percutaneous cholecystostomy
B) Acute cholangitis—ERCP
C) Chronic cholecystitis—oral antibiotics
D) Gallstone pancreatitis—urgent cholecystectomy
Correct ANS: A
Rationale: Critically ill patients can develop acalculous cholecystitis;
percutaneous cholecystostomy is the preferred temporizing intervention.
---
Colorectal Disorders (5 questions)
6. A 70-year-old woman with sudden onset left lower quadrant pain and
fever is diagnosed with uncomplicated diverticulitis on CT. Management
should include:
A) Oral antibiotics, clear liquid diet, outpatient follow-up
B) Immediate surgical resection
C) High‐fiber diet without antibiotics
3
Final Test Review
(Questions & Solutions)
2025
1
,1. A 48-year-old woman with right upper quadrant pain, fever, and
leukocytosis has an ultrasound showing gallbladder wall thickening and a
positive sonographic Murphy’s sign. What is the next best step?
A) Administer ceftriaxone and schedule cholecystectomy within 24–48
hours
B) Oral ursodeoxycholic acid for 6 months
C) Percutaneous cholecystostomy only
D) ERCP to remove gallstones
Correct ANS: A
Rationale: Acute calculous cholecystitis is best managed initially with
broad‐spectrum antibiotics and early laparoscopic cholecystectomy
within 1–2 days in a stable patient.
2. A 65-year-old diabetic man has biliary colic pain and an ultrasound
showing multiple 3–5 mm gallstones without inflammation. Which is the
most appropriate management?
A) Elective laparoscopic cholecystectomy
B) Emergency ERCP
C) Observation only
D) Ursodeoxycholic acid dissolution therapy
Correct ANS: A
Rationale: Symptomatic cholelithiasis warrants elective cholecystectomy;
dissolution therapy is slower and less effective for multiple stones.
3. A 55-year-old woman presents with Charcot’s triad (fever, RUQ pain,
jaundice). Labs show elevated ALP and bilirubin. Ultrasound reveals a
dilated common bile duct. What is the initial intervention?
A) Emergent ERCP with biliary decompression
B) IV fluids only
C) Immediate cholecystectomy
D) Percutaneous transhepatic cholangiography
Correct ANS: A
Rationale: Acute cholangitis requires prompt biliary drainage—preferably
2
, ERCP—to reduce mortality along with antibiotics.
4. A 45-year-old man presents with acute epigastric pain radiating to the
back. Serum lipase is elevated. Ultrasound shows gallstones in the
gallbladder without CBD stones. What is the next step?
A) Conservative management then early cholecystectomy
B) Immediate ERCP
C) Ursodeoxycholic acid
D) Pancreatic resection
Correct ANS: A
Rationale: In gallstone pancreatitis without evidence of ductal
obstruction, initial supportive care followed by cholecystectomy during
the same hospitalization prevents recurrence.
5. An ICU patient on TPN develops unexplained fever and RUQ
tenderness. Ultrasound shows gallbladder distention without stones.
What is most likely and how treat?
A) Acalculous cholecystitis—percutaneous cholecystostomy
B) Acute cholangitis—ERCP
C) Chronic cholecystitis—oral antibiotics
D) Gallstone pancreatitis—urgent cholecystectomy
Correct ANS: A
Rationale: Critically ill patients can develop acalculous cholecystitis;
percutaneous cholecystostomy is the preferred temporizing intervention.
---
Colorectal Disorders (5 questions)
6. A 70-year-old woman with sudden onset left lower quadrant pain and
fever is diagnosed with uncomplicated diverticulitis on CT. Management
should include:
A) Oral antibiotics, clear liquid diet, outpatient follow-up
B) Immediate surgical resection
C) High‐fiber diet without antibiotics
3
