OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is cholecystitis. While this may seem a odd practice, it is useful to see multiple examples of how cholecystitis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
QUESTION EXAMPLES
Question # 1
A 45-year-old female who has a history of alcoholism and presents to the emergency room with right upper quadrant abdominal pain that began after she had her dinner. She describes the pain is being sharp, and explains that it radiates to her left scapula. She also complains that she feels nauseous and has been vomiting. Her past medical history is remarkable for asymptomatic gallstones. She explains that she drinks about seven beers a day for the past 15 years. Her temperature is 101.3 F, blood pressure is 115/60 mm HG, her pulse is 96/min, and respirations are 18/min. On physical exam there is right upper quadrant tenderness with deep inspiration. The rest of her physical exam is noncontributory. Lab studies are shown below.
- Total bilirubin; space 1.2 mg/dL
- Direct bilirubin: 0.7 mg/dL
- Alkaline phosphatase: 126 U/L
- Aspartate aminotransferase: 45 U/L:
- Alanine aminotransferase: 67 U/L
- Amylase: 130 U/L
CBC shows leukocytosis with a left shift. What is the likely diagnosis in this patient?
Explanation: RUQ pain + Murphy sign + increased ALP = cholecystitis
Question # 2
A 45 year old obese mother of five children, has severe right upper quadrant abdominal pain that began five hours ago. The pain was colicky at first, radiated to the right shoulder and was accompanied by nausea and vomiting. For the past 2 hours the pain has been constant. She has tenderness to deep palpation, muscle guarding and rebound in the right upper quadrant. Her temperature is 101.3°F and she has a WBC count of 15,000. She has had similar episodes of pain in the past, brought about by ingestion of fatty food, but they all had been of brief duration and relented spontaneously or with anticholinergic medications.
Question # 3
An overweight age 40 female patient explains that she has had a history of repeated episodes of high supper quadrant pain. She explains that this pain is brought on when she eats fatty fast food, and becomes relieved when she takes anticholinergic medications. The pain is colicky, and is accompanied by nausea. Her past medical history is notable for 5 vaginal deliveries. Her physical exam is non-contributory. What is the likely diagnosis?
Explanation: cholecystitis (secondary to cholelithiasis)
Page Updated: 01.31.2017