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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose topic is acalculous cholecystitis. While this may seem a odd practice, it is useful to see multiple examples of how acalculous 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 topic is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for acalculous cholecystitis.
- Patines demographic: severely ill (often hospitalized) patients.
- Fever is often present
- RUQ abdominal pain: is often present
- Lab findings include:
- Elevated white count
- Elevated liver enzymes
QUESTION EXAMPLES
Question # 1
An 80 year old hospitalized male is evaluated for a fever and abdominal pain. He was admitted to the floor 3 weeks ago for severe sepsis caused by necrotizing fasciitis of his upper thigh. He has been treated with surgical debridement, IV antibiotics, and IV fluids. For the past few days he has complained of right upper quadrant pain and nausea. His vitals have also shown a recurrent fever. His past medical history is notable for hypertension, type 2 diabetes, COPD, . Currently is temperature is 102.1°F. His physical exam reveals tenderness of the right subcostal area. Labs are notable for a white count of 17,000/mm³ that arose today compared to a count of 8,700/mm³ two days ago. What is a possible diagnosis in this patient?
Explanation # 1
Severely ill patient + fever + RUQ pain + leukocytosis = acalculous cholecystitis
Question # 2
A 60 year old male develops a fever 3 days after undergoing coronary artery bypass surgery that required 3 grafts. Currently the patient is intubated and still is receiving mechanical ventilation. His past medical history is notable for hypertension, hyperlipidemia, and type 2 diabetes. His temperature is 102.2°F, blood pressure is 125/85 mmHg, and pulse is 87 bpm. A physical exam reveals coarse breath sounds bilaterally. His cardiac exam is unremarkable. When his right upper quadrant is palpated the patient grimaces in pain. Laboratory results are shown below:
- Hemoglobin: 11.0 g/dL
- Platelets: 160,000/mm³
- Leukocytes: 17,500/mm³**
- Total bilirubin: 1.0 mg/dL
- ALP: 105 U/L
- AST: 30 U/L
- ALT: 32 U/L
- Amylase: 100 U/L
A portable chest X-ray is performed and is non-contributory to the workup. What diagnosis must be considered in this patient?
Explanation # 2
Severely ill patient + fever + RUQ pain + leukocytosis = acalculous cholecystitis
Question # 3
Explanation # 3
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Page Updated: 05.25.2017