Hepatobiliary and pancreatic surgery: acute cholangitis management: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hepatobiliary and pancreatic surgery: acute cholangitis management

Sample item

A patient with gallstones has fever with rigors, jaundice, right upper quadrant pain, confusion and a blood pressure of 80/50 mmHg. Which is the best definitive step after resuscitation and antibiotics?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Urgent biliary decompression by ERCP

Charcot triad plus shock and confusion is Reynolds pentad, indicating severe suppurative cholangitis. Urgent decompression by ERCP with stent or sphincterotomy is lifesaving, with percutaneous transhepatic drainage if ERCP fails.

Option by option

  • A. Elective cholecystectomy next month

    Elective surgery leaves the patient in septic shock.

  • B. Liver biopsy

    Biopsy does not treat sepsis.

  • C. Urgent biliary decompression by ERCP (correct)

    Correct. Drainage of the infected obstructed system is urgent.

  • D. Oral ursodeoxycholic acid

    Oral drugs will not relieve obstruction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Urgent biliary decompression by ERCP. Charcot triad plus shock and confusion is Reynolds pentad, indicating severe suppurative cholangitis.

Why is "Elective cholecystectomy next month" not the answer?

Elective surgery leaves the patient in septic shock.

Why is "Liver biopsy" not the answer?

Biopsy does not treat sepsis.

Why is "Oral ursodeoxycholic acid" not the answer?

Oral drugs will not relieve obstruction.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: acute cholangitis management in General Surgery. Urgent decompression by ERCP with stent or sphincterotomy is lifesaving, with percutaneous transhepatic drainage if ERCP fails.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary and pancreatic surgery: acute cholangitis management?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.