Hepatobiliary: acute cholecystitis: 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: acute cholecystitis

Sample item

A 45-year-old woman has 36 hours of right upper quadrant pain, fever and a positive Murphy sign. Ultrasound shows gallstones, a thickened gallbladder wall and pericholecystic fluid, without bile duct dilatation. What is the best definitive management?

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

The answer and the reasoning

B. Intravenous antibiotics and early laparoscopic cholecystectomy, ideally within 72 hours of onset

Acute calculous cholecystitis follows cystic duct obstruction by a stone, with inflammation and secondary infection. Early laparoscopic cholecystectomy, preferably within 72 hours of onset and up to 7 days, shortens hospital stay and reduces complications compared with delayed surgery. Antibiotics and analgesia are given at once. Drainage by percutaneous cholecystostomy is for patients too unwell for surgery.

Option by option

  • A. Antibiotics alone, with elective surgery after 6 months

    Delaying surgery for months risks recurrent attacks, empyema or perforation during the wait.

  • B. Intravenous antibiotics and early laparoscopic cholecystectomy, ideally within 72 hours of onset (correct)

    Correct. Early laparoscopic surgery after starting antibiotics is the preferred definitive treatment.

  • C. Immediate open exploration of the common bile duct

    There is no sign of a bile duct stone, so exploration is not needed.

  • D. Oral ursodeoxycholic acid to dissolve the stones

    Bile acid therapy dissolves only small cholesterol stones over a long period and does not treat acute inflammation.

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 B, Intravenous antibiotics and early laparoscopic cholecystectomy, ideally within 72 hours of onset. Acute calculous cholecystitis follows cystic duct obstruction by a stone, with inflammation and secondary infection.

Why is "Antibiotics alone, with elective surgery after 6 months" not the answer?

Delaying surgery for months risks recurrent attacks, empyema or perforation during the wait.

Why is "Immediate open exploration of the common bile duct" not the answer?

There is no sign of a bile duct stone, so exploration is not needed.

Why is "Oral ursodeoxycholic acid to dissolve the stones" not the answer?

Bile acid therapy dissolves only small cholesterol stones over a long period and does not treat acute inflammation.

What concept does this question test?

It tests Hepatobiliary: acute cholecystitis in General Surgery. Early laparoscopic cholecystectomy, preferably within 72 hours of onset and up to 7 days, shortens hospital stay and reduces complications compared with delayed surgery. Antibiotics and analgesia are given at once. Drainage by percutaneous cholecystostomy is for patients too unwell for surgery.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: acute cholecystitis?

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.