Biliary: primary sclerosing cholangitis: 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 · Biliary: primary sclerosing cholangitis

Sample item

A 32-year-old man with long-standing ulcerative colitis has fatigue, pruritus and a raised alkaline phosphatase. MRCP shows multifocal strictures and dilatations of intrahepatic and extrahepatic bile ducts. Which complication is he at increased risk of developing?

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

The answer and the reasoning

A. Cholangiocarcinoma

Primary sclerosing cholangitis is a progressive fibrosing inflammation of bile ducts with a beaded appearance on cholangiography, strongly associated with ulcerative colitis. Patients develop cirrhosis and have a markedly increased lifetime risk of cholangiocarcinoma, and also of colorectal cancer. Liver transplantation is the only definitive therapy.

Option by option

  • A. Cholangiocarcinoma (correct)

    Correct. Chronic duct inflammation predisposes to cholangiocarcinoma.

  • B. Pancreatic pseudocyst

    Pseudocyst follows pancreatitis and is not a characteristic complication of sclerosing cholangitis.

  • C. Gallbladder empyema

    Empyema of the gallbladder results from cystic duct obstruction by a stone.

  • D. Hepatic adenoma

    Hepatic adenoma is linked to oral contraceptives and anabolic steroids, not to biliary sclerosis.

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.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Cholangiocarcinoma. Primary sclerosing cholangitis is a progressive fibrosing inflammation of bile ducts with a beaded appearance on cholangiography, strongly associated with ulcerative colitis.

Why is "Pancreatic pseudocyst" not the answer?

Pseudocyst follows pancreatitis and is not a characteristic complication of sclerosing cholangitis.

Why is "Gallbladder empyema" not the answer?

Empyema of the gallbladder results from cystic duct obstruction by a stone.

Why is "Hepatic adenoma" not the answer?

Hepatic adenoma is linked to oral contraceptives and anabolic steroids, not to biliary sclerosis.

What concept does this question test?

It tests Biliary: primary sclerosing cholangitis in General Surgery. Patients develop cirrhosis and have a markedly increased lifetime risk of cholangiocarcinoma, and also of colorectal cancer. Liver transplantation is the only definitive therapy.

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 Biliary: primary sclerosing cholangitis?

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.