Hepatobiliary and pancreatic surgery: recurrent pyogenic 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 · Hepatobiliary and pancreatic surgery: recurrent pyogenic cholangitis

Sample item

A 40-year-old woman from East Asia has repeated episodes of cholangitis. Imaging shows dilated intrahepatic ducts of the left lateral segment and right posterior sector filled with soft stones. Which type of stone is typical of this condition?

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

The answer and the reasoning

B. Brown pigment stones

Recurrent pyogenic cholangitis is associated with biliary parasitic infestation and bacterial infection. Bacterial beta-glucuronidase deconjugates bilirubin, forming soft brown pigment stones within intrahepatic and extrahepatic ducts, with strictures and repeated cholangitis.

Option by option

  • A. Pure cholesterol stones

    Cholesterol stones form in the gallbladder from supersaturated bile.

  • B. Brown pigment stones (correct)

    Correct. Infected, stagnant bile produces soft brown pigment stones.

  • C. Black pigment stones

    Black stones are associated with chronic haemolysis and cirrhosis, not duct infection.

  • D. Calcium carbonate stones

    Calcium carbonate stones are rare and associated with limy bile.

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, Brown pigment stones. Recurrent pyogenic cholangitis is associated with biliary parasitic infestation and bacterial infection.

Why is "Pure cholesterol stones" not the answer?

Cholesterol stones form in the gallbladder from supersaturated bile.

Why is "Black pigment stones" not the answer?

Black stones are associated with chronic haemolysis and cirrhosis, not duct infection.

Why is "Calcium carbonate stones" not the answer?

Calcium carbonate stones are rare and associated with limy bile.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: recurrent pyogenic cholangitis in General Surgery. Bacterial beta-glucuronidase deconjugates bilirubin, forming soft brown pigment stones within intrahepatic and extrahepatic ducts, with strictures and repeated cholangitis.

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: recurrent pyogenic 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.