Hepatobiliary: 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

Sample item

A man with gallstones presents with fever, jaundice, right upper quadrant pain, hypotension and confusion. Which step is most important after starting antibiotics and fluid resuscitation?

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

The answer and the reasoning

D. Urgent biliary decompression by ERCP

Fever, jaundice and pain with hypotension and confusion form Reynolds pentad, indicating severe acute suppurative cholangitis from an obstructed bile duct. Antibiotics and resuscitation alone are insufficient, and the obstructed duct must be drained urgently, usually by ERCP with stenting or stone removal.

Option by option

  • A. HIDA scan before any intervention

    A HIDA scan delays treatment and is not needed to diagnose obstructive cholangitis.

  • B. Elective cholecystectomy after discharge

    Cholecystectomy is deferred and does not drain an infected obstructed duct in the emergency.

  • C. Oral antibiotics and review in a week

    Oral antibiotics and a delayed review are unsafe for a septic, shocked patient.

  • D. Urgent biliary decompression by ERCP (correct)

    Correct. Relieving the biliary obstruction is lifesaving in severe cholangitis.

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 D, Urgent biliary decompression by ERCP. Fever, jaundice and pain with hypotension and confusion form Reynolds pentad, indicating severe acute suppurative cholangitis from an obstructed bile duct.

Why is "HIDA scan before any intervention" not the answer?

A HIDA scan delays treatment and is not needed to diagnose obstructive cholangitis.

Why is "Elective cholecystectomy after discharge" not the answer?

Cholecystectomy is deferred and does not drain an infected obstructed duct in the emergency.

Why is "Oral antibiotics and review in a week" not the answer?

Oral antibiotics and a delayed review are unsafe for a septic, shocked patient.

What concept does this question test?

It tests Hepatobiliary in General Surgery. Antibiotics and resuscitation alone are insufficient, and the obstructed duct must be drained urgently, usually by ERCP with stenting or stone removal.

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?

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.