Acute cholecystitis — MCCQE Part 1 MCQ

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ModerateAbdominal PainAcute cholecystitisMCCQE Part 1

A 47-year-old woman has right upper quadrant pain for 12 hours, fever, positive Murphy sign and ultrasound showing gallstones with gallbladder wall thickening. Which of the following is the most appropriate next step?

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Correct answer: B — Admit for antibiotics, analgesia and early laparoscopic cholecystectomy assessment

Admit for antibiotics, analgesia and early laparoscopic cholecystectomy assessment is the single best answer because the age, timing, examination findings and investigations in the vignette fit Acute cholecystitis better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian Association of General Surgeons guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian Association of General Surgeons guidance