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Acute cholecystitis — MCCQE Part 1 MCQ

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ModerateAbdominal PainAcute cholecystitisMCCQE Part 1

52-year-old woman presents with right upper-quadrant pain and fever. Murphy sign is positive, WBC is elevated and ultrasound shows gallstones with gallbladder wall thickening. Which of the following is the most appropriate next step?

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Correct answer: D — Start antibiotics and arrange early laparoscopic cholecystectomy consultation

Start antibiotics and arrange early laparoscopic cholecystectomy consultation is best because fever, Murphy sign and ultrasound findings are consistent with acute cholecystitis. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Biliary colic is episodic without systemic inflammation; cholecystitis is inflammatory.

Reference: Canadian Association of General Surgeons guidance