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Acute cholangitis with sepsis — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesAcute cholangitis with sepsisSCE Acute Medicine

A 29-year-old woman presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show fever, jaundice, shock and dilated common bile duct. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Give intravenous antibiotics and arrange urgent biliary drainage

The key discriminator is that fever, jaundice, shock and dilated common bile duct, which makes Give intravenous antibiotics and arrange urgent biliary drainage the single best answer. Arrange urgent CT imaging is less appropriate because it does not address the dominant acute risk in the vignette; Start anticoagulation after assessing bleeding risk would fit a different presentation or later stage of care. Give analgesia and antiemetic therapy and Arrange routine outpatient follow-up are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Tokyo Guidelines; NICE NG253