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Acute cholecystitis — SCE Acute Medicine MCQ

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ModerateAcute Gastrointestinal PresentationsAcute cholecystitisSCE Acute Medicine

A 69-year-old woman presents with acute abdominal pain, bleeding, jaundice or vomiting. Relevant history includes gastrointestinal or hepatobiliary risk factors. On assessment, abdominal examination and physiology suggest significant acute illness. Investigations show Murphy sign with gallbladder wall thickening and pericholecystic fluid. 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 IV antibiotics and refer for early laparoscopic cholecystectomy

The key discriminator is that Murphy sign with gallbladder wall thickening and pericholecystic fluid, which makes Give IV antibiotics and refer for early laparoscopic cholecystectomy the single best answer. Start anticoagulation after assessing bleeding risk is less appropriate because it does not address the dominant acute risk in the vignette; Give analgesia and antiemetic therapy would fit a different presentation or later stage of care. Call critical care for escalation and Provide supportive care and close monitoring 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: NICE CG188