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Acute cholecystitis — MCCQE Part 1 MCQ

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HardAbdominal PainAcute cholecystitisMCCQE Part 1

A 47-year-old woman presents with right upper-quadrant pain, fever, and vomiting after meals. She has a positive Murphy sign, WBC 16 x 10^9/L, bilirubin 18 µmol/L, and ultrasound shows gallstones with gallbladder wall thickening. What is the most likely diagnosis?

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Correct answer: D — Acute cholecystitis

Fever, leukocytosis, Murphy sign, gallstones, and gallbladder wall thickening indicate acute cholecystitis. Biliary colic causes episodic pain without systemic inflammation or wall thickening. Ascending cholangitis usually has jaundice and biliary obstruction. Hepatitis and pneumonia can cause right-sided discomfort but do not fit the ultrasound and Murphy sign pattern.

Reference: Canadian Association of General Surgeons biliary disease resources