Published 14 October 2009, doi:10.1136/bmj.b4157
Cite this as: BMJ 2009;339:b4157

Endgames

OnExamination quiz

Gallbladder disease

The answers to this question, and more questions on this topic, are available from www.onexamination.com/endgames until midnight on Wednesday.

This week’s quiz is on gallbladder disease and is taken from the OnExamination revision questions for the MRCS part A exam, papers 1 and 2.

Presentation 1

A 48 year old woman is referred as an emergency with severe right upper quadrant pain. On examination she has a fever and a tender, palpable right subcostal mass with local peritonism.

Presentation 2

A 43 year old obese, multiparous woman seen in the emergency department reports a first episode of right upper quadrant pain and nausea. The pain settled completely by the time the casualty officer has her blood results back. She does not have a fever and has only minimal right subcostal tenderness.

Presentation 3

A 54 year old woman is admitted with severe epigastric pain and vomiting. She has a long history of recurrent right upper quadrant pain. An upper abdominal ultrasound arranged by her general practitioner had shown gallstones but the patient had not been referred. On examination she has marked epigastric tenderness.

Presentation 4

A 47 year old woman has had recurrent episodes of biliary colic. She is admitted with severe right upper quadrant pain associated with a fever of 38°C and localised tenderness in the right hypochondrium.

Presentation 5

An 82 year old man with heart failure is referred from the cardiology ward with sudden onset of severe abdominal pain and vomiting. On examination he has tachycardia of 110 beats a minute, is hypotensive (85/60 mm Hg), and his abdomen is rigid.

For each of these presentations, choose the single most likely cause from the list of options below. Each option may be used once, more than once, or not at all.

A Acute cholecystitis

B Acute pancreatitis

C Ascending cholangitis

D Biliary colic

E Biliary peritonitis

F Choledocholithiasis

G Empyema

H Gallstone ileus

I Mirizzi syndrome

J Mucocele

Cite this as: BMJ 2009;339:b4157

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