Arab Board Surgery Clinical Practice Questions - Arab Board General Surgery Final Clinical And Oral Exam

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A 52-year-old female presents with a 36-hour history of severe right upper quadrant pain radiating to the right scapula, nausea, vomiting, and a fever of 38.4°C. On examination, she exhibits marked inspiratory arrest during deep palpation of the right subcostal margin (positive Murphy's sign). Laboratory tests show a white blood cell count of 15,400/mcL, with normal bilirubin, alkaline phosphatase, and transaminases. Ultrasound shows a distended gallbladder with multiple gallstones, gallbladder wall thickness of 5 mm, and pericholecystic fluid, with a 4 mm common bile duct. What is the most appropriate management plan?

Elective laparoscopic cholecystectomy 6 to 8 weeks after conservative antibiotic therapy Early laparoscopic cholecystectomy during the index admission Endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy Percutaneous cholecystostomy tube placement under local anesthesia

Correct Answer:

Early laparoscopic cholecystectomy during the index admission

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