CSHK Part 2 EMQ Practice Questions - MHKICBSC Part 2 - Clinical Problem Solving EMQ Exam

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A 45-year-old diabetic female presents with a 24-hour history of severe, constant right upper quadrant pain, radiating to the right scapula, accompanied by nausea and low-grade fever (37.9°C). On examination, she has marked tenderness in the right upper quadrant with a positive Murphy's sign. Lab results show a white blood cell count of 14.8 x 10^9/L and mildly elevated C-reactive protein. Transabdominal ultrasound reveals a distended gallbladder with a thickened wall (5 mm), pericholecystic fluid, and multiple gallstones, with one impacted in the gallbladder neck. What is the most appropriate management?

Early laparoscopic cholecystectomy within 72 hours of symptom onset Intravenous antibiotics and bowel rest, followed by elective interval cholecystectomy in 6 to 8 weeks Emergent percutaneous transhepatic cholecystostomy tube placement Endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting

Correct Answer:

Early laparoscopic cholecystectomy within 72 hours of symptom onset

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