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

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A 68-year-old female presents with severe right upper quadrant pain, deep jaundice, and high swinging fevers with rigors (temperature 39.2°C). Her blood pressure is 95/60 mmHg and heart rate is 114 bpm. Laboratory studies reveal total bilirubin of 7.2 mg/dL, alkaline phosphatase 480 IU/L, and leukocyte count of 18,200/mcL. Abdominal ultrasound shows a dilated common bile duct (13 mm) with an acoustic shadow in the distal duct and intrahepatic biliary radical dilation. What is the most appropriate next step in definitive management following fluid resuscitation and broad-spectrum intravenous antibiotics?

Urgent endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy and drainage Emergency open choledochotomy and T-tube placement Elective MRCP in 48 hours after clinical stabilization Immediate surgical common bile duct exploration via laparotomy

Correct Answer:

Urgent endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy and drainage

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