#march2020mccqe1
A 45-year-old woman presents with a 12-hour history of right upper quadrant (RUQ) pain, fever and nausea. She has recently had two other episodes of less severe RUQ pain. She had a successful renal transplant 20 years ago and is on a stable dose of cyclosporin and steroids. Examination reveals a pulse rate of 95/min, temperature of 37.6°C and right upper quadrant abdominal tenderness. No underlying masses are palpable and the kidney transplant is nontender. Ultrasound examination shows a thick-walled gall bladder containing small stones. Which one of the following is the most appropriate treatment?
(A) Biliary lithotripsy
(B) Laparoscopic cholecystectomy
(C) Percutaneous cholecystostomy
(D) Endoscopic retrograde cholangiopancreatography (ERCP) and stone retrieval
(E) Prolonged course of intravenous gentamicin and penicillin
A 45-year-old woman presents with a 12-hour history of right upper quadrant (RUQ) pain, fever and nausea. She has recently had two other episodes of less severe RUQ pain. She had a successful renal transplant 20 years ago and is on a stable dose of cyclosporin and steroids. Examination reveals a pulse rate of 95/min, temperature of 37.6°C and right upper quadrant abdominal tenderness. No underlying masses are palpable and the kidney transplant is nontender. Ultrasound examination shows a thick-walled gall bladder containing small stones. Which one of the following is the most appropriate treatment?
(A) Biliary lithotripsy
(B) Laparoscopic cholecystectomy
(C) Percutaneous cholecystostomy
(D) Endoscopic retrograde cholangiopancreatography (ERCP) and stone retrieval
(E) Prolonged course of intravenous gentamicin and penicillin
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