surger q - step1step1

[ArchivalUser]

Q88). A 75 year old woman is sent from the nursing home for evaluation of fever and altered mental status. The patient’s past medical history is significant for moderate Alzheimer’s dementia. On examination, she is confused. Her vitals reveal Temperature of 102F, Blood pressure 80/60 and a HR of 102/min. Chest and cardiovascular examination is benign. On abdominal examination, the patient moans upon palpation of right upper quadrant. Cholecystitis is suspected and ultrasound is obtained that reveals very distended gall bladder with pericholecystic fluid, a normal caliber common bile duct and a gall stone in the cystic duct. The patient is started on IV Normal saline and broad spectrum antibiotics. Her blood pressure despite initial hydration is still 80/40. She is started on Norepinephrine drip. The next most important step in managing this patient ?

A. Urgent Cholecystectomy

B. Endoscopic Retrograde Cholangiopancreatography

C. Percutaneous Cholecystostomy

D. 2D echocardiogram

E. Exploratory Laporotomy

I do not have answer for this..... Is this A? But patient is unstable.... I am not sure...

[ArchivalUser]

C? this patient is very sick

[ArchivalUser]

c..

[ArchivalUser]

C...

[ArchivalUser]

C because less invasive?

[ArchivalUser]

Answer. C
Unstable patient in most likely, septic shock because of gall bladder empyema. Drainage of pus is the first step. Open drainage and cholecystectomy carry a high mortality in this patient who is already hypotensive. Hence, percutaneous cholecystostomy can be safely done to drain the pus and control infection in a less invasive way. ( this a question from archer review )

[ArchivalUser]

ccc

[ArchivalUser]

C. Percutaneous Cholecystostomy