This page is dedicated to organizing various examples of standardized exam questions whose answer is choledocholithiasis. While this may seem a odd practice, it is useful to see multiple examples of how choledocholithiasis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
Question # 1
A 45 year old woman comes to the clinic because she has had slow eyes, nausea, and right sided abdominal cramps for 1 week. About 7 weeks ago this patient underwent a laparoscopic cholecystectomy for acute cholecystitis. A the time of the operation an intra-operative cholangiography was not performed. She currently does not take any medications and has no allergies. Her vital signs are all within reference range. A physical exam reveals scleral icterus and there is right upper quadrant tenderness. There is no abodminla distention and no rebound tenderness. Serum studies are performed and shown below:
- Total bilirubin: 9 mg/dL
- Direct bilirubin: 6 mg/dL
- Alkaline phosphatase: 660 U/L
- AST: 18 U/L
- ALT: 15 U/L
What is the likely cause of this patient’s jaundice?
Explanation: jaundice+ high direct bilirubin + lap chole but no cholangiography + high alkaline phosphatase + normal AST/ALT = choledocholithiasis
Page Updated: 01.23.2017