Hepatobiliary: Mirizzi syndrome: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Surgery · Hepatobiliary: Mirizzi syndrome

Sample item

A 60-year-old woman has jaundice and right upper quadrant pain. Ultrasound shows a large stone impacted in the neck of the gallbladder, dilated intrahepatic ducts and common hepatic duct, and a normal-calibre distal common bile duct. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Mirizzi syndrome

In Mirizzi syndrome a stone in the gallbladder neck or cystic duct compresses the common hepatic duct from outside, or erodes into it forming a cholecystocholedochal fistula. The result is obstructive jaundice with a normal distal common bile duct. Operative bile duct injury is a particular risk, so this is usually managed by partial cholecystectomy or bile duct reconstruction.

Option by option

  • A. Mirizzi syndrome (correct)

    Extrinsic compression of the common hepatic duct above a normal distal duct is the hallmark of Mirizzi syndrome.

  • B. Caroli disease

    Caroli disease is congenital saccular dilatation of intrahepatic bile ducts, not a stone-related problem.

  • C. Choledocholithiasis

    A stone in the common bile duct would dilate the duct down to the distal obstruction.

  • D. Bouveret syndrome

    Bouveret syndrome is a gallstone impacted in the duodenum causing gastric outlet obstruction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is A, Mirizzi syndrome. In Mirizzi syndrome a stone in the gallbladder neck or cystic duct compresses the common hepatic duct from outside, or erodes into it forming a cholecystocholedochal fistula.

Why is "Caroli disease" not the answer?

Caroli disease is congenital saccular dilatation of intrahepatic bile ducts, not a stone-related problem.

Why is "Choledocholithiasis" not the answer?

A stone in the common bile duct would dilate the duct down to the distal obstruction.

Why is "Bouveret syndrome" not the answer?

Bouveret syndrome is a gallstone impacted in the duodenum causing gastric outlet obstruction.

What concept does this question test?

It tests Hepatobiliary: Mirizzi syndrome in General Surgery. The result is obstructive jaundice with a normal distal common bile duct. Operative bile duct injury is a particular risk, so this is usually managed by partial cholecystectomy or bile duct reconstruction.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary: Mirizzi syndrome?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.