Biliary: risk stratification for duct stones: 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.

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General Surgery · Biliary: risk stratification for duct stones

Sample item

A 38-year-old woman with symptomatic gallstones has ALT 130 U/L, total bilirubin 2.8 mg/dL and a common bile duct of 7 mm on ultrasound with no stone seen. She has no fever. What is the best next step before cholecystectomy?

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

The answer and the reasoning

B. MRCP or endoscopic ultrasound

Abnormal liver tests and a mildly dilated duct without a visible stone place her at intermediate risk of choledocholithiasis. Intermediate-risk patients should have a non-invasive confirmatory test, MRCP or endoscopic ultrasound, or intraoperative cholangiography. ERCP, which carries pancreatitis and bleeding risks, is reserved for a stone seen on imaging, cholangitis or very high-risk features.

Option by option

  • A. Cholecystectomy without any biliary evaluation

    Proceeding blind risks leaving an obstructing stone in the duct.

  • B. MRCP or endoscopic ultrasound (correct)

    Correct. MRCP or EUS confirms or excludes a duct stone non-invasively in intermediate risk.

  • C. Oral ursodeoxycholic acid for 6 months

    Dissolution therapy is slow and does not address a possible duct stone.

  • D. Direct ERCP with sphincterotomy

    Direct ERCP exposes her to avoidable complications when no stone has been demonstrated.

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.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, MRCP or endoscopic ultrasound. Abnormal liver tests and a mildly dilated duct without a visible stone place her at intermediate risk of choledocholithiasis.

Why is "Cholecystectomy without any biliary evaluation" not the answer?

Proceeding blind risks leaving an obstructing stone in the duct.

Why is "Oral ursodeoxycholic acid for 6 months" not the answer?

Dissolution therapy is slow and does not address a possible duct stone.

Why is "Direct ERCP with sphincterotomy" not the answer?

Direct ERCP exposes her to avoidable complications when no stone has been demonstrated.

What concept does this question test?

It tests Biliary: risk stratification for duct stones in General Surgery. Intermediate-risk patients should have a non-invasive confirmatory test, MRCP or endoscopic ultrasound, or intraoperative cholangiography. ERCP, which carries pancreatitis and bleeding risks, is reserved for a stone seen on imaging, cholangitis or very high-risk features.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Biliary: risk stratification for duct stones?

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.