USMLE Step 1 Question 297

Question:

A 42-year-old woman presents to the ER with five hours of steadily increasing abdominal pain. The pain is associated with nausea and vomiting, and began soon after a heavy meal. Physical exam reveals an overweight middle aged woman in mild distress. She has no signs of jaundice. Her abdomen is exquisitely tender in the right upper quadrant. The remainder of the exam is normal. Ultrasound shows several 3 cm gallstones, an edematous gallbladder wall, and a positive sonographic Murphy’s sign.

For what malignancy is she at increased risk?

Correct Answer: A.  Carcinoma of the gallbladder

This patient demonstrates the clinical picture of acute cholecystitis, which is not a risk factor for carcinoma of the gallbladder. However, multiple large stones do increase the risk of this condition. It should be noted that the vast majority of patients with cholelithiasis will not develop carcinoma of the gallbladder.

Neither cholelithiasis nor cholecystitis are associated with increased risk of cholangiocarcinoma. Risk factors include Primary sclerosing cholangitis, chronic duct inflammation, infections, and ulcerative colitis.

Hepatoblastoma is a rare malignant neoplasm of children.

Hepatocellular carcinoma risk factors include cirrhosis, Hepatitis C, and Hepatitis B.

Pancreatic cancer risk factors include smoking, a high fat diet, and chemical exposures. Of note, alcohol consumption is not a demonstrated risk factor.