American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most common clinical presentation in patients with symptomatic gallstones?

1. Biliary colic

2. Cholecystitis

3. Pancreatitis

4. Gastritis

The correct answer is: Biliary colic

Biliary colic is the most common clinical presentation in patients with symptomatic gallstones due to the nature of the pain associated with gallstones blocking the cystic duct. This pain typically occurs in episodes and is characterized by a sudden onset, often triggered by the ingestion of fatty foods. Patients usually experience right upper quadrant pain, which may radiate to the back or right shoulder. In contrast, while cholecystitis can also occur with gallstones, it is typically a complication of biliary colic, resulting from prolonged obstruction leading to inflammation of the gallbladder. Pancreatitis can arise from gallstones as well, particularly if a stone travels to block the pancreatic duct, but it is less common than biliary colic as an initial symptom. Gastritis is unrelated to gallstones and involves inflammation of the stomach lining, making it an inappropriate choice in this context. Therefore, biliary colic stands out as the primary and most common manifestation of symptomatic gallstone disease.