American Board of Internal Medicine (ABIM) Certification Practice Exam

Prophylactic cholecystectomy should be performed in asymptomatic patients with gallbladder polyps larger than what size?

1. 0.5 cm

2. 1 cm

3. 1.5 cm

4. 2 cm

The correct answer is: 1 cm

Prophylactic cholecystectomy is recommended for asymptomatic patients with gallbladder polyps when the polyps are larger than 1 cm. This threshold is based on the understanding that polyps of this size carry a greater risk of malignancy, specifically gallbladder cancer. Studies have shown that polyps larger than 1 cm have a significant likelihood of being neoplastic or having other potential complications, hence justifying surgical intervention to prevent future issues. While smaller polyps, especially those under 1 cm, are generally considered to have a much lower risk of cancer and may simply be monitored instead of surgically removed, the 1 cm mark serves as a critical point at which the risk-benefit analysis favors surgery. This is why routine surveillance or management strategies might be more appropriate for polyps below this size. The decision-making process takes into account not only the size of the polyp but also factors like patient age, overall health, and possible symptoms in order to determine the best course of action. Thus, the recommendation for prophylactic cholecystectomy is particularly focused on polyps that meet or exceed the 1 cm size criterion.