American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition should be evaluated in a critically ill patient presenting with fever and abdominal pain?

1. Acute pancreatitis

2. Acalculous cholecystitis

3. Appendicitis

4. Diverticulitis

The correct answer is: Acalculous cholecystitis

In critically ill patients, acalculous cholecystitis is a condition that warrants careful evaluation, particularly when symptoms such as fever and abdominal pain are present. This condition refers to inflammation of the gallbladder in the absence of gallstones, which is more common in patients who are critically ill, hospitalized, or who have other risk factors such as sepsis or prolonged fasting. The presentation of fever and abdominal pain in this context may indicate cholecystitis, and in critically ill patients, the typical signs may be less pronounced than in those who are otherwise healthy. Acalculous cholecystitis can lead to severe complications, including perforation and peritonitis, making timely diagnosis and management essential. Most other conditions listed, while they can cause fever and abdominal pain, may not be as commonly associated with critically ill patients as acalculous cholecystitis. For instance, acute pancreatitis and appendicitis are often linked to specific previous conditions and less frequently seen in a critically ill scenario unless those conditions are present. Diverticulitis also typically presents with certain risk factors that might not be as relevant in critically ill patients compared to acalculous cholecystitis. This highlights the importance