American Board of Internal Medicine (ABIM) Certification Practice Exam

What immediate treatment is recommended for a patient diagnosed with cholangitis?

1. Antibiotic therapy only

2. Urgent surgical exploration

3. Immediate broad-spectrum antimicrobial therapy

4. Intravenous hydration therapy

The correct answer is: Immediate broad-spectrum antimicrobial therapy

Immediate broad-spectrum antimicrobial therapy is essential for a patient diagnosed with cholangitis because this condition often results from a bacterial infection due to obstruction of the bile ducts, which can lead to severe complications including sepsis. Cholangitis is characterized by the classic triad of fever, jaundice, and right upper quadrant pain, and the presence of these symptoms indicates a potentially life-threatening situation. By initiating broad-spectrum antibiotic therapy right away, the treatment aims to control the infection and prevent it from progressing to a more critical state. This early intervention is crucial, particularly in patients who may present with signs of septic shock or other systemic manifestations of the infection. While surgical intervention or procedures like endoscopic retrograde cholangiopancreatography (ERCP) may be needed to relieve any obstruction, the immediate need in managing cholangitis is to effectively combat the infection with appropriate antibiotics. This is why broad-spectrum antimicrobial therapy is prioritized as the first line of treatment.