MBBS OSCE · General Surgery / Gastroenterology

OSCE — ascending cholangitis and obstructive jaundice

Emergency OSCE on Charcot/Reynolds cholangitis: resuscitation, Tokyo severity, IV antibiotics, parenteral vitamin K, and urgent ERCP decompression versus painless malignant pathway.

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Exam tags

NEET-PGINICETUSMLEPLAB

Brief (to candidate)

A 55-year-old woman has RUQ pain, fever, and jaundice. BP 88/50, confused. US: dilated CBD, gallstones. Manage this emergency in 8 minutes.[1]

Candidate instructions

  1. Recognise acute cholangitis (Charcot/Reynolds) and septic shock.
  2. ABCDE resuscitation; blood cultures; lactate.
  3. Start IV antibiotics (name a TG18-class empirical agent).
  4. Correct coagulopathy (parenteral vitamin K).
  5. Arrange urgent ERCP drainage (PTBD if ERCP fails).
  6. Mention later cholecystectomy for stone source.[1][2]

Examiner checklist

DomainExpected
DiagnosisCholangitis; severity (organ dysfunction = Tokyo III)
ResuscitationFluids, oxygen, cultures before Abx, critical care
AntibioticsEmpirical IV agent by TG18 grade/setting (name local protocol, e.g. pip-tazo)
Source controlUrgent biliary decompression — do not delay for prolonged “cooling”
CoagulopathyVitamin K for cholestasis before procedures
DifferentialsAlso know painless Courvoisier malignant pathway separately
[1] [3]

Common errors

  • Antibiotics alone without drainage plan.
  • Waiting for MRCP in unstable cholangitis.
  • Using aspirin for fever in unrelated thyroid storm confusion (not this station) — here focus on source control.[1]

Model key actions

  • Blood cultures then IV antibiotics then fluid resuscitation then urgent ERCP (PTBD salvage).[1][2]
  • Parenteral vitamin K for cholestatic coagulopathy before sphincterotomy when INR prolonged.
  • Tokyo Grade III = organ dysfunction — critical care + earliest feasible drainage.
  • After recovery from stone cholangitis: plan cholecystectomy to prevent recurrence.[1][2]

Common errors

  • Delaying drainage for more imaging while the patient remains septic.
  • Using only oral antibiotics for Reynolds-pentad disease.
  • Forgetting the malignant Courvoisier pathway when painless progressive jaundice presents.[3]
References3Show
  1. [1]Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos) J Hepatobiliary Pancreat Sci, 2018.PMID 29032610
  2. [2]Gomi H, Solomkin JS, Takada T, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis J Hepatobiliary Pancreat Sci, 2018.PMID 29090866
  3. [3]van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas N Engl J Med, 2010.PMID 20071702
OSCE — ascending cholangitis and obstructive jaundice · MBBS OSCE · NeetVellum