Monday, December 31 (2018); Infectious Disease Antibiotics and Sepsis
Question 9 from the second paper of 2016 presented the candidates with a scenario of an elderly woman with jaundice, confusion, hypotension, fever and abdominal pain. This describes Reynolds' Pentad, the constellation of clinical signs which is actually absent in 97% of cholangitis patients. Fortunately, the modern definitions (Tokyo Guidelines, 2013) only require signs of infection and characteristic abdominal pain, with confirmation by imaging. Cholangitis is managed by draining the infected bile by ERCP, percutaneously, or via some sort of horrible surgical T-tube.