This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Miscellaneous, Subject name: Medicine
Untrue about acute cholecystitis 
Select and explain. 
A. Jaundice is the earliest symptom, B. Mild raise in serum bilirubin level, C. Right upper quadrant pain, D. Vomiting is relatively common
A: Jaundice is the earliest symptom
Answer: A: Jaundice is the earliest symptom 
Explanation: (A) Jaundice is the earliest symptom # ACUTE CHOLECYSTITIS often begins as an attack of biliary pain that progressively worsens.> Approximately 60 to 70% of patients report having experienced prior attacks that resolved spontaneously.> As the episode progresses, however, the pain of acute cholecystitis becomes more generalized in the right upper abdomen.> As with biliary colic, the pain of cholecystitis may radiate to the interscapular area, right scapula, or shoulder.> Peritoneal signs of inflammation such as increased pain with jarring or on deep respiration may be apparent.> The patient is anorectic and often nauseated.> Vomiting is relatively common and may produce symptoms and signs of vascular and extracellular volume depletion.> Jaundice is unusual early in the course of acute cholecystitis but may occur when edematous inflammatory changes involve the bile ducts and surrounding lymph nodes.> The serum bilirubin is mildly elevated in fewer than half of patients, while about one-fourth have modest elevations in serum aminotransferases (usually less than a fivefold elevation)> The radionuclide (e.g., HIDA) biliary scan may be confirmatory if bile duct imaging is seen without visualization of the gallbladder.> Ultrasound will demonstrate calculi in 90 to 95% of cases