Pretend you are a teacher preparing a quiz for the text I will provide. 
            Each quiz question should follow the format below. 
            Ensure that you carefully recheck the questions and answers for accuracy. 
            The output should be a ready-to-use list of dictionaries for the Python eval function:

            [

                    "question": "WRITE THE QUESTION HERE",
                    "options": ["A) OPTION_1", "B) OPTION_2", "C) OPTION_3", "D) OPTION_4"],
                    "answer": INDEX_OF_CORRECT_ANSWER_IN_OPTIONS_LIST,
                    "explanation": "EXPLAIN WHY THE ANSWER IS CORRECT"

            ]

            Text:
            ted women (female) 
• are usually older than 40 years of age 
(forty) 
• Multiparous (fertile), 
• and obese (fatty).
• Stone formation is more frequent in
people who use oral contraceptives,
estrogens,
or
clofibrate;
these
medications are known to increase
biliary cholesterol saturation.
• The
incidence
of
stone
formation
increases with age as a result of
increased
hepatic
secretion
of
cholesterol and decreased bile acid
synthesis.
Manifestations
Gallstones may be silent, producing no pain and only
mild gastrointestinal symptoms. Such stones may be
detected incidentally during surgery .
The patient with gallbladder disease from gallstones
may develop two types of symptoms:
• Due to disease of gallbladder itself
• Due to obstruction of the bile passages by a
gallstone.
1- Pain and Biliary Colic
• If a gallstone obstructs the cystic duct,
the
gallbladder
becomes
distended,
inflamed, and eventually infected.
• The patient develops a fever and may
have a palpable abdominal mass.
• The patient may have biliary colic with
excruciating upper right abdominal pain
that
radiates
to
the
back
or
right
shoulder.
• Biliary colic is usually associated with
nausea
and
vomiting,
and
it
is
noticeable several hours after a heavy
meal.
• The patient moves about restlessly,
unable to find a comfortable position.
In some patients, the pain is constant
rather than colicky.
2- Jaundice
• Jaundice occurs in a few patients with
gallbladder
disease,
usually
with
obstruction of the common bile duct.
• The bile, which is no longer carried to the
duodenum, is absorbed by the blood and
gives the skin and mucous membranes a
yellow
color.
This
is
frequently
accompanied
by
marked
pruritus
(itching) of the skin.
3- Changes in Urine and Stool Color
• The excretion of the bile pigments by
the kidneys gives the urine a very dark
color. The feces, no longer colored
with bile pigments, are grayish, like
putty, or clay-colored.
4- Vitamin Deficiency
• Obstruction
of
bile
flow
interferes
with
absorption of the fat-soluble vitamins A, D, E,
and K. Patients may exhibit deficiencies of these
vitamins
if
biliary
obstruction
has
been
prolonged. For example, a patient may have
bleeding caused by vitamin K deficiency.
Assessment and Diagnostic Finding
• Abdominal X- Ray
• Ultrasonography. The procedure is most
accurate if the patient fasts overnight so
that
the
gallbladder
is
distended.
Ultrasonography can detect calculi in
the gallbladder or a dilated common bile
duct.
• Cholecystography: It has been replaced by
ultrasonography as the test of choice, oral
cholecystography may be performed to detect
gallstone and to assess the ability of the
gallbladder to fill. If gallstones are present they
appear as shadows on the X-ray.
• Endoscopic Retrograde Cholangiopancreatography
(ERCP).
Permits direct visualization of structure that could
once
be
seen
only
during
laparotomy.
The
examination of the hepatobiliary system is carried out
via a side –viewing of the flexible fiberoptic endoscope
inserted in

            Quiz: