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Prep4USMLE Forum » USMLE Step 2 CK Forum » Pediatrics Forum

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dr_jojo

03/10/07 - 10:46 AM

A 14-month-old girl is brought to the physician because of a 14-hour history of irritability and episodes of drawing her knees toward her chest. During this period, she has vomited nonbilious fluid twice and had a bowel movement containing a small amount of blood. She had an upper respiratory tract infection 2 weeks ago. She is listless except for intermittent episodes of discomfort. Her temperature is 38 C (100.4 F). Abdominal examination shows right-sided tenderness without guarding or rebound; bowel sounds are present. Rectal examination shows bright red blood and mucus. An x-ray film of the abdomen shows no abnormalities. Which of the following is the most appropriate next step in management?

A
) X-ray film of the upper gastrointestinal tract with contrast

B
) Water-soluble contrast enema

C
) Corticosteroid enemas

D
) Admission to the hospital for total parenteral nutrition

E
) Immediate laparotomy

robin082006
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03/10/07 - 10:48 AM

B, this is intussusception

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huyniid
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03/10/07 - 11:54 AM

B. This is a Qbank question. choose B for both Dx and Rx

fongch
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04/19/07 - 08:03 PM

But water-soluble contrast enema is for meconium ileus due to cystic fibrosis, right? Intussusception needs barium enema for Dx and Rx.

vradojc1
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04/20/07 - 08:34 PM

Air enema is preferred to barium, but B is the only one that makes sense.

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