Neonatal surgery: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Neonatal surgery

Sample item

A term neonate has not passed meconium for 48 hours, with abdominal distension and bilious vomiting. Contrast enema shows a transition zone with a dilated proximal colon and a narrow rectum. Which test establishes the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Rectal suction biopsy showing absent ganglion cells

Hirschsprung disease is failure of neural crest migration so that the distal bowel lacks myenteric and submucosal ganglion cells. The aganglionic segment cannot relax, causing functional obstruction. Suction rectal biopsy shows absent ganglia, hypertrophic nerve fibres and increased acetylcholinesterase, and treatment is pull-through surgery.

Option by option

  • A. Upper GI endoscopy

    Upper endoscopy does not assess the distal ganglion cells.

  • B. Serum immunoreactive trypsinogen

    Raised immunoreactive trypsinogen screens for cystic fibrosis.

  • C. Sweat chloride test

    Sweat chloride tests for cystic fibrosis, which can cause meconium ileus but with a different contrast enema picture.

  • D. Rectal suction biopsy showing absent ganglion cells (correct)

    Correct. Absent ganglion cells on biopsy confirm the diagnosis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is D, Rectal suction biopsy showing absent ganglion cells. Hirschsprung disease is failure of neural crest migration so that the distal bowel lacks myenteric and submucosal ganglion cells.

Why is "Upper GI endoscopy" not the answer?

Upper endoscopy does not assess the distal ganglion cells.

Why is "Serum immunoreactive trypsinogen" not the answer?

Raised immunoreactive trypsinogen screens for cystic fibrosis.

Why is "Sweat chloride test" not the answer?

Sweat chloride tests for cystic fibrosis, which can cause meconium ileus but with a different contrast enema picture.

What concept does this question test?

It tests Neonatal surgery in Pediatrics. The aganglionic segment cannot relax, causing functional obstruction. Suction rectal biopsy shows absent ganglia, hypertrophic nerve fibres and increased acetylcholinesterase, and treatment is pull-through surgery.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neonatal surgery?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.