Paediatric radiology: practice question

A Radiology 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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Radiology · Paediatric radiology

Sample item

A neonate presents with bilious vomiting on day 3. An upper GI contrast study shows the duodenojejunal flexure on the right side of the spine with a corkscrew appearance of the proximal jejunum. What is the most appropriate management?

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

The answer and the reasoning

A. Emergency Ladd procedure

Bilious vomiting in a neonate with an abnormally positioned duodenojejunal junction and a corkscrew duodenum indicates malrotation with midgut volvulus. This is a surgical emergency because of the risk of bowel infarction. A Ladd procedure untwists the bowel, divides the bands and widens the mesentery.

Option by option

  • A. Emergency Ladd procedure (correct)

    Correct. Malrotation with volvulus requires urgent Ladd procedure.

  • B. Pyloromyotomy

    Pyloromyotomy treats hypertrophic pyloric stenosis, which causes non-bilious vomiting.

  • C. Nasogastric decompression and feeds

    Decompression alone does not correct the volvulus.

  • D. Observation and repeat study in 24 hours

    Delay risks bowel ischaemia and short gut.

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 Radiology question

What is the answer to this Radiology question?

The best answer is A, Emergency Ladd procedure. Bilious vomiting in a neonate with an abnormally positioned duodenojejunal junction and a corkscrew duodenum indicates malrotation with midgut volvulus.

Why is "Pyloromyotomy" not the answer?

Pyloromyotomy treats hypertrophic pyloric stenosis, which causes non-bilious vomiting.

Why is "Nasogastric decompression and feeds" not the answer?

Decompression alone does not correct the volvulus.

Why is "Observation and repeat study in 24 hours" not the answer?

Delay risks bowel ischaemia and short gut.

What concept does this question test?

It tests Paediatric radiology in Radiology. This is a surgical emergency because of the risk of bowel infarction. A Ladd procedure untwists the bowel, divides the bands and widens the mesentery.

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 Paediatric radiology?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology 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.