Paediatric infections: typhoid intestinal perforation: 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 · Paediatric infections: typhoid intestinal perforation

Sample item

A 9-year-old in the third week of enteric fever suddenly develops severe abdominal pain, a rigid abdomen and a fall in temperature and blood pressure. An erect abdominal film shows free gas under the diaphragm. Which site is most likely perforated?

ATerminal ileumBJejunumCCaecumDSigmoid colon

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

The answer and the reasoning

A. Terminal ileum

In the third week, necrosis of the lymphoid Peyer patches in the terminal ileum can lead to haemorrhage or perforation. Perforation needs resuscitation, broad antibiotics and surgery. Other bowel segments have little lymphoid tissue and are rarely involved.

Option by option

A. Terminal ileum (correct)
Correct. Peyer patches of the terminal ileum are the usual site of typhoid perforation.
B. Jejunum
The jejunum has few Peyer patches and is rarely perforated.
C. Caecum
The caecum is not the typical site, as lymphoid tissue is concentrated in the ileum.
D. Sigmoid colon
The sigmoid colon is not involved in typhoid ulceration.

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.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is A, Terminal ileum. In the third week, necrosis of the lymphoid Peyer patches in the terminal ileum can lead to haemorrhage or perforation.

Why is "Jejunum" not the answer?

The jejunum has few Peyer patches and is rarely perforated.

Why is "Caecum" not the answer?

The caecum is not the typical site, as lymphoid tissue is concentrated in the ileum.

Why is "Sigmoid colon" not the answer?

The sigmoid colon is not involved in typhoid ulceration.

What concept does this question test?

It tests Paediatric infections: typhoid intestinal perforation in Pediatrics. Perforation needs resuscitation, broad antibiotics and surgery. Other bowel segments have little lymphoid tissue and are rarely involved.

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 infections: typhoid intestinal perforation?

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.