Systemic paediatrics: choledochal cyst: 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.

Try it

Pediatrics · Systemic paediatrics: choledochal cyst

Sample item

A 4-year-old girl has recurrent right upper abdominal pain, intermittent jaundice and a palpable right upper quadrant mass. Ultrasound shows a fusiform cystic dilatation of the common bile duct. What is the definitive treatment?

AObservation with ursodeoxycholic acid for symptomsBPercutaneous aspiration of the cyst under ultrasoundCComplete cyst excision with Roux-en-Y hepaticojejunostomyDCystoduodenostomy for internal drainage of the cyst

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

The answer and the reasoning

C. Complete cyst excision with Roux-en-Y hepaticojejunostomy

A choledochal cyst presents with the triad of pain, jaundice and a mass, though few children have all three. The cyst carries a risk of cholangitis, stones and malignant change, so complete excision with Roux-en-Y hepaticojejunostomy is the standard treatment.

Option by option

A. Observation with ursodeoxycholic acid for symptoms
Ursodeoxycholic acid does not treat a structural duct anomaly.
B. Percutaneous aspiration of the cyst under ultrasound
Percutaneous aspiration is only a temporary measure and the cyst refills.
C. Complete cyst excision with Roux-en-Y hepaticojejunostomy (correct)
Correct. Complete excision with biliary-enteric reconstruction removes the epithelium that carries the malignancy risk.
D. Cystoduodenostomy for internal drainage of the cyst
Internal drainage leaves the cyst wall in place, with persistent cholangitis and a malignancy risk.

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 C, Complete cyst excision with Roux-en-Y hepaticojejunostomy. A choledochal cyst presents with the triad of pain, jaundice and a mass, though few children have all three.

Why is "Observation with ursodeoxycholic acid for symptoms" not the answer?

Ursodeoxycholic acid does not treat a structural duct anomaly.

Why is "Percutaneous aspiration of the cyst under ultrasound" not the answer?

Percutaneous aspiration is only a temporary measure and the cyst refills.

Why is "Cystoduodenostomy for internal drainage of the cyst" not the answer?

Internal drainage leaves the cyst wall in place, with persistent cholangitis and a malignancy risk.

What concept does this question test?

It tests Systemic paediatrics: choledochal cyst in Pediatrics. The cyst carries a risk of cholangitis, stones and malignant change, so complete excision with Roux-en-Y hepaticojejunostomy is the standard treatment.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Systemic paediatrics: choledochal cyst?

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.