Paediatric imaging: malrotation: 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.

Try it

Radiology · Paediatric imaging: malrotation

Sample item

A neonate presents with sudden bilious vomiting. Upper GI contrast study shows the duodenojejunal flexure to the right of the midline, and the duodenum and jejunum take a corkscrew course. What is the diagnosis and urgency?

AMeconium ileus, enema onlyBHirschsprung disease, elective surgeryCNormal variant needing observationDMalrotation with midgut volvulus, a surgical emergency

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

The answer and the reasoning

D. Malrotation with midgut volvulus, a surgical emergency

In normal anatomy, the duodenojejunal junction lies to the left of the left pedicle at the level of the duodenal bulb. An abnormal position with a corkscrew duodenum implies volvulus, with the risk of midgut infarction, so urgent Ladd procedure is needed. Ultrasound may show a whirlpool sign and reversed SMA-SMV relation.

Option by option

A. Meconium ileus, enema only
Meconium ileus shows a soap-bubble appearance in cystic fibrosis.
B. Hirschsprung disease, elective surgery
Hirschsprung disease presents with delayed meconium and a distal transition zone.
C. Normal variant needing observation
This finding is pathological and an emergency.
D. Malrotation with midgut volvulus, a surgical emergency (correct)
Correct. Abnormal duodenojejunal junction with corkscrew indicates malrotation with volvulus.

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 Radiology question

What is the answer to this Radiology question?

The best answer is D, Malrotation with midgut volvulus, a surgical emergency. In normal anatomy, the duodenojejunal junction lies to the left of the left pedicle at the level of the duodenal bulb.

Why is "Meconium ileus, enema only" not the answer?

Meconium ileus shows a soap-bubble appearance in cystic fibrosis.

Why is "Hirschsprung disease, elective surgery" not the answer?

Hirschsprung disease presents with delayed meconium and a distal transition zone.

Why is "Normal variant needing observation" not the answer?

This finding is pathological and an emergency.

What concept does this question test?

It tests Paediatric imaging: malrotation in Radiology. An abnormal position with a corkscrew duodenum implies volvulus, with the risk of midgut infarction, so urgent Ladd procedure is needed. Ultrasound may show a whirlpool sign and reversed SMA-SMV relation.

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 Paediatric imaging: malrotation?

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.