Neonatology: anorectal malformation: 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 · Neonatology: anorectal malformation

Sample item

A male newborn has no anal opening and passes meconium in the urine. A perineal inspection shows a flat bottom with no fistula. What is the most appropriate management?

AImmediate posterior sagittal anorectoplasty on day 1BAnal dilatation and observationCDiverting colostomy followed by later definitive repairDTotal parenteral nutrition and delayed surgery at age 5

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

The answer and the reasoning

C. Diverting colostomy followed by later definitive repair

Meconium in the urine means a rectourinary fistula, a high lesion in boys. These infants need a diverting colostomy first, with later posterior sagittal anorectoplasty once the anatomy is defined. Low lesions with a perineal fistula can be repaired primarily.

Option by option

A. Immediate posterior sagittal anorectoplasty on day 1
Primary repair is reserved for low lesions and a high lesion risks damage to the sphincters and urethra.
B. Anal dilatation and observation
Dilatation treats anal stenosis or a low membrane, not a high lesion.
C. Diverting colostomy followed by later definitive repair (correct)
Correct. A high lesion with a rectourinary fistula needs a colostomy first.
D. Total parenteral nutrition and delayed surgery at age 5
Delaying surgery for years leaves the bowel obstructed and risks perforation and sepsis.

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, Diverting colostomy followed by later definitive repair. Meconium in the urine means a rectourinary fistula, a high lesion in boys.

Why is "Immediate posterior sagittal anorectoplasty on day 1" not the answer?

Primary repair is reserved for low lesions and a high lesion risks damage to the sphincters and urethra.

Why is "Anal dilatation and observation" not the answer?

Dilatation treats anal stenosis or a low membrane, not a high lesion.

Why is "Total parenteral nutrition and delayed surgery at age 5" not the answer?

Delaying surgery for years leaves the bowel obstructed and risks perforation and sepsis.

What concept does this question test?

It tests Neonatology: anorectal malformation in Pediatrics. These infants need a diverting colostomy first, with later posterior sagittal anorectoplasty once the anatomy is defined. Low lesions with a perineal fistula can be repaired primarily.

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 Neonatology: anorectal malformation?

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.