Intussusception — MCQs
A 5-month old child rushed into hospital with complaint of colicky pain, bilious vomiting and red current jelly like appearance of stools. On examination, there was a sausage shaped mass in the right lumbar region. Which of the following is the preferred modality that is used as both diagnostic and therapeutic?
A patient with right lower quadrant pain shows target sign on ultrasound. Diagnosis?
The "Target sign" ultrasonographically means:
A 10 month old infant presents with acute intestinal obstruction. Contrast enema X-ray shows the intussusception, likely cause is -
Which radiological finding is shown in the image?
A 9 month old child presents with excessive cry, right iliac fossa sausage lump and blood in stools. What is the best treatment?
Most common age for intussusception is
A 6-month-old child woke up at night, crying with severe colicky abdominal pain, and later passed red currant jelly stools. What is the most likely diagnosis?
A 6-year-old child with abdominal pain and a rash is shown. Comment on the diagnosis?
An infant brought to the clinic with non-bilious projectile vomiting. The investigation of choice includes:
Intussusception Indian Medical PG Practice Questions and MCQs
Question 1: A 5-month old child rushed into hospital with complaint of colicky pain, bilious vomiting and red current jelly like appearance of stools. On examination, there was a sausage shaped mass in the right lumbar region. Which of the following is the preferred modality that is used as both diagnostic and therapeutic?
- A. Air enema (Correct Answer)
- B. MRI
- C. Anoscopy
- D. Barium enema
Explanation: ***Air enema*** - An **air enema** can be both diagnostic and therapeutic for **intussusception**, using air pressure to reduce the telescoping bowel segment. - The classic triad of **colicky pain, bilious vomiting, and red currant jelly stools** strongly suggests intussusception, and an air enema is often the first-line intervention. *MRI* - **MRI** is not typically used for the initial diagnosis or treatment of pediatric intussusception due to its long imaging times and need for sedation. - While it can provide detailed anatomical information, it is not a **therapeutic** modality for this condition. *Anoscopy* - **Anoscopy** is a procedure used to visualize the anal canal and distal rectum, primarily for conditions like hemorrhoids or anal fissures. - It is **not suitable** for diagnosing or treating intussusception, which involves a more proximal bowel obstruction. *Barium enema* - A **barium enema** can be diagnostic and therapeutic for intussusception, using barium solution to reduce the intussusception. - However, **air enema** is generally preferred due to a lower risk of perforation and easier interpretation of reduction, making it the more common choice.
Question 2: A patient with right lower quadrant pain shows target sign on ultrasound. Diagnosis?
- A. Intussusception (Correct Answer)
- B. Diverticulitis
- C. Mesenteric cyst
- D. Appendicitis
Explanation: ***Intussusception*** - The **target sign** on ultrasound is a classic radiological finding in **intussusception**, indicating a segment of bowel telescoping into an adjacent segment. - This condition is a common cause of **acute abdominal pain** and bowel obstruction, particularly in young children, though it can occur in adults. *Diverticulitis* - Diverticulitis presents with **inflammation of diverticula**, often in the left lower quadrant, but can occur in the right. - Ultrasound findings typically include **thickened bowel wall**, pericolic fat stranding, and sometimes abscesses, not a target sign. *Mesenteric cyst* - A mesenteric cyst is a **fluid-filled mass** located within the mesentery and would appear as a well-defined, anechoic (fluid-filled) structure on ultrasound. - It would not exhibit the characteristic concentric layers of the target sign. *Appendicitis* - Acute appendicitis is characterized by a **dilated, non-compressible appendix** with a thickened wall and surrounding inflammation on ultrasound. - While it causes right lower quadrant pain, the specific **target sign** is not typical for appendicitis.
Question 3: The "Target sign" ultrasonographically means:
- A. Liver metastasis
- B. Ectopic kidney
- C. Intussusception (Correct Answer)
- D. Ovarian carcinoma
Explanation: ***Intussusception*** - The **"target sign"** (also known as the **"donut sign"** or **"pseudokidney sign"**) on ultrasound is a classic finding for **intussusception**. - It represents concentric layers of bowel telescoping into an adjacent segment, creating a central hyperechoic core surrounded by hypoechoic rings. *Liver metastasis* - Liver metastases often appear as **hypoechoic, hyperechoic, or mixed echogenicity lesions** on ultrasound, and vary widely in appearance. - While some can have a "target-like" appearance with a hyperechoic rim, it's not the primary or most specific sign for liver metastasis and is less distinct than in intussusception. *Ectopic kidney* - An ectopic kidney is an anatomical variant where the kidney is located outside its normal position, most commonly in the **pelvis**. - On ultrasound, it would appear as a normally formed kidney in an atypical location, without the distinct concentric layers seen in the "target sign." *Ovarian carcinoma* - Ovarian carcinomas present with **complex masses** that can be solid, cystic, or mixed, often with septations, papillary projections, and areas of necrosis. - Their ultrasound appearance is highly variable but does not typically manifest as a "target sign" with concentric rings.
Question 4: A 10 month old infant presents with acute intestinal obstruction. Contrast enema X-ray shows the intussusception, likely cause is -
- A. Mucosal polyp
- B. Duplication cyst
- C. Meckel's diverticulum
- D. Peyer's patch hypertrophy (Correct Answer)
Explanation: ***Peyer's patch hypertrophy*** - In infants, **idiopathic intussusception** is most often linked to **lymphoid hyperplasia** (Peyer's patch hypertrophy) in the terminal ileum, often triggered by viral infections. - Enlarged Peyer's patches act as a **leading point** for the intussusception into the colon. *Mucosal polyp* - While polyps can act as a leading point for intussusception, they are a **less common cause** in this age group than lymphoid hyperplasia. - **Pediatric polyps** are typically **juvenile polyps**, usually asymptomatic or causing painless rectal bleeding, and rarely trigger intussusception in infants. *Duplication cyst* - **Duplication cysts** can serve as a leading point for intussusception, but they are relatively **rare** compared to Peyer's patch hypertrophy. - They are usually discovered due to their mass effect or complications like hemorrhage or obstruction, but are not the most common cause of intussusception in an otherwise healthy infant. *Meckel's diverticulum* - **Meckel's diverticulum** can indeed cause intussusception, especially in older children or adults, but it's **less likely** than lymphoid hyperplasia in a typically developing 10-month-old infant. - When Meckel's diverticulum causes intussusception, it often presents with other symptoms like **painless rectal bleeding** due to ectopic gastric mucosa.
Question 5: Which radiological finding is shown in the image?
- A. Intussusception (Correct Answer)
- B. Colon carcinoma
- C. Sigmoid volvulus
- D. Ileus
Explanation: ***Intussusception*** - The image clearly displays the classic "coiled spring" appearance, which is pathognomonic for **intussusception** on a barium enema study. This pattern is created by barium trapped between the intussusceptum and intussuscipiens. - The arrow specifically points to the leading edge of the intussusception, where the bowel telescopes into an adjacent segment. *Colon carcinoma* - Colon carcinoma typically presents as an **irregular narrowing** or an **apple-core lesion** on barium studies, a sign of luminal stricture due to a mass. - The radiological appearance for carcinoma would not show the distinct layered or coiled pattern seen in the provided image. *Sigmoid volvulus* - Sigmoid volvulus is characterized by a **"coffee bean" sign** on plain radiographs due to the massively dilated, inverted U-shaped loop of colon, or a **"bird's beak" appearance** on contrast studies at the twisted obstruction point. - This contrasts significantly with the concentric rings and linear striations indicative of intussusception. *Ileus* - Ileus, or paralytic ileus, involves generalized **bowel dilation** without a clear point of mechanical obstruction, often with gas present throughout the large and small bowel. - The image shows a very specific, localized abnormality with a characteristic pattern, not generalized bowel distension associated with ileus.
Question 6: A 9 month old child presents with excessive cry, right iliac fossa sausage lump and blood in stools. What is the best treatment?
- A. IV Fluids - antibiotics - barium enema
- B. IV Fluids - antibiotics - NG tube
- C. IV Fluids - antibiotics - warm saline enema
- D. IV Fluids - antibiotics - air enema (Correct Answer)
Explanation: ***IV Fluids - antibiotics - air enema*** - The presentation of an excessive cry, a **right iliac fossa sausage-shaped lump**, and **blood in stools** (currant jelly stools) is classic for **intussusception** in an infant. - An **air enema** is the preferred initial treatment for uncomplicated intussusception as it is diagnostic and therapeutic, often reducing the intussusception while being safer than barium. Prompt IV fluids and antibiotics are crucial for stabilization and infection prophylaxis. *IV Fluids - antibiotics - barium enema* - While a **barium enema** can also be used for reduction, it carries a higher risk of **perforation** and is less frequently used than air enema due to its lower safety profile. - The diagnostic capabilities are similar, but the therapeutic benefits of air enema, particularly with lower complications, make it the preferred option. *IV Fluids - antibiotics - NG tube* - An **NG tube** is used for **gastric decompression** in cases of intestinal obstruction, which might be a part of the management if patients are vomiting or have significant abdominal distension. - However, an NG tube alone does not address the underlying **intussusception** and is not a definitive treatment for reducing the telescoped bowel itself. *IV Fluids - antibiotics - warm saline enema* - A **warm saline enema** is primarily used for evacuating contents from the bowel or for diagnostic purposes (e.g., imaging the colon). - It is **ineffective in reducing intussusception**, as it lacks the pressure capabilities required to successfully push back the invaginated bowel.
Question 7: Most common age for intussusception is
- A. 0 - 6 months
- B. 6 months - 3 years (Correct Answer)
- C. 3 - 5 years
- D. > 5 years
Explanation: ***6 months - 3 years*** - Intussusception commonly occurs in infants and young children, with the peak incidence between **6 months and 3 years** of age. - This age range coincides with changes in feeding practices and increased exposure to viral infections, which can sometimes precede intussusception. - The **typical age** is 5-9 months, with most cases occurring before 2 years. *0 - 6 months* - While intussusception can occur in this age group, it is **less common** than in slightly older infants. - Intussusception in very young infants may have different underlying causes, such as a **pathologic lead point**. *3 - 5 years* - Intussusception is **less frequent** in this age group compared to infants and toddlers. - When it does occur, there is a higher likelihood of an **identifiable lead point**, such as a Meckel's diverticulum or polyp. *> 5 years* - Intussusception is **rare** in children over the age of 5 years. - In older children and adults, it is almost always associated with a **pathological lead point**, such as a tumor or postoperative adhesions.
Question 8: A 6-month-old child woke up at night, crying with severe colicky abdominal pain, and later passed red currant jelly stools. What is the most likely diagnosis?
- A. Malrotation
- B. Meckel's diverticulum
- C. Intestinal obstruction
- D. Intussusception (Correct Answer)
Explanation: ***Intussusception*** - The classic presentation of **intussusception** includes sudden onset of **severe colicky abdominal pain** (intermittent crying spells), drawing legs to the chest, and passing **red currant jelly stools** (blood and mucus). - The pain occurs in intermittent episodes with periods of relative calm in between. Red currant jelly stools typically appear later in the disease course (often after 12-24 hours). - This is a **pediatric emergency** with peak incidence at **6-18 months** of age. *Malrotation* - Malrotation typically presents with **bilious vomiting** due to midgut volvulus and duodenal obstruction, particularly in the neonatal period. - While it can cause abdominal pain, the hallmark is persistent bilious vomiting rather than the intermittent colicky pain with red currant jelly stools seen in intussusception. *Meckel's diverticulum* - Meckel's diverticulum typically causes **painless rectal bleeding** (due to **heterotopic gastric mucosa** causing ulceration). - When it causes pain, it's usually due to **diverticulitis** or obstruction from an inverted diverticulum, but these do not produce the classic red currant jelly stools of intussusception. *Intestinal obstruction* - While intussusception is a specific type of intestinal obstruction, this option is too general. Other forms of intestinal obstruction (e.g., from adhesions, hernias) in an infant would typically present with **bilious vomiting**, abdominal distension, and may not produce red currant jelly stools. - The combination of intermittent colicky pain and red currant jelly stools is pathognomonic for intussusception.
Question 9: A 6-year-old child with abdominal pain and a rash is shown. Comment on the diagnosis?
- A. Kawasaki
- B. Varicella
- C. Meningococcemia
- D. Henoch-Schonlein purpura (Correct Answer)
Explanation: ***Henoch Schonlein purpura*** - This diagnosis is strongly suggested by the child's age (6 years old), presentation of abdominal pain, and the characteristic **palpable purpuric rash**, particularly on the lower extremities, as seen in the image. - **Henoch-Schönlein purpura (HSP)**, now known as IgA vasculitis, is a systemic small-vessel vasculitis predominantly affecting children, characterized by the classic triad of palpable purpura, arthritis/arthralgia, and abdominal pain. *Kawasaki* - **Kawasaki disease** primarily affects children under 5 years of age and presents with persistent fever, conjunctivitis, oral mucosal changes (strawberry tongue), cervical lymphadenopathy, and a polymorphous rash. Abdominal pain is less common as a primary feature. - The rash in Kawasaki disease is typically not purpuric but can be maculopapular or scarlatiniform, and does not show the characteristic distribution seen in the image. *Varicella* - **Varicella (chickenpox)** is characterized by a pruritic vesicular rash that progresses from macules to papules to vesicles and then crusts, usually starting on the trunk and spreading centrifugally. This is distinctly different from the purpuric rash shown. - While it can cause abdominal pain, the skin lesions are the key differentiator, and the image does not depict vesicular lesions. *Meningococcemia* - **Meningococcemia** is a severe bacterial infection often presenting with petechial or purpuric rash, fever, and signs of sepsis. However, the rash in meningococcemia rapidly progresses to large ecchymoses and is often associated with signs of critical illness (e.g., hypotension, altered mental status). - While purpura is present, the widespread, relatively uniform appearance of the rash, combined with abdominal pain in a 6-year-old, points away from the fulminant course typical of meningococcemia towards a vasculitis like HSP.
Question 10: An infant brought to the clinic with non-bilious projectile vomiting. The investigation of choice includes:
- A. Sigmoidoscopy
- B. Abdominal ultrasonography (Correct Answer)
- C. Barium meal
- D. Flexible Endoscopy
Explanation: ***Abdominal ultrasonography*** - **Abdominal ultrasonography** is the **investigation of choice** for **hypertrophic pyloric stenosis** presenting with non-bilious projectile vomiting in infants. - It is **non-invasive**, avoids **radiation exposure**, and has high sensitivity and specificity (>95%). - USG demonstrates a **thickened pyloric muscle** (>3 mm), **elongated pyloric channel** (>15-17 mm), and **absent or reduced passage of gastric contents** through the pylorus. - The characteristic **"target sign"** or **"doughnut sign"** on transverse view and **"cervix sign"** on longitudinal view are diagnostic. *Barium meal* - A **barium meal** (upper GI series) can demonstrate the characteristic **"string sign"** or **"shoulder sign"** in pyloric stenosis, showing a narrowed pyloric channel. - However, it is **not the first-line investigation** due to **radiation exposure**, being more time-consuming, and less practical in sick infants. - It may be used when **USG is inconclusive** or unavailable, but has been largely replaced by ultrasound in modern practice. *Flexible Endoscopy* - **Flexible endoscopy** is an **invasive procedure** and is not the first-line diagnostic tool for pyloric stenosis in infants. - It may be considered in atypical cases to rule out other diagnoses like **gastroesophageal reflux disease (GERD)**, **esophagitis**, or **gastritis**. *Sigmoidoscopy* - **Sigmoidoscopy** examines the **lower gastrointestinal tract** (sigmoid colon and rectum) and is completely **irrelevant** to the diagnosis of non-bilious projectile vomiting. - This presentation indicates an **upper GI pathology** (pyloric stenosis), not a lower GI condition. - Sigmoidoscopy is used for conditions like **inflammatory bowel disease** or **rectal bleeding**.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free