A 2-year-old presents to the emergency center with several days of rectal bleeding. The mother first noticed reddish-colored stools 2 days prior to arrival and has since changed several diapers with just blood. The child is afebrile, alert, and playful, and is eating well without emesis. He is slightly tachycardic, and his abdominal examination is normal. Which of the following is the best diagnostic study to order at this time?
a. Exploratory laparotomy
b. Barium enema
c. Ultrasound of the abdomen
d. Radionucleotide scan
e. Stool culture
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is d; Radionucleotide scan.
The child described has a typical presentation for Meckel diverticulum. Children with this condition usually present with painless rectal bleeding in the first 2 years of life, but they can have symptoms throughout the first decade. The embryonic duct connecting the yolk sac to the intestine can fail to regress completely and persist as a diverticulum attached to the ileum. The lining of this Meckel diverticulum usually contains acid-secreting gastric mucosa that can produce ulcerations of the diverticulum itself or the adjacent ileum. Bleeding, perforation, or diverticulitis can occur. More seriously, the diverticulum can lead to volvulus of itself and of the small intestine, and it can also undergo eversion and intussusception. Diagnosis can be made by technetium scan, and treatment is by surgical excision. Barium studies do not readily reveal the diverticulum, nor do plain films.