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Biliary atresia — USMLE Step 2 CK MCQ

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HardPediatricsBiliary atresiaUSMLE Step 2 CK

A 3-year-old boy is brought in 45 minutes after his parent saw him swallow a 20-mm lithium button battery. He is drooling but breathing comfortably. Radiographs show the double-ring sign in the mid-esophagus. The parent gave honey twice while driving to the hospital. What is the most appropriate next step?

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Correct answer: C — Arrange immediate endoscopic removal without delaying for fasting

The best answer is “Arrange immediate endoscopic removal without delaying for fasting”. An esophageal button battery is a time-critical emergency because liquefactive necrosis and deep tissue injury can begin within two hours. Immediate endoscopic removal must not be delayed for fasting status, repeat imaging, or additional honey. Honey can reduce injury while a child older than 12 months travels to care but is not definitive therapy. Activated charcoal does not bind the battery, and blind advancement risks perforation and further injury.

Reference: National Capital Poison Center: button battery triage and treatment guideline. https://www.poison.org/battery/guideline