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Chlamydia screening — USMLE Step 2 CK MCQ

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HardPreventive Medicine & BiostatisticsChlamydia screeningUSMLE Step 2 CK

A 3-month-old infant with biopsy-confirmed Hirschsprung disease develops fever, lethargy, marked abdominal distention, and explosive foul-smelling diarrhea while awaiting pull-through surgery. Abdominal radiography shows diffuse bowel dilation without free air. What is the most appropriate immediate management?

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Correct answer: D — Resuscitate, give broad antibiotics, and begin rectal irrigations

This infant has Hirschsprung-associated enterocolitis, a potentially fatal complication characterized by systemic illness, distention, and diarrhea. Management begins immediately with intravenous fluid resuscitation, broad-spectrum antibiotics, gastric decompression as needed, and repeated rectal irrigations to evacuate stool and bacteria. Definitive pull-through surgery is undertaken after acute stabilization; operating without decompression and resuscitation increases risk. Osmotic laxatives and outpatient care are unsafe in systemic illness. A contrast enema is unnecessary once the diagnosis is established and may increase perforation risk during acute enterocolitis. Antidiarrheals worsen stasis and do not treat the infection.

Reference: American Pediatric Surgical Association: Hirschsprung Disease and Enterocolitis: https://apsapedsurg.org/parents/learn-about-a-condition/f-o/