Rosh Pediatrics Practice Exam

What is the clinical manifestation most likely associated with suspected intussusception in an 18-month-old boy?

1. Family history of gastroenteritis

2. Fever

3. Lethargy

4. Relapsing-remitting pain episodes

The correct answer is: Relapsing-remitting pain episodes

In an 18-month-old boy with suspected intussusception, the clinical manifestation most likely associated is relapsing-remitting pain episodes. Intussusception occurs when one segment of the intestine telescopes into another, leading to obstruction. This condition often presents with intermittent abdominal pain, which may manifest as the child displaying episodes of severe crying, drawing their knees toward their chest, or appearing to be in severe discomfort, followed by periods of relative calm. The nature of the pain being relapsing and remitting is characteristic of this condition because as the bowel intermittently obstructs and then potentially resolves those episodes of obstruction, the painful symptoms will wax and wane. This distinctive pattern helps differentiate intussusception from other potential abdominal conditions in young children. While other clinical manifestations such as fever, lethargy, or a family history of gastroenteritis may be present depending on the individual case or other underlying conditions, they are not as specific for intussusception as the relapsing nature of abdominal pain is. Lethargy may occur in severe cases, but it is more a result of the overall distress and dehydration rather than a specific symptom of the intussusception itself.