A 8 year old girl with bright red rectal bleeding - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 07-12-2011
aksyonez's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 218
Threads: 74
Thanked 116 Times in 64 Posts
Reputation: 128
Question A 8 year old girl with bright red rectal bleeding

An 8 year old girl has bright red rectal bleeding off an on for a few months. She has a history of constipation and intermittent encopresis. She denies inappropriate touching . Upon examination, the child's anus has lost its stellate pattern and its tone. She has three deep fissures in the anus and a scar at 8 o'clock. Which of the following is a likely cause of the boy's finding?

A. Constipation
B. Eczema
C. Hemorrhoids
D. Hirschsprung disease
E. Penetrating anal trauma
Reply With Quote Quick reply to this message



  #2  
Old 07-12-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 79
Threads: 12
Thanked 213 Times in 37 Posts
Reputation: 225
Default

E i think. Out of midline scars are generally indicative of trauma rather than constipation
Reply With Quote Quick reply to this message
  #3  
Old 07-12-2011
cool_atomic's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 472
Threads: 29
Thanked 224 Times in 135 Posts
Reputation: 247
Default

i think its constipation. midline tears especially anterior ones are more common because the blood supply is not as good as the other areas. The scar is a healed fissure with more in the making. Constipation breaks the mucosa as the hard stool passes forming the fissures.
Reply With Quote Quick reply to this message
 
  #4  
Old 07-13-2011
USMLE Forums Addict
 
Steps History: ---
Posts: 146
Threads: 27
Thanked 74 Times in 42 Posts
Reputation: 84
Default penetrating injury

good question..i think its penetrating trauma as well.please post a reply
Reply With Quote Quick reply to this message
  #5  
Old 07-13-2011
USMLE-Syndrome's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,203
Threads: 180
Thanked 1,251 Times in 441 Posts
Reputation: 1265
Default

Quote:
Originally Posted by cool_atomic View Post
i think its constipation. midline tears especially anterior ones are more common because the blood supply is not as good as the other areas. The scar is a healed fissure with more in the making. Constipation breaks the mucosa as the hard stool passes forming the fissures.
not A. Constipation (normal anal tone ) because she lost anal tone

not D. Hirschsprung disease (has normal anal tone )


E. Penetrating anal trauma i think the answer (child abuse )
Reply With Quote Quick reply to this message
The above post was thanked by:
abosaqr (07-13-2011)
  #6  
Old 07-13-2011
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 289 Times in 191 Posts
Reputation: 301
Default

i think its a..........
Reply With Quote Quick reply to this message
  #7  
Old 07-13-2011
cool_atomic's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 472
Threads: 29
Thanked 224 Times in 135 Posts
Reputation: 247
Default

Quote:
Originally Posted by miss patho View Post
not A. Constipation (normal anal tone ) because she lost anal tone

not D. Hirschsprung disease (has normal anal tone )


E. Penetrating anal trauma i think the answer (child abuse )
having constipation for prolonged periods can have an effect on the anal tone.
anyways, plz post the answer aksyonez!
Reply With Quote Quick reply to this message
  #8  
Old 07-13-2011
aksyonez's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 218
Threads: 74
Thanked 116 Times in 64 Posts
Reputation: 128
Default

The correct answer is E. Repeated anal trauma causes loss of stellate pattern of the anus, loss of tone, and deep fissures. Constipation would be less likely to cause such dramatic findings. Sexual abuse must be suspected, and history is indicated.
Reply With Quote Quick reply to this message



Reply

Tags
Gastroenterology-, Pediatrics-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
A 15 year old girl has ataxia aksyonez USMLE Step 2 CK Forum 5 07-12-2011 03:42 AM
5 year old female girl with swelling of the right eye aksyonez USMLE Step 2 CK Forum 4 07-06-2011 07:23 AM
18-year-old woman with gingival bleeding and heavy menstruation... USMLE-Syndrome USMLE Step 2 CK Forum 3 06-22-2011 01:55 PM
19 year old girl vomits after meals--commonly associated symptoms? aksyonez USMLE Step 2 CK Forum 4 06-21-2011 08:08 AM
Microbiology question in a healthy 5 year old girl tinhi USMLE Step 1 Forum 7 04-12-2011 01:17 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)