INI-CET 2013 — Pediatrics

Q: A toddler presents with a few drops of blood coming out of the rectum. What is the probable diagnosis?

Juvenile rectal polyp. ### Explanation **1. Why Juvenile Rectal Polyp is the Correct Answer:** In the pediatric age group (especially toddlers aged 2–5 years), **Juvenile Polyps** are the most common cause of painless lower gastrointestinal bleeding. These are typically "hamartomatous" (benign) solitary lesions located in the rectosigmoid area. The classic presentation is **painless, bright red streaks of blood** on the surface of the stool or a few drops of blood at the end of defecation. Occasionally, the polyp may prolapse through the anus during straining. **2. Why the Other Options are Incorrect:** * **Adenomatous Polyposis Coli (APC):** This is a premalignant condition characterized by hundreds of polyps. It usually presents in late childhood or adolescence, not typically in a toddler, and is associated with a high risk of malignancy. * **Rectal Ulcer:** Solitary Rectal Ulcer Syndrome (SRUS) is rare in toddlers and is usually associated with chronic straining, mucus discharge, and a feeling of incomplete evacuation. * **Piles (Hemorrhoids):** These are extremely rare in the pediatric population. If present in a child, they are usually secondary to portal hypertension (e.g., cirrhosis or extrahepatic portal vein obstruction). **3. NEET-PG High-Yield Pearls:** * **Most common site:** Rectosigmoid (80-90%). * **Histology:** Hamartomatous (not neoplastic). * **Management:** Colonoscopic snare polypectomy is the treatment of choice. * **Differential Diagnosis:** If the bleeding is associated with pain, consider **Anal Fissure** (the most common cause of *painful* rectal bleeding in children). * **Juvenile Polyposis Syndrome:** Defined by >5 polyps or a family history; unlike solitary polyps, this syndrome carries an increased risk of GI malignancy. [Practice more Pediatrics PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

All Subjects Biochemistry (2)Forensic Medicine (1)General Medicine (1)Obstetrics and Gynecology (2)Ophthalmology (1)Orthopaedics (1)Pediatrics (2)Pharmacology (1)Surgery (1)

Q1Medium

A 2-day-old premature neonate develops generalized tonic-clonic seizures. What is the investigation done to diagnose the underlying pathology?

Q2Easy

A toddler presents with a few drops of blood coming out of the rectum. What is the probable diagnosis?