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NBME 4 Peds Question - goatmilk
#1
3-15) 6 month old boy, chronic constipation since the age of 1 week. Current Rx with rectal stimulation, glycerin suppositories, and 4 ounces of prune juice produces string-like stool every 4 days. No vomiting. Growth and development are appropriate for age. Abdominal exam shows distension, no tenderness. Rectal exam, no palpable stool in ampulla. What is next step in mangement?
A) Switch to a lactose-free formula
B) Test of the stool for botulism toxin
C) Stool culture
D) Measurement of serum TSH concentration
E) Rectal manometry (correct answer)
F) Upper GI series

Why is rectal manometry the correct answer in this question??
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#2
To help diagnose the hirshsprungs disease which the patient has.
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