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Pyloric stenosis — MCCQE Part 1 MCQ

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EasyVomitingPyloric stenosisMCCQE Part 1

5-week-old boy presents with progressively forceful non-bilious vomiting. He remains hungry and has hypochloraemic metabolic alkalosis. Which of the following is the most appropriate next step?

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Correct answer: B — Obtain ultrasound and correct fluids/electrolytes before pyloromyotomy

Obtain ultrasound and correct fluids/electrolytes before pyloromyotomy is best because projectile non-bilious vomiting in early infancy suggests pyloric stenosis. Discharge with oral analgesia only is suboptimal because analgesia alone may mask a surgical emergency; Delay surgical assessment until routine clinic is suboptimal because time-sensitive surgical presentations require urgent assessment; Treat with laxatives or antacids as sole therapy is suboptimal because a benign gastrointestinal explanation does not account for the red flags; Perform an invasive bedside procedure without imaging or senior input is suboptimal because invasive treatment can worsen outcomes when anatomy or diagnosis is uncertain. Resuscitation precedes surgery.

Reference: Canadian paediatric surgery guidance