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Malrotation with volvulus — USMLE Step 2 CK MCQ

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ModeratePediatricsMalrotation with volvulusUSMLE Step 2 CK

A 6-week-old Native American boy comes to the pediatric clinic because of new symptoms noticed by a caregiver. History and focused examination are notable for bilious vomiting in an infant with abdominal distention. Temperature is 100.6°F (38.1°C), blood pressure is age appropriate, pulse is 128/min, respirations are 32/min, and oxygen saturation is 96% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Growth parameters, hydration status, and focused testing are consistent with the described pediatric presentation. Which of the following is the most appropriate next step in management?

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Correct answer: D — Upper gastrointestinal contrast series

The vignette describes Malrotation with volvulus, supported by bilious vomiting in an infant with abdominal distention. Upper gastrointestinal contrast series is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: American Pediatric Surgical Association Guidance