Common pediatric surgical conditions (pyloric stenosis, intussusception, appendicitis) and their management tested on USMLE Step 2 CK.
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- At what age do infants typically present with pyloric stenosis?
- 2 to 8 weeks old
- What is the classic character of vomiting in pyloric stenosis?
- Projectile, nonbilious vomiting
- What abdominal exam finding is classic for pyloric stenosis?
- A palpable olive-shaped mass in the epigastrium
- What acid-base and electrolyte disturbance results from pyloric stenosis?
- Hypochloremic, hypokalemic metabolic alkalosis
- What is the imaging study of choice to confirm pyloric stenosis?
- Abdominal ultrasound
- What is the definitive surgical treatment for pyloric stenosis?
- Pyloromyotomy
- Before pyloromyotomy, what must be corrected first?
- Dehydration and the electrolyte/acid-base abnormalities, with IV fluids
- What is the peak age range for intussusception?
- 6 months to 3 years
- What stool finding is classically described in intussusception?
- Currant jelly stools
- What is the most common location for intussusception in children?
- Ileocolic (ileocecal) region
- What is the first-line diagnostic and therapeutic procedure for intussusception?
- Air (or contrast) enema
- In an older child with intussusception, what is a common pathologic lead point?
- Meckel diverticulum
- How does the abdominal pain of acute appendicitis classically progress?
- It starts as vague periumbilical pain, then migrates to the right lower quadrant
- The point of maximal tenderness in appendicitis, ____, lies one third of the way from the anterior superior iliac spine to the umbilicus.
- McBurney point
- What is the preferred initial imaging modality for suspected appendicitis in children?
- Abdominal ultrasound