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OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose answer is pyloric stenosis. While this may seem a odd practice, it is useful to see multiple examples of how pyloric stenosis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for pyloric stenosis.
- Young infants are the classic patient population (usually within first 2 months of life)
- Forceful vomiting after feeding: can be described as forceful/projectile/etc. Only occurs after feeding
- Non-blood/non-billious emesis: given position of the pylorus there will be no bile in the emesis.
- Palpable mass is often felt on the child’s abodminla exam. Often described as “olive shaped“
QUESTION EXAMPLES
Question # 1
A previously healthy 2 month old boy is brought to the clinic because he has been vomiting for the past 3 days. His mother explains that he has been eating his cow milk based formula well, but vomits soon after every feeding. The child’s vomiting seems to be increasing in its amount and force. The mother explains that the commits appears to be non bloody, non bilious undigested formula. The patient appears to be mildly dehydrated. He is at the 25th percentile for length, and 12th percentile for weight. His vital signs are unremarkable. The remainder of the physical exam does not show any abnormalities. Serum study values are listed below:
- Na+: 130 mEq/L
- K+: 4.1 mEq/L
- Cl-: 86 mEq/L
- Hc03-: 35 mEq/L
What is the most likely diagnosis?
Explanation # 1
Young infant + forceful vomiting right after feeding + non bloody/bilious vomiting = pyloric stenosis
Question # 2
A 2 week old baby girl is brought to the clinic because she has been having excessive forceful vomiting after eating. The parents explain that the vomitus is not green or bloody. The patient continues to breast feed hungrily, and the parents have noticed fewer and fewer wet diapers. On physical exam the newborn appears to be mildly dehydrated. Her temperature is 98.0°F and pulse is 130/min. The abdomen is soft, and the physical is able to perform deep palpation of the abdomen without the child crying. What diagnosis could explain this presentation?
Explanation # 2
Young infant + forceful vomiting right after feeding + non bloody/bilious vomiting = pyloric stenosis
Question # 3
A 4 week old full term newborn girl is brought the clinic because she has been vomiting. The parents explain that the patient has always had spit ups after feeding and more recently her vomiting has become more forceful. The emesis contains formula and is neither bilious or bloody. The child also always appears to be hungry. She passes one small stool about every other day. The patients weight so far has remained unchanged from her birthweight. Upon physical examination the child is alert and awake. The anterior fontanels is sunken in and she has decreased skin turgor. The patients abdomen is non-distended, soft, non-tender, and no masses are palpated. The rest of the exam is non-contributory. What could be the diagnosis that explains this presentation?
Explanation # 3
Young infant + forceful vomiting right after feeding + non bloody/bilious vomiting = pyloric stenosis
Question # 4
A 6 week old boy is brought to the clinic with vomiting over the past 2 weeks. The vomiting occurs with every feed, is non-bilious, and is projectile. Even though the mother has tried small, frequent feeding and holding the infant upright after feeds, the vomiting has persisted. On physical examination peristaltic woes are seen over the upper abdomen, and a olive shaped mass is palpated in the right upper quadrant. What is the likely diagnosis in this patient?
Explanation # 4
Young infant + forceful vomiting right after feeding + non bloody/bilious vomiting + palpable olive shaped mass = pyloric stenosis
Question # 5
A 20 day old full term baby male began to vomit three days ago. His vomiting is projectile, and has no bile in it. He only vomits after feedings, and is hungry and eager to eat even after he vomits. A physical exam reveals a dehydrated infant, who has a palpable olive shaped mass in his right upper quadrant.
Explanation # 5
Young infant + forceful vomiting right after feeding + non bloody/bilious vomiting + palpable olive shaped mass = pyloric stenosis
Question # 6
A 6 week old male is brought to the ER because he has been experiencing non bilious emesis. The mother explains that he has been regurgitation breast milk about one week ago. This began intermittently at first, and now the emesis occurs after every feeding, and has become progressively more forceful. The patient’s appetite remains intact, even after vomiting. His delivery was uneventful. His vitals are unremarkable except for tachycardia. A physical exam shows an irritable infant, with a sunken fontanelle. A small firm mass is palpated in the right upper quadrant of the abdomen.
Explanation # 6
Young infant + forceful vomiting right after feeding + non bloody/bilious vomiting + palpable mass = pyloric stenosis
Question # 7
Explanation # 7
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Page Updated: 11.06.2016