Rosh Pediatrics Practice Exam

Which intervention is appropriate for a child presenting with a palpable right upper quadrant mass indicating pyloric stenosis?

1. AReassurance and observation

2. BEndoscopic evaluation

3. CUltrasound examination

4. DReferral for surgical consultation

The correct answer is: DReferral for surgical consultation

In cases where a child presents with a palpable right upper quadrant mass that suggests pyloric stenosis, referral for surgical consultation is a crucial intervention. Pyloric stenosis is characterized by the narrowing of the pylorus, which often leads to vomiting and dehydration due to gastric outlet obstruction. A surgical intervention, typically in the form of a pyloromyotomy, is necessary to relieve the obstruction once the diagnosis is confirmed. The palpable mass often described is the hypertrophied pylorus, which can be felt upon examination and suggests the need for immediate surgical evaluation rather than simple reassurance or further testing. While imaging studies such as an ultrasound examination may be used to confirm the diagnosis and assess the severity of the condition, the presenting signs, particularly a palpable mass coupled with clinical symptoms, warrant prompt surgical consultation. Endoscopic evaluation is not typically indicated in this scenario, as it does not address the underlying issue of the pyloric stenosis. Thus, timely referral to a surgical specialist is the most appropriate intervention to initiate proper management and treatment for the child.