Paediatric surgery: infantile hypertrophic pyloric stenosis: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Paediatric surgery: infantile hypertrophic pyloric stenosis

Sample item

A 5-week-old first-born boy has projectile non-bilious vomiting after every feed and an olive-sized mass in the epigastrium. He is dehydrated with serum sodium 132, chloride 82 and potassium 3.0 mmol/L. What is the next step before surgery?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Intravenous fluid and electrolyte correction

Pyloric stenosis causes loss of gastric hydrochloric acid, producing hypochloraemic, hypokalaemic metabolic alkalosis. It is a medical, not surgical, emergency, and pyloromyotomy is performed only after fluids, chloride and potassium are corrected and the bicarbonate falls, because anaesthesia in an alkalotic infant risks apnoea. Ultrasound is the usual confirmatory test.

Option by option

  • A. Atropine therapy at home

    Atropine is not standard treatment and the infant needs hospital resuscitation.

  • B. Immediate Ramstedt pyloromyotomy

    Operating before correction exposes the infant to post-anaesthetic apnoea and arrhythmia.

  • C. Barium meal to confirm

    The clinical picture is clear and ultrasound, not barium, is preferred if imaging is needed.

  • D. Intravenous fluid and electrolyte correction (correct)

    Correct. Resuscitation and correction of alkalosis precede safe anaesthesia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Intravenous fluid and electrolyte correction. Pyloric stenosis causes loss of gastric hydrochloric acid, producing hypochloraemic, hypokalaemic metabolic alkalosis.

Why is "Atropine therapy at home" not the answer?

Atropine is not standard treatment and the infant needs hospital resuscitation.

Why is "Immediate Ramstedt pyloromyotomy" not the answer?

Operating before correction exposes the infant to post-anaesthetic apnoea and arrhythmia.

Why is "Barium meal to confirm" not the answer?

The clinical picture is clear and ultrasound, not barium, is preferred if imaging is needed.

What concept does this question test?

It tests Paediatric surgery: infantile hypertrophic pyloric stenosis in General Surgery. It is a medical, not surgical, emergency, and pyloromyotomy is performed only after fluids, chloride and potassium are corrected and the bicarbonate falls, because anaesthesia in an alkalotic infant risks apnoea. Ultrasound is the usual confirmatory test.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric surgery: infantile hypertrophic pyloric stenosis?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.