Arab Board Pediatrics Clinical Exam

Practice session

A 4-week-old first-born male infant presents with a 5-day history of non-bilious, projectile vomiting occurring immediately after every feed. The infant is eagerly demanding feeds ('hungry vomiter'). Physical examination reveals mild dehydration and a palpable 1.5 cm firm, mobile 'olive-shaped' mass in the epigastrium. Venous blood gas reveals pH 7.54, sodium 132 mmol/L, potassium 2.9 mmol/L, and chloride 84 mmol/L. What is the mandatory step prior to definitive surgical pyloromyotomy?

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