KROK 2 Pediatrics

Practice session

A 4-week-old first-born male infant presents with non-bilious projectile vomiting that occurs 15 to 30 minutes after every feeding. His mother states that he is constantly hungry and eagerly demands to nurse immediately after vomiting. Physical examination reveals a hungry infant with mild sunken fontanelle and dry lips. Inspection of the epigastrium demonstrates visible peristaltic waves travelling from left to right. Deep palpation of the right upper quadrant reveals a firm, mobile, nontender, 2-cm oval mass ('olive-shaped' mass). Serum chemistry reveals: sodium 134 mmol/L, potassium 3.1 mmol/L (hypokalemia), chloride 86 mmol/L (hypochloremia), and bicarbonate 34 mmol/L (metabolic alkalosis). What is the definitive imaging modality and classic criteria for diagnosis?

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