A 28-year-old primigravid woman is brought to the emergency department after complaining of severe abdominal pain for 3 hours. She has had no prenatal care. There is no leakage of amniotic fluid. Since arrival, she has had 5 contractions in 10 minutes, each lasting 70 to 90 seconds. Pelvic examination shows a closed cervix and a uterus consistent in size with a 38-week gestation. Ultrasound shows a single live intrauterine fetus in a breech presentation consistent with a gestational age of approximately 37 weeks. The amniotic fluid index is 26 and the fetal heart rate is 92/min. The placenta is not detached. She is scheduled for an emergency lower segment transverse cesarean section because of a nonreassuring fetal heart rate. The infant is delivered and APGAR score is noted to be 8 at 1 minute. The doctor soon notices cyanosis of the lips and oral mucosa, which does not resolve when the infant cries. The infant is foaming at the mouth and drooling. He also has an intractable cough. Which of the following is the most likely diagnosis?
APulmonary hypoplasia
BDefective swallowing reflex
CEsophageal stricture
DAchalasia
EEsophageal atresia
A 4-week-old infant is brought to the emergency department by his parents with violent vomiting. It started about 3 days ago and has slowly gotten worse. He vomits after most feedings but seems to keep some formula down. His mother notes that he is eager to feed between episodes and seems to be putting on weight. Other than an uncomplicated course of chlamydia conjunctivitis, the infant has been healthy. He was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. The physical exam is significant for a palpable mass in the right upper quadrant. What is the first-line confirmatory diagnostic test and associated finding?
AAbdominal ultrasound; elongated pyloric channel and muscle hypertrophy
BBarium upper GI series; GE junction and portion of the stomach in thorax
CAir enema; filling defect and coil spring sign
DBarium upper GI series; bird beak sign and corkscrewing
EAbdominal X-ray; ‘double bubble’ sign
A 3-week-old boy has non-bilious projectile vomiting that occurred after feeding. After vomiting, the infant is still hungry. The infant appears dehydrated and malnourished. A firm, “olive-like” mass of about 1.5 cm in diameter is palpated in the right upper quadrant, by the lateral edge of the rectus abdominus muscle. On laboratory testing, the infant is found to have a hypochloremic, hypokalemic metabolic alkalosis. Which of the following is most likely the cause of this patient’s symptoms?
AHypertrophy of the pylorus muscle
BIntussusception
CAchalasia
DDuodenal atresia
EAganglionic colon segment
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