A 16-year-old female with a body mass index in the 97th percentile presents with several months of recurrent, colicky right upper quadrant pain, which is worse after eating fatty foods. An abdominal ultrasound confirms cholelithiasis. Given the patient’s demographic and primary risk factor, what is the most likely composition of her gallstones?
A 4-month-old infant, born at 34 weeks gestation, presents with an intermittent bulge in his right groin that becomes more prominent when he cries. The examination reveals a smooth, firm mass emerging from the external inguinal ring that is easily reducible. What is the most appropriate next step in management?
An infant presents with acute, nonbilious vomiting, dyspnea, and apnea. An erect abdominal film demonstrates a double fluid level and a characteristic “beak” near the lower esophageal junction. This radiographic finding is most consistent with which type of gastric volvulus?
A 12-year-old boy with chronic, unexplained hepatitis is being evaluated for Wilson disease. His serum ceruloplasmin level is 15 mg/dL (normal > 20 mg/dL), and a 24-hour urine collection shows copper excretion of 180 µg/day (normal < 40 µg/day). A slit-lamp examination by an ophthalmologist is negative for Kayser-Fleischer rings. What is the most definitive test to confirm the diagnosis?
A pediatrician is evaluating a 9-year-old boy with chronic, intermittent upper abdominal pain. The mother notes he sometimes complains of a burning sensation in his chest after meals and occasionally has a persistent cough. Which of the following gastroesophageal reflux disease (GERD)-related manifestations is more characteristic of this age group compared to infancy?
A 6-year-old child with nephrotic syndrome and tense ascites presents to the hospital with a fever of 39°C (102.2°F), diffuse abdominal pain, and a toxic appearance. A diagnostic paracentesis is performed on the ascitic fluid. Which of the following findings is most diagnostic of primary (spontaneous) bacterial peritonitis?
A 4-year-old boy presents to his pediatrician with several episodes of painless, scant, intermittent rectal bleeding after defecation. A colonoscopy is performed, which reveals a single, pedunculated, vascular-appearing polyp in the rectosigmoid colon that is removed via snare cautery. What is the most likely histologic classification of this polyp?
A 2-year-old boy presents with painless, brick-colored rectal bleeding. A Meckel scan using technetium-99m pertechnetate is performed but is initially negative. Which pharmacologic agent can be administered to enhance the uptake of the radiotracer by ectopic gastric mucosa and increase the sensitivity of the scan?
A 3-month-old male who underwent an emergent open repair of a strangulated right inguinal hernia two months prior presents for a follow-up visit. The parents express concern that the right testis feels smaller than the left. What is the reported incidence of testicular atrophy following an incarcerated inguinal hernia in an infant of this age?
A newborn infant with Down syndrome develops bilious vomiting on the first day of life. An abdominal radiograph shows a “double-bubble” sign with no gas in the distal bowel. This clinical and radiographic presentation is most suggestive of which congenital anomaly?
