65 Top PEDIATRIC SURGERY Multiple Choice Questions and Answers pdf

1. Polyhydramnios is frequently observed in all of the following conditions except:
A. Esophageal atresia.
B. Duodenal atresia.
C. Pyloric atresia.
D. Hirschsprung’s disease.
E. Congenital diaphragmatic hernia.
Answer: D

2. Which of the following statements about Hirschsprung’s disease is/are true?
A. There are no ganglion cells seen in Auerbach’s plexus.
B. There is an increased incidence of Down syndrome.
C. It is more common in girls.
D. It may be associated with enterocolitis.
E. It may involve the small intestine.
Answer: ABDE

3. Which of the following statements is/are true of infants with gastroschisis?
A. It is associated with malrotation.
B. There is a high incidence of associated anomalies.
C. There is prolonged adynamic ileus following repair.
D. It is complicated by intestinal atresia in 10% to 12% of cases.
E. It is associated with chromosomal syndromes.
Answer: ACD

4. In neonates with congenital diaphragmatic hernia, which of the following statements is true?
A. The defect is more common on the right side.
B. Survival is significantly improved by administration of pulmonary vasodilators.
C. An oxygen index of 20 is an indication for extracorporeal membrane oxygenation (ECMO).
D. Oligohydramnios is a frequent occurrence.
E. Mortality is the result of pulmonary hypoplasia.
Answer: E

5. Which of the following statements are true regarding the premature neonate?
A. A 15% to 20% right-to-left shunt occurs across the foramen ovale and patent ductus arteriosus.
B. Surfactant levels are normal after 30 weeks’ gestation.
C. Fluid requirements are higher than in a full-term baby.
D. Rectal temperature is the best indicator of core body temperature.
E. They are more at risk for infection than the full-term infant.
Answer: ACE

6. In neonates with necrotizing enterocolitis, which of the following findings is an indication of significant bowel ischemia?
A. Increased gastric residuals.
B. Septic shock.
C. Cardiac failure due to a patent ductus arteriosus.
D. Elevated platelet count.
E. Erythema of the abdominal wall.
Answer: E

7. The treatment of choice for neonates with uncomplicated meconium ileus is:
A. Observation.
B. Emergency laparotomy, bowel resection, and Bishop-Koop enterostomy.
C. Intravenous hydration and a gastrograffin enema.
D. Emergency laparotomy, bowel resection, and anastomosis.
E. Sweat chloride test and pancreatic enzyme therapy.
Answer: C

8. The pentalogy of Cantrell includes all of the following except:
A. Epigastric omphalocele.
B. Sternal cleft.
C. Intracardiac defect.
D. Pericardial cyst.
E. Ectopia cordis.
Answer: D

9. In infants with duodenal atresia all the following statements are true except:
A. There is an increased incidence of Down syndrome.
B. Duodenal atresia can be detected by prenatal ultrasound examination.
C. It may occur in infants with situs inversus, malrotation, annular pancreas, and anterior portal vein.
D. It is best treated by gastroenterostomy.
E. There is a high incidence of associated cardiac defects.
Answer: D

10. The initial treatment of choice for a 2.5-kg. infant with a 20.0-cm. long proximal jejunal atresia and 8.0 cm. of distal ileum is:
A. Laparotomy, nasogastric suction, proximal dilatation to lengthen the atretic jejunum, total parenteral nutrition, and delayed anastomosis.
B. Laparotomy and proximal end-jejunostomy.
C. Laparotomy and immediate small bowel transplantation.
D. Laparotomy and double-barrel enterostomy (jejunum and ileum), with refeeding of jejunal contents into distal ileum and delayed anastomosis.
E. Laparotomy, tapering jejunoplasty, and end-to-oblique jejunoileal anastomosis.
Answer: E

11. A 2.8-kg. neonate with excessive salivation develops respiratory distress. Attempts to pass an orogastric catheter fail because the catheter coils in the back of the throat. A chest film is obtained and shows right upper lobe atelectasis and a gasless abdomen. The most likely diagnosis is:
A. Proximal esophageal atresia without a fistula.
B. Proximal esophageal atresia with a distal tracheoesophageal (TE) fistula.
C. “H-type” TE fistula.
D. Esophageal atresia with both proximal and distal TE fistula.
E. Congenital esophageal stricture.
Answer: A

12. Neonates with NEC may demonstrate all of the following findings on abdominal films except:
A. Pneumatosis intestinalis.
B. Portal vein air.
C. Pneumoperitoneum.
D. Colovesical fistula.
E. Fixed and thickened bowel loops.
Answer: D

13. The most common type of congenital diaphragmatic hernia is caused by:
A. A defect in the central tendon.
B. Eventration of the diaphragm in the fetus.
C. A defect through the space of Larrey.
D. An abnormally wide esophageal hiatus.
E. A defect through the pleuroperitoneal fold.
Answer: E

14. The calorie-nitrogen ratio for an infant should be maintained at:
A. 75:1.
B. 100:1.
C. 50:1.
D. 150:1.
E. 25:1.
Answer: D

15. All of the following conditions are derived from the primitive embryonic foregut except:
A. Bronchogenic cyst.
B. Cystic adenomatoid malformation.
C. Gastric duplication.
D. Mesenteric cyst.
E. Pulmonary sequestration.
Answer: D

16. For a 22-kg infant, the maintenance daily fluid requirement is approximately which of the following?

a. 1100 ml
b. 1250 ml
c. 1550 ml
d. 1700 ml
e. 1850 ml
Answer: c

17. Which of the following statements regarding nutritional requirements in infants are true?

a. The total daily water requirement is estimated to be 100 ml/100 kcal ingested
b. The resting energy expenditure is approximately twice that of an adult
c. The highest rate of nitrogen retention with parenteral nutrition occurs in infants given approximately 40% of the calories as carbohydrate and the remainder as fat
d. The protein requirement for a newborn infant is approximately 2.5 g/kg/day
Answer: a, b, c, d

18. A term infant 48 hours of age suddenly develops hypoxemia, irritability, and glucose and temperature instability. Which of the following statements are true?

a. Empiric antibiotic coverage for b-hemolytic Streptococci and Escherichia coli should be initiated
b. An intravenous infusion of prostaglandin E1 should be initiated immediately
c. Exogenous surfactant should be given immediately
d. The mortality rate for this child is approximately 50%
Answer: a,d

19. Which of the following statements about pulmonary surfactant are true?

a. Endogenous surfactant deficiency is the key physiologic problem in preterm infants with the infant respiratory distress syndrome
b. Surfactant function can be restored to normal using aerosolized phosphatidylcholine administration
c. Exogenous surfactant replacement has been shown to reduce mortality in preterm infants with the infant respiratory distress syndrome
d. Surfactant is produced by Type I alveolar epithelial cells
Answer: a, c

20. Which of the following statements regarding premature infants are true?

a. Complications of prematurity account for approximately 85% of fetal deaths
b. Prematurity is defined by the World Health Organization as birth prior to 35 weeks gestation
c. Infants with intrauterine growth retardation have physiologic problems which are more dependent on the birth weight than the gestational age
d. Preterm infants are at increased risk for hypocalcemia and hypoglycemia when compared to term infants
Answer: a, d

21. Other than the history and physical exam, which of the following tests is considered an essential feature of the preoperative evaluation of a patient with a suspected thyroglossal duct cyst?

a. Cervical ultrasound
b. Thyroid scan
c. Serum T3 and T4 levels
d. Needle aspiration
e. None of the above
Answer: e

22. Suppurative cervical lymphadenitis in a 3-year-old child is commonly related to which of the following organisms?

a. Staphylococcus aureus
b. Atypical mycobacterial organisms
c. Streptococcal organisms
d. Lymphoma with secondary pyogenic organisms
e. Cat scratch
Answer: a, c

23. Branchial cleft remnants most often present with which of the following clinical problems?

a. Infection
b. Airway obstruction
c. Hemorrhage
d. Malignant degeneration
e. Pain
Answer: a

24. Proximity to which of the following structures places it at risk during surgical excision of a second branchial cleft remnant?

a. Internal carotid artery
b. External carotid artery
c. Hypoglossal nerve
d. All of the above
e. None of the above
Answer: d

25. Standard therapy for acute epiglottitis in a child is:

a. Tracheostomy
b. Intravenous antibiotic treatment in an ICU setting
c. Endotracheal intubation in the operating room and intravenous antibiotic therapy
d. Indirect laryngoscopy and intravenous antibiotics
e. Intravenous steroids and antibiotics
Answer: c

26. Which of the following statements regarding congenital diaphragmatic hernia are true?

a. The incidence of right and left-sided lesions is equal
b. Malrotation is to be expected
c. Left-to-right shunting via a patent ductus arteriosus is a serious but expected physiologic consequence of pulmonary hypoplasia
d. Survival rates of 75% are reported in several contemporary series
e. Congenital heart disease is present in approximately 20% of these infants
Answer: b, d, e

27. Of the following cystic malformations of the tracheobronchial tree, which is most likely to be asymptomatic when discovered?

a. Intralobar pulmonary sequestration
b. Extralobar pulmonary sequestration
c. Congenital cystic adenomatoid malformation
d. Congenital lobar emphysema
Answer: b

28. Infants with a double aortic arch most commonly present with which of the following problems?

a. Dysphagia
b. High output cardiac failure related to a patent ductus arteriosus
c. Positional hyperemia and edema of the right upper extremity
d. Symptomatic tracheal compression
Answer: d

29. Which of the following is most common after primary esophagostomy for esophageal atresia with a distal tracheoesophageal fistula?

a. Anastomotic leak
b. Esophageal stricture
c. Recurrent tracheoesophageal fistula
d. Gastroesophageal reflux
e. Tracheomalacia requiring aortopexy
Answer: d

30. Which of the following is the most common primary lung tumor in infants and children?

a. Pulmonary blastoma
b. Squamous cell carcinoma
c. Endobronchial carcinoid
d. Leiomyoma
e. Metastatic osteogenic sarcoma
Answer: c

31. Which of the following statements regarding congenital chest wall deformities are true?

a. Children with pectus excavatum deformities typically have physiologically insignificant limitation of exercise tolerance
b. The rate of recurrence after operative repair of a pectus excavatum deformity is between 5% and 10%
c. Pectus carinatum is the most common congenital chest wall defect
d. The most common indication for operative repair of congenital chest wall deformities is cosmesis
Answer: a, d

32. The definitive evaluation of a child with a suspected congenital cystic abnormality of the tracheobronchial tree is best done using which of the following?

a. Rigid bronchoscopy
b. Computerized tomography or magnetic resonance imaging
c. Chest x-ray
d. Angiography
e. Barium esophagogram
Answer: b

33. A newborn infant develops coughing, choking and cyanosis with his first feeding. He is noted to have excessive drooling. What are the important associated anomalies that must be screened for prior to surgical intervention?

a. Right-sided aortic arch
b. Hydrocephalus
c. Genitourinary obstruction
d. Congenital heart disease
Answer: c

34. Which of the following ventilation strategies is the best initial approach for a neonate with a left congenital diaphragmatic hernia and the following post ductal arterial blood gases: PaO2 50 mm Hg, PaCO2 60 mm Hg, pH 7.35?

a. High-frequency jet ventilation
b. Permissive hypercapnia with convential pressure controlled ventilation
c. Extracorporeal membrane oxygenation (ECMO)
d. Induced respiratory alkalosis
e. Inhaled nitric oxide with conventional volume controlled ventilation
Answer: b

35. There is an emerging consensus that the surgical repair for congenital diaphragmatic hernia is best done:

a. Emergently at the bedside, eliminating the risks of transporting an unstable neonate
b. While on extracorporeal membrane oxygenation
c. When the infant is potentially extubatable
d. Within the first 48 to 72 hours of life
Answer: c

PEDIATRIC SURGERY Interview Questions and Answers ::

36. Meckel’s diverticulum may present with which of the following signs or symptoms?

a. Hemorrhage
b. Intussusception
c. Volvulus
d. Patent omphalomesenteric duct
e. Right lower quadrant peritoneal findings
Answer: a, b, c, d, e

37. A 3-week old infant has a barium upper gastrointestinal series to evaluate vomiting. The duodenojejunal flexure is found to be to the right of the midline as well as more caudal and anterior than a normal ligament of Treitz. The child is seen to reflux barium spontaneously to the level of the mid-thoracic esophagus. You would recommend which of the following?

a. Barium enema
b. Emergency laparotomy
c. A trial of H2, blockade and cisapride therapy
d. Upper gastrointestinal endoscopy
e. Overnight pH probe analysis
Answer: b

38. Which of the following statements regarding duodenal atresia are true?

a. 20% to 40% of these infants have Trisomy 21
b. When associated with an annular pancreas, division of the pancreas at the site of obstruction is curative
c. Bilious vomiting is typical because the obstruction is usually distal to the ampulla of Vater
d. Reconstruction is best achieved with Roux-en-Y duodenojejunostomy
Answer: a, c

39. A 1500-gram, 30-week gestation neonate is fed at 2 weeks of age. He develops abdominal distention, bilious vomiting and guaiac-positive stool. A plain film of the abdomen demonstrates pneumotosis intestinalis. Which of the following related statements are true?

a. An emergency barium upper GI series should be done to rule out malrotation
b. The child should have a nasogastric tube placed, broad spectrum intravenous antibiotics begun, and sequential abdominal films obtained.
c. The likelihood of intestinal perforation is in excess of 50%
d. The expected survival rate is in the range of 70%
Answer: b, d

40. The most common cause of pyogenic liver abscess in children today is which of the following?

a. Perforated appendicitis
b. Blunt liver injury
c. Immunocompromised host
d. Percutaneous liver biopsy
e. Omphalitis
Answer: c

41. Which of the followings statements regarding an infant with meconium ileus are true?

a. The probability is 100% that he will have cystic fibrosis
b. Nonoperative therapy resolves this problem in approximately two-thirds of patients
c. The average life expectancy is approximately 26 to 28 years for this infant at present
d. The finding illustrated below on plain film is an absolute operative indication (Figure 103-23A)
Answer: a, b, c, d

42. You are asked to recommend therapy for an asymptomatic 2 year old who swallowed a small alkaline watch battery 4 hours ago. A plain film shows the intact battery in the intestine beyond the stomach. The best course of therapy is?

a. Immediate laparotomy, enterotomy and removal of the battery
b. Enteroscopy with extraction
c. Laparoscopy with ultrasound localization and extraction
d. Cathartics and a follow-up plain film in 48 hours if the child remains asymptomatic
Answer: d

43. A jaundiced 6 week old infant has biliary atresia. Which of the following statements are true?

a. Portoenterostomy is the initial procedure of choice
b. Primary liver transplantation using either a reduced sized cadaveric graft or a living related graft is now the procedure of choice
c. Approximately two-thirds of patients managed with portoenterostomy will develop chronic liver disease sufficient to indicate liver transplantation
d. Because biliary atresia has pathogenic components of acute and chronic inflammation, antiinflammatory therapy is known to delay onset of liver failure
Answer: a, c

44. Of the following, which is the most likely cause of hemodynamically significant lower gastrointestinal bleeding in a 6 month old male child?

a. Meckel diverticulum
b. Henoch-Schonlein purpura
c. Intussusception
d. Crohn’s colitis
e. Hemolytic uremic syndrome
Answer: a, c

45. Which of the followings statement regarding Hirschprung’s disease are true?

a. Suction rectal biopsy is virtually always diagnostic if the specimen includes submucosa
b. Hirschprung’s disease is the result of a sex linked dominant gene
c. The endorectal pullthrough is demonstrably superior to other forms of surgical construction
d. Ninety percent or more of patients have an excellent or good functional result following reconstructive surgery
e. The important cause of mortality in contemporary practice is enterocolitis
Answer: a, d, e

46. The operative procedure of choice for managing the most common type of choledochal cyst is which of the following?

a. Cyst gastrostomy
b. Cyst jejunostomy
c. Excision with Roux-en-Y hepaticojejunostomy
d. Transduodenal marsupialization
e. Endoscopic sphincterotomy
Answer: c

47. Which of the following is the most common liver tumor of childhood?

a. Hemangioma and hemangioendothelioma
b. Hepatoblastoma
c. Hepatocellular carcinoma
d. Mesenchymal hamaratoma
Answer: b

48. The risk of biliary tract adenocarcinoma developing in a patient with a choledochal cyst left in situ is approximately which of the following?

a. Less than 1%
b. 3% to 5%
c. 10% to 15%
d. Greater than 25%
Answer: b

49. The most common cause of acute pancreatitis in childhood is which of the following?

a. Pancreas divisum
b. Cholelithiasis
c. Trauma
d. Valproic acid
e. Annular pancreas
Answer: c

50. Which of the following statements regarding gastroschisis are true?

a. Primary fascial closure can be achieved in only about 25% of these infants
b. These infants have an incidence of approximately 40% to 50% of associated anomalies
c. Overall survival is approximately 80% to 90%
d. When the diagnosis is known prenatally, planned cesarean section is the safest method of delivery
Answer: c

51. Which of the following are typical causes of neonatal intestinal obstruction?

a. Intussusception
b. Meconium ileus
c. Hirschprung’s disease
d. Meckel’s diverticulum
e. Incarcerated hernia
Answer: b, c, e

52. A 6-week-old child presents with generalized seizures, a serum glucose of 30 mg/dL and concurrent hyperinsulinemia. This child’s first priority is which of the following?

a. Permanent central venous access and glucose infusion
b. Administration of cortisone and adrenocorticotropic hormone
c. Computerized tomographic scan of the abdomen to look for an islet cell adenoma
d. Urgent pancreatic resection
Answer: a

53. At what age is surgical orchiopexy recommended for a child with a unilateral undescended testis?

a. Promptly upon discovery, regardless of age
b. 1 year
c. 5 to 6 years
d. Any time prior to puberty
Answer: b

54. An infant is noted to have a left flank mass shortly after birth and an ultrasound examination demonstrates left hydronephrosis. The most common cause of this finding is which of the following?

a. Neonatal Wilm’s tumor
b. Congenital ureteropelvic junction obstruction
c. Multicystic dysplastic kidney
d. Vesicoureteral reflux
Answer: b

55. The medical indications for circumcision include which of the following?

a. Infants with a history of urinary tract infection
b. Hypospadias
c. Phimosis
d. Enuresis
e. Vesicoureteral reflux
Answer: a, c, e

56. Which of the following statements regarding neuroblastoma are true?

a. Neuroblastoma is the most common abdominal malignancy of childhood
b. Approximately 80% of neuroblastoma patients are diagnosed prior to age 4 years
c. N-myc oncogene copy number in neuroblastoma tissue is inversely related to survival probability
d. Trk proto-oncogene expression in neuroblastoma tissue is inversely related to survival probability
e. All of the above
Answer: a, b, c

57. Which of the following are considered low risk features for neuroblastoma patients?

a. Age less than one year
b. Stage 2A and 2B disease (International Staging Criteria)
c. Stage 4S disease (International Staging Criteria)
d. Neuron specific enolase plasma level less than 100 ng/ml
e. None of the above
Answer: a, b, c, d

58. A one month old female infant is brought to you for evaluation of afriable polypoid mass prolapsing through the vaginal introitus. Your presumptive diagnosis is which of the following?

a. Ectopic ureterocele
b. Rectal prolapse
c. Congenital adrenal hyperplasia with ambiguous genitalia
d. Embryonal rhabdomyosarcoma
Answer: d

59. Which of the following approaches is considered standard care for most Wilms’ tumor patients in the United States today?

a. Adriamycin and vincristine therapy followed by surgical resection
b. Needle biopsy followed by either chemotherapy or resection depending upon the histology
c. Primary surgical resection followed by chemotherapy
d. Radiation therapy if judged unresectable on CT or MRI imaging
Answer: c

60. Which of the following statements regarding rhabdomyosarcoma are true?

a. Surgical resection of the primary tumor results in cure of approximately 80 to 90% of all patients
b. Currently recommended therapy includes complete resection of primary tumors prior to chemotherapy for small noninvasive lesions, or after documented response with more formidable primary tumors
c. Alveolar histology is a favorable prognostic finding
d. Overall survival of all patients is now approximately 50%
Answer: b, d

61. Patients with Wilms’ tumors most frequently present with which of the following?

a. Bilateral metachronous lesions
b. Bilateral synchronous lesions
c. An extrarenal primary
d. A multicentric primary lesion
e. A unifocal, unilateral lesion
Answer: e

62. Hepatoblastomas are childhood liver tumors characterized by which of the following features?

a. Multicentricity
b. Cirrhosis in the uninvolved liver
c. Unresectable tumors subjected to cytoreductive chemotherapy may be resected with long-term survival
d. Jaundice
Answer: c

63. Common sites of neuroblastoma metastasis are which of the following?

a. Lung
b. Regional lymph nodes
c. Bone marrow
d. Cortical bone
Liver
Answer: b, c, d

64. Which of the following statements regarding renal tumors of childhood and adolescence are true?

a. Clear cell sarcoma is presently considered a variant of Wilms’ tumor with a poor prognosis
b. Clear cell sarcoma of the kidney has a high rate of metastasis to bone
c. Rhabdoid tumors may arise in the kidney, mediastinum or brain
d. Childhood rhabdoid tumors of the kidney carry an excellent prognosis
Answer: b, c

65. Which of the following syndromes are associated with the development of Wilms’ tumor?

a. Beckwith-Wiedemann Syndrome (hemi-hypertrophy, macroglossia, aniridia)
b. Neurofibromatosis
c. Denys-Drash syndrome (pseudohermaphroditism, glomerulopathy)
d. Gonadal dysgenesis
e. Hemolytic uremic syndrome
Answer: a, b, c, d