Surgical Questions PDF

39 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 WRONG?...

39 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 WRONG? 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: C 3. Which of the following statements is WRONG about 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. Answer: B 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. 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 6. In infants with duodenal atresia all the following statements are true except: 40 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 7. 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 8. 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 9. 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 10. 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 41 c. Lymphoma with secondary pyogenic organisms d. Cat scratch Answer: a 11. 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 11. 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 12. 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 13. 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 42 14. 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 15. 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 16. 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 17. 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 18. The medical indications for circumcision include all the following except…… a. Infants with a history of urinary tract infection b. Hypospadias c. Phimosis d. Vesicoureteral reflux Answer: b 19. The most common form of esophageal atresia (EA) is: 43 a. Pure EA (no fistula) b. Pure TEF (no atresia) c. EA with distal tracheoesophageal fistula d. EA with proximal tracheoesophageal fistula Answer: c 20. A "double bubble" on an abdominal radiograph in an infant is characteristic of: a. Duodenal atresia b. Jejunal atresia c. Meconium ileus d. Pyloric stenosis Answer: a 21.The defect in gastroschisis is: a. To the left of the umbilicus b. To the right of the umbilicus c. Through the umbilicus d. Superior to the umbilicus Answer: b 23.The most common branchial cleft fistula originates from the: a. First branchial cleft b. Second branchial cleft c. Third branchial cleft d. Fourth branchial cleft Answer: b 24.An infant is referred to your clinic for evaluation of a neck mass. On physical examination, the patient has a left lateral neck mass with his head rotated to the opposite side. Which of the following is the most likely diagnosis? a. Thyroglossal duct cyst b. Torticollis c. Thymic cyst d. Lymphatic malformation Answer: b 25. Umbilical hernia in a child - indication for surgery is/are: a. Failure to disappear by 3 years b. >2 cm size c. Symptomatic 44 d. All of the above Answer: d 26.Most common type of hernia in females is: a. Direct inguinal hernia b. Indirect inguinal hernia c. Femoral hernia d. Umbilical hernia Answer: b 27.For differentiating inguinal hernia and femoral hernia the landmark will be: a. Pubic symphysis b. Femoral artery c. Inferior epigastric level d. Pubic tubercle Answer: d 28.The treatment of choice for inguinal hernia in infants is: a. Herniotomy b. Herniorrhaphy c. Truss d. Hernioplasty Answer: a 29-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- A defect through the pleuroperitoneal fold. Answer : D 30-True about congenital hypertrophic pyloric stenosis (CHPS) is: a- Usually Presents at birth b- Produces non bilious vomiting c- Common in female children d- Causes hypochloremic metabolic acidosis Answer : B 45 31-Most common site of thyroglossal cyst: a- Suprahyoid b- Hyoid c- Subhyoid d- Intra-thyroid Answer : A 32-Which of the following investigation is used to confirm anorchia? a. PET b. MRI c. Laparoscopy d. USG Answer : C 33-Stephen Fowler surgery is done for: a. Ectopic testis b. inta-abdominal Undescended testis c. Hypospadias d. Intra-inguinal Undescended testis Answer : B 34-Most common site of ectopic testis: a. Superficial inguinal pouch b. Root of penis c. Femoral trinangle d. Perineum Answer : D 35-1- A male newborn with history of maternal polyhydramnios. On trial of feeding, he suffered from chocking and cyanosis. The baby is drooling saliva all the time. 46  What is the most probable diagnosis? A. Congenital diaphragmatic hernia. B. Cleft palate. C. Exomphalos. D. Esophageal atresia. E. Anorectal malformation. ANSWER: D 36- Hemangiomas are characterized by: A- Their rapid growth in early infancy. B- Normal endothelial turnover on pathological examination. C- Usually present since birth. D- They never regress spontaneously. E- They are either slow flow or fast flow on Doopler examination. Answer: A 37-Which of the following types of anorectal malformations will need three-staged operation for correction? A. A male with rectoperineal fistula. B. A female with rectovestibular fistula. C. A male with rectoprostatic fistula. D. A female with rectoperineal fistula. E. A male with skin-bowel distance 1.5 cm. ANSWER: C 47 48 49 50 51 52 53 54 55 56 57 58 59 Answers 60  True or False 1.Most common type of esophgeal atresia is type 2 ( ) 2.Repair of esophgeal atresia can be done using thoracoscopy ( ) 3.Most common presentation of a baby with esophgeal atresia is excessive salivation( ) 4.Baby with CDH should be put in mechanical ventilator strictly after birth ( ) 5.Bochdaleck type of CDH means an anterior defect( ) 6.Most common presentation of CDH is cyanosis ( ) 7.VACTREL is associative syndrome including TEF and anorectal malformation ( ) 8.pulmunary hypertension is highly associated with CDH ( ) 9.CHIPS is characterized by projectile billious vomiting ( ) 10.CHIPS is diagosed with pyloric thickness less than 4mm ( ) 11.Most common complication of baby with CHIPS is Dehydration and shock ( ) 12.CHIPS is surgically operated by Ramstedt pyloromyotomy ( ) 13.High ARMs is surgically managed by PSARP ( ) 14.Rectovestibular fistula is considered most common type of ARM in males ( ) 15.Hirshsprung dse means absence of ganglion cells in colonic submucosa ( ) 16. In patient with hirshsprung dse. Transition zone is found between two ganglionic zone() 17.HD is responding well for medical ttt ( ) 18.operation done for HD is TEPT ( ) 19.Delayed passage of meconium is highly suggestive for HD ( ) 20. Idiopathic constipation is early presented rather than HD ( ) 21.Non palpable UDT should be managed by laparoscopy ( ) 22.Most suitable time for operation for UDT is one year ( ) 23.operation of choice for palpable UDT is orchiopexy ( ) 24.Vas deferens should be cut during orchiopexy ( ) 25.Orchiopexy means fixation of testis in subdartos pouch ( ) 26.Rectal biopsy is golden role for diagnosis of HD ( ) 27.coiled ryle is confirmatory radiographic sign for TEF ( ) 28. Repair of congenital inguinal hernia can be delayed for age of one year ( ) 29.Repair of umbilical hernia should be done at birth ( ) 30.operation of choice for congenital inguinal hernia is mesh repair ( ) 31.pampiniform plexus is from the content of spermatic cord ( ) 32.post wall of inguinal canal is formed from fascia transvarsalis( ) 33. Operation of choice for cleft palate is millard’s repair 34.operation of choice for illeal atresia is kimura operation ( ) 61 35.operation of choice for long segment HD is laparoscopic assisted TEPT( ) 3Obstructed inguinal hernia is presented with non billious vomiting ( ) 37.Incisiional hernia means hernia on top of previous scar ( ) 38.cleft lip repair should be done at age of one year ( ) 39.High ARM should be operated for pena colostomy at birth 40.Cleft palate repair better be done at age of 10 months ( ) 41.congenital hydrocele should be operated at birth ( ) 42.circumsicion can be done using plastbills( ) 43.circumcision should be done in baby with hypospadias( ) 44.one complication of non circumsicion is recurrent ballanitis ( ) 45.bleeding is the most serious complication after circumsicion ( ) 46.incarcerated inguinal hernia is presented with acute abdomen ( ) 47.palatoplasty is done using vicryl sutures ( ) 48.Buried penis is common complication after overcircumcision ( ) 49.one of serious complication of HD is intestinal obstruction ( ) 50.Hypovoleamic shock is associated with hypertension ( ) 51.Hemmorage is a common cause for septic shock ( ) 52.Case with NIO should be managed with nasogastric tube ( ) 53. In cases having laparotomy..oral feeding started two hours postoperatively? ) 54.Duodenal web can cause partial intestinal obstruction ? ) 55.rectal biopsy with ganglionic colon should go for colectomy ( ) 56.management of wilms tumor is radical nephrectomy ( ) 57.symptoms of pyloric stenosis started two days after birth ( ) 58.first radiological tool for diagonsis of CDH is xray ( ) 59.peeping testis can be managed either open approach or laparoscopic ( ) 60.Baby with TEF should be suctioned very well ( ) 61.nursing care for abdominal exploration regarding ryle tubes and drains ( ) 62.hypospadias means presence of urethral opening above its normal site( ) 63.TIP repair is common operation for hypospadias repair 64.urethrocutaneous fistula means track between urinary bladder and penile skin( ) 65.circumcision can be done using gomco clamp ( ) 66.circumcision must be done without anathesia ( ) 67.Inguinal hernia in pediatrics cannot be done using laparoscopy ( ) 68.proline is nonabsorpable sutures ( ) 69.Appendictomy better be done using laparoscopy ( ) 70.wound care is important for guarding against wound infection ( ) 62 Answers 1-F 2-t 3-T 4-T 5-F 6-T 7-T 8-T 9-F 10-F 11-T 12-T 13-T 14-F 15-T 16-F 17-F 18-T 19-T 20-F 21-T 22-F 23-T 24-F 25-T 26-T 27-T 28-F 29-F 30-F 31-T 32-T 33-F 34-F 35-T 36-F 37-T 63 38-F 39-T 40-T 41-F 42-T 43-F 44-T 45-T 46-T 47-T 48-T 49-T 50-F 51-F 52-T 53-F 54-T 55-F 56-T 57-F 58-T 59-T 60-T 61-T 62-F 63-T 64-F 65-T 66-F 67-F 68-T 69-T 70-T 64