Pediatric Surgery Question Bank

Read the Pediatric Surgery Question Bank sample questions

1. 1.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 cystCorrect

   Why: The bronchopulmonary foregut malformations (bronchogenic cyst, congenital cystic adenomatoid/pulmonary airway malformation) and gut duplications such as gastric duplication all arise from the embryonic foregut. A mesenteric cyst is a lymphatic (mesothelial/lymphangiomatous) lesion of the mesentery and is not of foregut origin, so it is the exception.

2. 2.A full-term male newborn experiences respiratory distress immediately after birth. A prenatal sonogram was read as normal. An emergency radiograph is shown here. The patient is intubated and placed on 100% O 2 . Arterial blood gases reveal pH 7.24, PO 2 60 kPa, and PCO 2 52 kPa. The baby has sternal retractions and a scaphoid abdomen. Which of the following should be performed in the management of this patient?

   • A.Administration of intravenous steroids
   • B.Placement of bilateral tube thoracostomies
   • C.Immediate thoracotomy with lung resection
   • D.Mechanical ventilation with low tidal volumesCorrect

   Why: The scaphoid abdomen, immediate respiratory distress and abnormal chest film indicate a congenital diaphragmatic hernia with pulmonary hypoplasia. Management is gentle ventilation that minimizes barotrauma; low-tidal-volume (lung-protective, 'permissive hypercapnia') ventilation avoids damaging the hypoplastic lungs. Tube thoracostomy and immediate thoracotomy are wrong, and the herniated bowel must not be mistaken for pneumothorax.

3. 3.Which of the following statements is/are true of infants with gastroschisis

   • A.It is associated with malrotationCorrect
   • 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

   Why: Gastroschisis results from a paraumbilical abdominal wall defect with extrusion of bowel that never returns to rotate and fix normally, so malrotation is essentially always present. Unlike omphalocele, gastroschisis has a LOW incidence of associated anomalies (apart from intestinal atresia in roughly 10-15%), so malrotation is the correct true statement.

4. 4.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 survivalCorrect
   • D.Jaundice

   Why: Hepatoblastoma classically arises in an otherwise non-cirrhotic liver and is usually unifocal. A key therapeutic principle is that initially unresectable tumors frequently become resectable after neoadjuvant (cytoreductive) chemotherapy, allowing complete resection with good long-term survival. Multicentricity, cirrhosis and jaundice are not characteristic.

5. 5.A 1-year-old child has repeated episodes of vomiting and abdominal distention. An x-ray shows obstruction at the second portion of the duodenum. Laparotomy is performed and an annular pancreas is discovered. For a symptomatic partial duodenal obstruction secondary to an annular pancreas, which of the following is the operative treatment of choice?

   • A.A Whipple procedure
   • B.Gastrojejunostomy
   • C.Vagotomy and gastrojejunostomy
   • D.DuodenoduodenostomyCorrect

   Why: Annular pancreas causing symptomatic duodenal obstruction is bypassed rather than divided, because dividing the pancreatic ring risks pancreatic injury, fistula and recurrent obstruction. Duodenoduodenostomy creates a side-to-side bypass around the obstruction and is the procedure of choice. A Whipple is far too radical for a benign condition.

6. 6.A 1-month-old female infant presents with persistent jaundice. A serum direct bilirubin is 4.0 mg/dL and an ultrasound of the abdomen shows a shrunken gallbladder and inability to visualize the extrahepatic bile ducts. Which of the following is the most appropriate initial management of this patient?

   • A.NPO and total parenteral nutrition
   • B.Oral choleretic bile salts
   • C.Methylprednisolone
   • D.Exploratory laparotomyCorrect

   Why: A 1-month-old with persistent conjugated (direct) hyperbilirubinemia, a contracted gallbladder and non-visualized extrahepatic ducts is highly suspicious for biliary atresia. The diagnosis must be confirmed and treated promptly, so operative exploration with intraoperative cholangiogram (and Kasai portoenterostomy if confirmed) is the appropriate step. Medical measures alone would dangerously delay the time-sensitive Kasai procedure.

7. 7.Meckel's diverticulum may present with which of the following signs or symptoms?

   • A.Hemorrhage
   • B.Intussusception
   • C.Volvulus
   • D.All of the aboveCorrect

   Why: A Meckel diverticulum can present in several ways: painless lower GI bleeding from ectopic gastric mucosa, intussusception (acting as a lead point), volvulus (around a persistent vitelline band), diverticulitis or obstruction. Because all the listed presentations occur, 'all of the above' is correct.

8. 8.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 hostCorrect
   • D.Percutaneous liver biopsy

   Why: In contemporary pediatric practice the most common setting for a pyogenic liver abscess is the immunocompromised child (e.g., chronic granulomatous disease, malignancy/chemotherapy, immunosuppression), in whom hematogenous seeding occurs. This has overtaken appendicitis-related portal pyemia as the leading cause.

9. 9.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%Correct
   • D.When the diagnosis is known prenatally, planned cesarean section is the safest method of delivery

   Why: Gastroschisis has an excellent prognosis today, with overall survival in the 80-90% (often higher) range. Primary fascial closure is achievable in the majority of infants, associated anomalies are uncommon (aside from intestinal atresia), and routine cesarean delivery has not been shown to improve outcome, making the survival statement the correct one.

10. 10.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%Correct

    Why: Despite multimodal therapy, overall survival for all rhabdomyosarcoma patients is roughly 50-70%. Surgery alone cures only a minority, alveolar histology is an UNFAVORABLE prognostic feature, and current management often uses chemotherapy before resection of bulky tumors, so the overall-survival statement is the accurate choice.