MCQs and Quiz section

Question 1

Pediatric surgery quiz 1 quiz1.pdf

Cbclips 1 A 4-year old boy presents with 6 days of abdominal pain and vomiting. On exam, he appears ill with a heart rate of 130 and temp of 39.3 C. His abdomen is distended and diffusely tender. Abdominal series shown (look carefully!). Diagnosis? Discussion

Question 1 A 17 year old boy with Marfan syndrome and a pectus excavatum desires repair. He undergoes a CT of the chest for preop planning with the following findings: his calculated Haller Index is 4 and his aortic root is 5.0 cm. He is without symptoms. The next step in management should be: A Immediate cardiac surgery for aortic root replacement alone B Immediate cardiac surgery evaluation for combined procedure C Elective Nuss bar repair D Elective Ravitch Repair E Observation

Question 1 A 12-year-old is referred to your clinic by their pediatrician for evaluation of crampy, post-prandial right upper quadrant pain of 8 months duration. A right upper quadrant ultrasound showed no gallstones or evidence of chronic cholecystitis. A HIDA scan was obtained and demonstrated an ejection fraction of 25%. The report notes that the patient had pain with CCK injection. What is the most appropriate next step in management? a Offer cholecystectomy or medical management based upon patient preference b Medical management c Cholecystectomy d Refer to a gastroenterologist for further evaluation

Question 1 A 500-gram, 23-week premature baby is born and immediately intubated. Multiple attempts at intubation were performed by individuals of varying level of experience. An airway was ultimately established with initial bloody secretions in the endotracheal tube. Chest radiographs immediately following intubation and four hours later are shown below. Immediately following intubation 4 hours after intubation The child develops a large right pneumothorax shown below. The child is transitioned to the high frequency oscillator and a chest tube is placed. Despite these interventions the lung remains deflated and there is a large continuous air leak. 24 hours after intub…

Question 1 A 10-year-old boy undergoing chemotherapy for acute lymphoblastic leukemia develops right lower quadrant pain, tenderness, fever and tachycardia. Computed tomography (CT) scanning demonstrates a thickened appendix, cecum and ascending colon with pericecal inflammation. A complete blood count (CBC) reveals an absolute neutrophil count of < 500. The next best step in treatment is: a Broad spectrum antibiotics b Recombinant human granulocyte-colony stimulating factor (GCSF) c Plasmapheresis d Laparoscopic appendectomy e Open right hemicolectomy

Question 1 A 14-year-old patient undergoes a thoracotomy and laparotomy after a shotgun injury results in severe left lower lobe contusion, large sucking chest wall wound, left diaphragmatic injury, liver injury, and gastric perforation. After damage control laparotomy, and primary closure of his chest wall, his abdomen is packed open. He is receiving continuous sedation, narcotics, and neuromuscular blockade. In this patient, neurally adjusted ventilatory assist (NAVA) would not be effective mode of ventilation because of a chest wall injury b need for continuous sedation c diaphragmatic injury d full neuromuscular paralysis e open abdomen

Question 1 A 3-month-old baby has a large microcystic malformation of the neck. The malformation abuts the trachea and bilateral carotid sheaths. The malformation has been enlarging at a rapid pace. Initial management of this lesion should include: A Administration of sirolimus B Administration of alpelisib C Administration of trametinib D Surgical debulking E Drain placement and sclerotherapy

Question 1 A fifteen-year old female with longstanding obesity and a body mass index (BMI) of 55 presents to your multidisciplinary weight loss center interested in weight loss surgery. Your team endocrinologist performs a metabolic evaluation. A contraindication to a weight loss surgery would be A increased serum leptin. B absent serum leptin. C increased ghrelin. D absent ghrelin. E decreased gastrointestinal peptide levels.

Question 1 A 4-month-old infant presents to clinic with a swollen, red left fourth toe (see images below). In addition to the swelling, the toe has an area of circumferential indentation (marked by arrow). His parents state that his toe was minimally swollen at birth, but it has continued to gradually worsen since then. What is this infant’s diagnosis? a Hair Tourniquet Syndrome b Klippel-Trenaunay Syndrome c Ingrown toenail d Milroy disease e Macrodactyly

Question 1 A 25-week gestation premature infant is nine days old and weighs 750 g. She has progressive distention. Radiographs show multiple dilated loops of bowel. Her mother received magnesium sulfate for preterm labor. The next best step in management of this premie with distension is A abdominal ultrasound. B water soluble contrast enema. C suction rectal biopsy. D sweat chloride test. E upper gastrointestinal contrast study.

Question 1 A full-term newborn boy is found to have a recto-perineal fistula located at the anterior aspect of the sphincter complex seen below, The strategy most likely to reduce the risk for postoperative perineal dehiscence is a Discharge with daily fistula dilations and minimal posterior sagittal anorectoplasty (PSARP) at 6 months of age b Perineal body preserving posterior sagittal anorectoplasty (PPP) c Posterior rectal advancement anoplasty (PRAA) before discharge d End-descending colostomy with minimal posterior sagittal anorectoplasty (PSARP) at 6 months e Minimal posterior sagittal anorectoplasty (PSARP) before discharge

Question 1 A three-kg term infant with prenatally identified congenital diaphragmatic hernia (CDH) is on high frequency oscillation ventilation. Persistent pulmonary hypertension and evidence of left ventricular dysfunction is noted on echocardiogram. Addition of which of the following pharmacologic agents is the best next step in management for this child? a Treprostinil b Sodium Nitroprusside c Milrinone d Sildenafil e Inhaled Nitric Oxide

Question 1 An 8-month-old girl presents with choking with every feeding. She had a previous proximal esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) repair at birth with an uneventful recovery although she is still taking antireflux medication. An esophagram shows minimal narrowing at the anastomosis but a smooth narrowing in the distal esophagus with contrast passing into the stomach. What is the most appropriate step in management? a increase proton pump inhibitor dose b esophagoscopy c laryngoscopy and bronchoscopy d balloon dilation e surgical resection Discussion

Question 1 A teenager, diagnosed three years ago with terminal ileal Crohn disease, presents with a three day history of diffuse abdominal pain, decreased oral intake and emesis. Over the last year they have required several admissions for similar presentations and an infliximab regimen was started. The physical exam is significant for abdominal distention with mild tenderness but no signs of peritonitis. The preferred noninvasive imaging modality to distinguish a Crohn disease flare up from chronic stricture is a abdominal ultrasonography. b capsule endoscopy. c magnetic resonance enterography. d computerized tomographic enterography. e barium small bowel follow through.

Question 1 A 28-week gestation premature newborn has a giant omphalocele. The sac was torn during delivery and a ten cm loop of small intestine has herniated through the tear. Although otherwise stable, he requires mechanical ventilation. The best initial management of this complicated omphalocele is A excision of sac and primary fascial repair. B comfort care only. C excision of sac and split thickness skin graft. D suture repair of the sac and topical antibiotic. E excision of sac and bowel resection.

Question 1 A four-year old child undergoes a Sistrunk procedure for resection of a thyroglossal duct cyst. Four months postoperatively a mass is again present in the upper midline of the neck. Which of the following is the best predictor for recurrence of thyroglossal duct tissue following a Sistrunk procedure? A use of a drain at the initial resection B intraoperative rupture of cyst C postoperative infection D preoperative infection E patient age

Question 1 You are called to see a newborn boy with prune belly syndrome. Which of the following statements regarding the surgical care of patients with prune belly syndrome is true? A malrotation is uncommon in this population B anesthesia risk is normal C abdominal wall reconstruction often improves constipation D mortality rate is five percent E pulmonary function is normal

Question 1 A one-week-old 25-week EGA infant on breast milk feeds develops abdominal distention and hypotension. Abdominal plain films reveal distended bowel loops, but no pneumoperitoneum, pneumatosis intestinalis or portal venous gas. The NICU team is interested in decreasing radiation exposure and would like to utilize bowel ultrasound for serial examinations. What findings on ultrasound have been associated with the need for surgery? A Absent peristalsis B Increased bowel wall perfusion C Pneumatosis intestinalis D Portal venous gas E Simple ascites

Question 1 A five-year old neurologically impaired child has developed symptoms of recurrent gastroesophageal reflux disease including vomiting of gastrostomy feedings, failure to thrive and aspiration pneumonia. The patient has undergone a revision Nissen fundoplication one year ago for the same problem. The parents want to know about reasonable treatment options other than another Nissen fundoplication. The option that would best resolve the child recurrent reflux is A surgical jejunostomy tube. B esophagogastric dissociation with Roux-en-Y reconstruction. C transgastric jejunostomy tube. D tracheostomy. E revision Thal fundoplication.

Question 1 A 12-year-old girl presents with acute appendicitis. She undergoes an uneventful laparoscopic appendectomy. Pathologic review reveals a 1 cm carcinoid/neuroendocrine tumor at the base of the appendix with perineural invasion but no evidence of lymphatic or vascular invasion. One lymph node was included in the specimen and was negative for tumor. What is the best next step in the management of this patient? A Octreotide scan B Observation alone C Right Hemicolectomy D Ileocecectomy E MRI of the abdomen

Question 1 A fourteen year old girl presents to the emergency department with a six month history of chronic, cyclic abdominal pain. She has not yet begun menstruating. She is Tanner Stage 4 with a palpable nontender lower abdominal mass and a bluish-tinged bulge at the introitus. An ultrasound (US) examination reveals a 10 cm fluid-filled mass arising from the pelvis thought to be a distended uterus. What is the best next step in this girl’s management? a Pelvic MRI b EUA with hymenectomy c EUA with circular hymenotomy d Percutaneous drainage of pelvic mass

Question 1 A four-month old girl is recovering after a truncus arteriosus repair. She is previously known to have a left-sided liver and right-sided stomach. Currently, she is tolerating oral feeds without difficulty and is passing stools normally. What is the next best step in management for this child’s likely intestinal rotational anomaly? A upper gastrointestinal series B diagnostic laparoscopy C prophylactic Ladd procedure D observation alone

Question 1 An otherwise healthy and normal appearing 11 year-old girl presents with sudden lower abdominal pain. She is tender in the LLQ to palpation. US shows an 8 cm complex cyst on the left ovary with a small amount of free fluid in the pelvis. There is decreased flow to the left ovary. The cyst shows septations with a 3 cm solid component. Tumor markers are pending. At laparoscopy, there is torsion of the left ovary and a few small lesions on the liver capsule. There are no peritoneal or omental implants. Peritoneal fluid is sent for cytology and the liver lesions are biopsied. After detorsion of the left ovary, what is the most appropriate step in management? A Clo…