General Surgery MCQ

Question 1

2 year old with 2 episodes of red currant jelly stool. Well otherwise, no abdo pain, no vomiting and no diarrhea. What is the best investigation to determine diagnosis

A. Meckels Scan
B. Air Enema
C. Abdo US
D. Colonoscopy

Answer 1

Meckels Scan

Question 2

2-year-old boy with a history of Hirschsprung pull-through presents with acute onset fever, vomiting and abdominal distension. What is the most likely diagnosis?
A. Enterocolitis
B. Intussusception
C. Pseudo obstruction
D. Meckel Diverticulum

Answer 2

Enterocolitis

Question 3

14 year old adolescent male with 2 day history of scrotal pain and dysuria. No fever, nausea, or vomiting. On exam, the right side of his scrotum is erythematous and tender. Both testes are palpable and in normal placement. Cremasteric reflex intact. What is the diagnosis?
A. Varicocele
B. Testicular torsion
C. Epididymitis
D. Incarcerated inguinal hernia

Answer 3

Epididymitis

Question 4

5yo girl with cerebral palsy who is non-verbal and wheelchair bound. She feeds orally and is very eager. Her parents take 90-120 minutes to feed her purees three times a day. She is on PPI for a GERD with minimal vomiting. Her weight dropped from 50th to 40th percentile over past 2 years. She had one aspiration pneumonia at age 2
What is the most significant indication for G tube insertion?
A. GERD
B. Failure to thrive
C. Aspiration pneumonia
D. Duration of feeds

Answer 4

Duration of feeds

Question 5

Young child, 6 months old, with a purulent erythematous drainage next to the anus. Otherwise very well. What is your management?
A. Warm washing/compress
B. Oral cephalexin
C. Incision and packing
D. Refer for excision

Answer 5

Warm washing/compress

Question 6

Teenage-ish boy with scrotal pain. Described blue dot, palpable mass at upper pole. What diagnosis:
A. Testicular appendage torsion
B. Testicular torsion
C. Varicocele
D. Epididymitis

Answer 6

Testicular appendage torsion

Question 7

A 17-month-old child presents to day surgery for an elective orchidopexy. His temperature is 38.2, respiratory rate is 24/min, and he has copious amounts of yellowish nasal discharge. He has an intermittent cough but no work of breathing or wheeze. What is the most appropriate step in management?
A. Proceed with surgery as planned
B. Proceed with surgery and admit to hospital overnight to monitor symptoms
C. Cancel surgery, reschedule for when symptoms resolve
D. Cancel surgery, reschedule surgery in 6 weeks after symptom resolution

Answer 7

Cancel surgery, reschedule surgery in 6 weeks after symptom resolution

Question 8

Repeat question about an infant with an umbilical hernia that measures 3cm. What do you do?
A. Something about strapping the hernia
B. Reassure
C. Refer in 2 years if still not resolved
D. Refer if the hernia grows to 5-6 cm

Answer 8

Refer if the hernia grows to 5-6 cm

Question 9

Ex-26 weeker with intermittent swelling of the groin. Both testes are descended bilaterally. What do you do?
A. Refer to surgery now
B. Scrotal US
C. Refer to surgery if persists at 6 months

Answer 9

Refer to surgery now

Question 10

What is the diagnosis?
A. Omphalocele
B. Gastroschisis
C. Severe diastasis recti
D. Umbilical hernia

Answer 10

Omphalocele

Question 11

Sexually active 16 year old boy with 4 hours of scrotal pain, which he woke up from. On assessment in the ED, his left testicle is elevated above the right, his scrotum is exquisitely tender, and epididymis is palpable anteriorly. What is the best management?
A. Consult general surgery
B. Rest and NSAIDs
C. Order outpatient scrotal ultrasound
D. Start a course of antibiotics after obtaining cultures

Answer 11

Consult general surgery

Question 12

A 3 year old girl presents with long-standing constipation. She did not pass meconium in the first 24 hours of life. On exam, there is mild abdo distension with no stool. What is the gold standard diagnostic test:

A. TTG
B. Anorectal manometry
C. Deep rectal biopsy
D. Barium enema

Answer 12

Deep rectal biopsy

Question 13

20 month boy with 3 days of fever and cough. RR normal. On auscultation has crackles to right chest. CXR shows diaphragmatic hernia or eventration (they tell you this). What is the next best step?

A. Fluoroscopy of diaphragm
B. CT Chest
C. Exploratory surgery
D. MRI chest

Answer 13

Fluoroscopy of diaphragm

Question 14

6mo with umbo hernia. Management?
A. Reassure
B. Elective repair in 2mo.
C. Put a coin on it
D. Refer to surgery if not closed by 2yo.

Answer 14

Reassure

Question 15

8 month old male with undescended left testis. Right testicle is palpable in the scrotum. What is your next best step in management?
A. Refer to surgery
B. Abdominal and scrotal ultrasound
C. Serum testosterone
D. See in follow-up in 1 year

Answer 15

Refer to surgery

Question 16

Child with 3cm umbilical hernia (I think the kid was 2-3 years):
A- Refer to surgery
B- Refer if hasn’t resolved in 2 yrs
C- Reassure

Answer 16

Refer if hasn’t resolved in 2 yrs

Question 17

Teenager with intermittent scrotal swelling with achy pain. Worse with standing. What is the cause?
A. Inguinal hernia
B. Varicocele
C. Spermatocele

Answer 17

Varicocele

Question 18

Tuboovarian abscess seen on US 3 days ago. No mention of vitals. What is the next step?
A. IM Cetriaxone x 1 and Doxycycline PO x 2 weeks
B. Admit and start IV Clindamycin and Gent
C. Surgery referral
Single dose Cefixime and Azithro

Answer 18

Admit and start IV Clindamycin and Gent

Question 19

Kid with few months of intermittent abdo pain and non-bilious vomiting. What investigation will reveal the diagnosis?
A. Abdo ultrasound
B. Upper GI series
C. AXR
D. Endoscopy

Answer 19

Upper GI series

Question 20

3 month old with spit ups x 1 month, projectile x 2 days, bilious x 2 episodes. Afebrile, unwell, dehydrated. Abdo distended with no tenderness or mass. What is most likely to give you the diagnosis?

A. Abdo X-ray
B. Abdo u/s
C. Barium enema
D. Upper GI

Answer 20

Upper GI

Question 21

4 month term male with parents noting intermittent swelling of left testis. Exam is normal.
A. Refer to surgery
B. Follow up at 6 months
C. Follow up at 12 months
D. Scrotal ultrasound

Answer 21

Refer to surgery - communicating hydrocele

Question 22

13 year old boy shows up to the ED with scrotal pain. On exam, there is a blue discoloration at the superior part of the testis. What do you do?
A. Urgent urology referral
B. Scrotal ultrasound
C. Reassure and NSAIDs

Answer 22

Scrotal ultrasound

Question 23

15 yr old sexually active male with 24 hrs low grade fever, dysuria, scrotal swelling and pain. Pyuria, microscopic hematuria. Treatment for the presumed diagnosis?
A. Rest & reassurance
B. Treat him with antibiotics
C. Treat him and partner(s) with antibiotics
D. Surgical consult for detorsion

Answer 23

Treat him and partner(s) with antibiotics

Question 24

7wk old with 3 days of non-bilious emesis which has become projectile in the past day. He has been breastfeeding less. He has no diarrhea and has normal urine output. On examination he is drowsy. BP is normal, HR 108, RR 44, capillary refill time is normal. Na 139, K 4.2, Cl 103, Cr 32, pH 7.32, CO2 27, bicarb 14. What is the NEXT best investigation?
A. Head ultrasound
B. Serum calcium
C. Abdominal ultrasound
D. Serum lactate

Answer 24

Abdominal ultrasound

Question 25

8mo. Old with elective OR for orchiopexy. Has a low grade fever, nasal congestion, crackles on chest. What should you recommend? A. Delay surgery when symptoms resolve B. Delay surgery for 6 weeks C. Just do the surgery now and watch in hospital overnight

Answer 25

Delay surgery for 6 weeks

Question 26

Umbilical granulation tissue at 7d old. What do you do? A. Observe B. Cauterize with silver nitrate

Answer 26

Cauterize with silver nitrate. If that does not work you can consider ligation or resection of the granulation tissue

Question 27

Toddler with intussusception, seen before and had air enema reduction. Returns with similar symptoms, but now looks sick, tachycardic, hypotensive. What to do next? A. Nasogastric decompression B. Consult surgery C. Air enema D. Abdo ultrasound

Answer 27

Consult surgery

Question 28

2 year old girl with painless bright red blood per rectum. What test will best reveal diagnosis? Low hgb A. Colon B. Meckel scan C. Abdo U/S

Answer 28

Meckel scan

Question 29

8mo with 3cm umbilical hernia. No strangulation. A. Continue to monitor B. Refer at 2y if still persistent

Answer 29

Continue to monitor

Question 30

Baby with G-tube that looks like this A. Reassure B. Silver nitrate cautery C. Topic ABx D. Fungal abx cream

Answer 30

Silver nitrate cautery

Question 31

When should repair for a persistent hydrocele occur? a. 6 months b. 12 months c. 18 months d. 24 months

Answer 31

18 months

Question 32

A 3 month old male infant presents to the emergency department with a 1 month history of “spit ups” and 2 day history of projectile vomiting. His last two vomits were bilious. On exam, he looks dehydrated and unwell. His abdomen is distended, non tender, with no palpable masses. What diagnostic test would MOST likely reveal the underlying abnormality? a. Abdominal ultrasound b. Barium enema c. Upper GI series

Answer 32

Upper GI Series

Question 33

Adolescent girl with scoliosis has undergone spinal surgery. She present with bilious vomiting for the last few days. What is the etiology? A. bowel adhesions B. superior mesenteric artery syndrome C. malrotation with volvulus D. Pancreatitis

Answer 33

superior mesenteric artery syndrome

Question 34

5 mo Kid flexion of arms and legs, and with associated vomiting and abdo distention, sleepy after episodes. What will give diagnosis? A. EEG B. US abdomen

Answer 34

US abdomen for possible intussusception

Question 35

Kid with abdo pain; describes kid with malrotation and intermittent volvulus; what investigation? A. AXR 2 views B. U/S C. UGI D. Barium enema

Answer 35

Upper GI Series - gold standard diagnosis for malrotation with volvulus

Question 36

Teen with large firm symmetrically enlarged thyroid. Negative for thyroid antibodies. What next? A. f/u in 6 mo B. do ultrasound C. biopsy

Answer 36

do ultrasound

Question 37

A 1 month old boy is diagnosed with pyloric stenosis. He has a severe metabolic alkalosis, bicarbonate 34. What do you do: A. Operate immediately B. Give HCl C. Give K bolus D. Give large amounts of chlorinated fluid IV

Answer 37

Give large amounts of chlorinated fluid IV

Question 38

Picture of gastroschisis. Most common associated anomaly?

Answer 38

Intestinal atresia

Question 39

7 year-old with 7d history of fever and diarrhea. Presents w rebound tenderness and guarding in RLQ. Bloodwork shows an elevated WBC >18 with mostly neutrophils. Abdominal ultrasound non specific. What will most likely reveal the diagnosis? A. Repeat Abdominal ultrasound B. Abdo CT C. Fecal calprotectin D. Stool culture

Answer 39

Abdominal CT