SURG LE3 Flashcards by Abby David

A 26-kg patient came in the emergency room for appendicitis. If you were the admitting physician, what is the maintenance fluid rate for the first 24 hours?

A. 65 ml/h
B. 60 ml/h
C. 50 ml/h
D. 45 ml/h

A. 65 ml/h

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What is the first management in children with trauma?

A. Airway
B. Breathing
C. Circulation
D. Disability

A. Airway

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RJ, a 15-year-old boy was admitted to retrieve a foreign body (red plastic push pin) which he aspirated while clowning around his friends. Where will this be most likely lodged?

A. Right main stem bronchus
B. Left main stem bronchus
C. Left upper lobe
D. Right upper lobe

A. Right main stem bronchus

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During LADD’s procedure for malrotation, which of the following is/are involved?

A. Lysis of cecal and duodenal bands
B. Broadening of mesentery
C. Appendectomy
D. All of the above

D. All of the above

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A newborn baby was referred by your colleague due to excessive drooling and in mild respiratory distress. Upon insertion of OGT you noted that it coils back and is unable to pass into the stomach. What is the most likely diagnosis?

A. Esophageal atresia
B. Esophageal atresia with proximal tracheoesophageal fistula
C. Esophageal atresia with distal tracheoesophageal fistula
D. H-type tracheoesophageal fistula

C. Esophageal atresia with distal tracheoesophageal fistula

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What is the metabolic derangement found in children with hypertrophic pyloric stenosis (HPS)?

A. Hypochloremic, hypokalemic, metabolic alkalosis
B. Hypochloremic, hypokalemic, metabolic acidosis
C. Hypochloremic, hypokalemic, respiratory acidosis
D. Hypochloremic, hypokalemic, respiratory alkalosis

A. Hypochloremic, hypokalemic, metabolic alkalosis

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The double bubble sign is pathognomonic for duodenal atresia which represents dilation of

A. esophagus and stomach
B. stomach and duodenum
C. duodenum and jejunum
D. stomach and jejunum

B. stomach and duodenum

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The soap bubble sign is pathognomonic in abdominal x-ray in a patient with

A. intestinal atresia
B. intussusception
C. meconium ileus
D. imperforate anus

C. meconium ileus

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Type 1 intestinal atresia is described as

A. mucosal atresia with intact membranes
B. atretic ends are connected by a fibrous band
C. two ends of the atresia are separated by a V-shaped defect in the mesentery
D. “apple-peel” deformity or “Christmas tree”

A. mucosal atresia with intact membranes

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A 1-month-old was diagnosed with necrotizing enterocolitis by a pediatric surgeon. Upon review of the chest and abdominal x-ray revealed subdiaphragmatic air. According to the Bell staging, what is the current stage?

A. I
B. II
C. III
D. IV

C. III

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Where is branchial cleft fistula most commonly seen?

A. First branchial cleft
B. Second branchial cleft
C. Third branchial cleft
D. Fourth branchial cleft

B. Second branchial cleft

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A 2-year-old patient came in for consult due to on and off abdominal pain. Diagnosed with intussusception…

A. Terminal ileum
B. Ligament of Treitz
C. Pylorus
D. Mid jejunum

A. Terminal ileum

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A newborn infant was examined at the ward for abdominal distention. Upon doing DRE, there was forceful explosion of foul-smelling liquid feces. What is the most likely diagnosis for this case?

A. Hirschsprung disease
B. Intussusception
C. Malrotation
D. Volvulus

A. Hirschsprung disease

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What is the Dance sign?

A. Elongated mass at the right upper quadrant or epigastrium and absence of the right lower quadrant
B. Elongated mass at the right upper quadrant or epigastrium and absence of the left lower quadrant
C. Elongated mass at the left upper quadrant and absence of the right lower quadrant
D. Elongated mass at the left upper quadrant and absence of the left lower quadrant

A. Elongated mass at the right upper quadrant or epigastrium and absence of the right lower quadrant

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Esophageal fistula without esophageal atresia

A. Type B
B. Type C
C. Type D
D. Type E

D. Type E

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Which of the following is the most common lead point for intussusception in children?

A. Polyps
B. Malignant tumor
C. Peyer’s patches hypertrophy
D. Meckel’s diverticulum

C. Peyer’s patches hypertrophy

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What is the radiologic modality that has the highest sensitivity and specificity that can help in the diagnosis of appendicitis?

A. Abdominal x-ray
B. Computed tomography
C. Magnetic resonance
D. Ultrasound

C. Magnetic resonance

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A 9-year-old, 20-kg boy was brought in due to fall from 10 flights of stairs, incurring blunt abdominal trauma presenting with rigid abdomen. Initial resuscitation of 400 ml of isotonic solution, the resident on duty requested for you to prepare packed RBC for resuscitation, how much will you give to the patient?

A. 150
B. 200
C. 250
D. 300

B. 200

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What is the treatment of choice for HPS?

A. Pyloromyotomy
B. Pyloroplasty
C. Anterectomy
D. Distal gastrectomy

A. Pyloromyotomy

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What is the most common location of Meckel’s diverticulum?

A. Within two feet of ileocecal valve
B. Within two feet of ligament of Treitz
C. Within two feet of jejunum
D. Within two feet of rectum

A. Within two feet of ileocecal valve

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Where is the absence of ganglion cells noted?

A. Auerbach’s plexus
B. Meissner’s plexus
C. Sacral plexus
D. Inferior hypogastric plexus

A. Auerbach’s plexus

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What is the most common congenital defect associated with imperforated anus?

A. Urinary tract anomaly
B. Gastrointestinal anomaly
C. Cardiac anomaly
D. Spinal anomaly

A. Urinary tract anomaly

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A 5-year-old patient underwent elective oophorectomy. Upon opening of the collective specimen (ovary) there were noted hairs, teeth and muscles. What is the most likely diagnosis?

A. Rhabdomyosarcoma
B. Ovarian cyst
C. Ovarian teratoma
D. Ovarian carcinoma

C. Ovarian teratoma

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What is the most common type of esophageal atresia?

A. Isolated esophageal atresia
B. Esophageal atresia with tracheoesophageal fistula between proximal segment of esophagus and trachea
C. Esophageal atresia with tracheoesophageal fistula between distal esophagus and trachea
D. Tracheoesophageal fistula without esophageal 3rd atresia

C. Esophageal atresia with tracheoesophageal fistula between distal esophagus and trachea

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Pathologic jaundice is considered if it persists beyond A. 2 hours B. 2 days C. 2 weeks D. 2 months

C. 2 weeks

What type of choledochal cyst is defined as multiple dilatations limited to the intrahepatic bile ducts? A. Type I B. Type IV A C. Type IV B D. Type V

D. Type V

What is the pathological segment of bowel in Hirschsprung disease as seen in barium enema? A. Distended bowel B. Constricted bowel C. Normal caliber bowel D. Perforated bowel

B. Constricted bowel

Wilms tumor is mainly the malignant tumor of the A. kidney B. adrenals C. neural crest D. pelvis

A. kidney

The most common type of choledochal cyst is A. type I B. type II C. type III D. type IV

A. type I

What is that type of multiple atresia with a “string of sausage” or “string of beads” appearance? A. Type 2 atresia B. Type 3A atresia C. Type 3B atresia D. Type 4 atresia

D. Type 4 atresia

What is the characteristic of gastroschisis? A. Covered by peritoneal and amniotic membrane B. The abdominal wall defect is located at the junction of the umbilicus and normal skin, and is almost always to the right of the umbilicus C. Greater than 4 cm in size D. Umbilical cord inserts into the sac

B. The abdominal wall defect is located at the junction of the umbilicus and normal skin, and is almost always to the right of the umbilicus

What is the most common congenital anomaly in gastroschisis? A. Intestinal atresia B. Undescended testes C. Malrotation D. Congenital heart defects

A. Intestinal atresia

What is the pathology behind inguinal hernia? A. Inability to console crying children B. Child’s high activity level C. Prematurity D. Failure of closure of processus vaginalis

D. Failure of closure of processus vaginalis

Most common gastrointestinal tract anomaly with imperforate anus? A. Duodenal atresia B. Malrotation C. Esophageal atresia D. Mesenteric cyst

C. Esophageal atresia

What is the treatment of choice for inguinal hernia in a 1-year-old baby? A. Herniotomy B. Hernioplasty C. Herniorrhaphy D. Observation until 2 years old

C. Herniorrhaphy

Operation for Wilms’ tumor on a 9-year-old patient. The surgeon inadvertently perforated the tumor which spilled into the abdominal cavity. What is the stage? A. Stage II B. Stage III C. Stage IV D. Stage V

B. Stage III

Ultrasound was done on a patient because of abdominal distention. What is the sonologist describing when he reports his findings of hyperechoic and hypoechoic layers of bowel? A. Donut sign B. Target sign C. Pseudokidney sign D. Dance sign

C. Pseudokidney sign

What is the most common site of rhabdomyosarcoma? A. Head and neck B. Extremities C. Genitourinary tract D. Trunk

A. Head and neck

Congenital hernia that has its defect located anterior or parasternal area A. Bochdalek hernia B. Diverticulum C. Morgagni hernia D. Hiatus hernia

C. Morgagni hernia

What is the most common malignancy of liver in children? A. Hepatocellular carcinoma B. Hepatoblastoma C. Hemangioma D. Cholangiocarcinoma

B. Hepatoblastoma

What is the leading cause of mortality in children older than 1 year of age? A. Trauma B. Malignancy C. Obstruction D. Pneumonia

A. Trauma

What is the hemoglobin trigger for a child or that value of hemoglobin below which RBC transfusion is indicated? A. 100 g/L B. 70 g/L C. 95 g/L D. 80 g/L

B. 70 g/L

A 10-month-old baby girl was admitted at the surgical intensive care unit after surgery for complete intestinal obstruction secondary to malrotation. What is the protein requirement for this patient if she had to be NPO for over a week? A. 2 gms/kg/d B. 1.5 gms/kg/d C. 1.2 gms/kg/d D. 1.0 gms/kg/d

B. 1.5 gms/kg/d

A patient is in for Sistrunk operation. Aside from removal of the thyroglossal duct, what is removed? A. Lateral portion of cricoid bone B. Lateral portion of hyoid bone C. Central portion of cricoid bone D. Central portion of hyoid bone

D. Central portion of hyoid bone

What is the management of choledochal cyst 1? A. Excision of choledochal cyst B. Biliary reconstruction C. Excision and biliary reconstruction D. Liver transplantation

C. Excision and biliary reconstruction

Where is the internal opening of the branchial cleft fistula usually seen? A. Middle ear B. Tonsillar fossa C. Pyriform sinus D. Lateral neck of the sternocleidomastoid

B. Tonsillar fossa

At what part of the diaphragm is the Bochdalek hernia located? A. Posteromedial B. Posterolateral C. Anteromedial D. Anterolateral

B. Posterolateral

What is the most commonly injured organ in blunt trauma in children? A. Liver B. Spleen C. Small intestine D. Large intestine

A. Liver B. Spleen

Which of the following statements is true of infants with gastroschisis? A. It is associated with malrotation and volvulus. B. There is a high incidence of associated anomalies. C. It is complicated by intestinal atresia in 50% of cases. D. There is prolonged adynamic ileus following repair.

D. There is prolonged adynamic ileus following repair.

An 18-month-old male was brought to the OPD because of a growing mass in the over the sacro-coccygeal area. If malignancy is considered, what is the tumor marker of choice? A. Carcinoembryonic antigen (CEA) B. Urine vanillylmandelic acid (VMA) C. Alpha-human chorionic gonadotrophin (a-HCG) D. Alpha-fetoprotein (AFP)

D. Alpha-fetoprotein (AFP)

A three-day old patient was referred to Surgery service for evaluation and management. Patient was noted to be tachypneic with a scaphoid abdomen and bowel sounds over the left lung field. What is most likely diagnosis? A. Congenital Diaphragmatic Hernia B. Tracheoesophageal fistula C. Congenital Pulmonary Airway Malformation D. Malrotation

A. Congenital Diaphragmatic Hernia

JK, a 4-month-old, male, term patient was brought to the ER for abdominal distention and fever. The mother claimed that there were no bowel movements for two days from birth, and only had minimal stools on insertion of glycerin suppository on the 3rd day of life. Patient was examined weak looking with pink palpebral conjunctivae and moist mucosae. The Abdomen was globular and tympanitic. Digital rectal exam was done which resulted in the explosive expulsion of gas and foul-smelling stools upon withdrawal of the examining finger. What is the immediate lifesaving procedure for this patient? A. Rehydration B. Insertion of NGT C. Exploratory Laparotomy D. Insertion of rectal tube and decompression and colonic washouts

A. Rehydration

Which of the following statement regarding Hirschsprung disease are true? A. The endorectal pullthrough is demonstrably superior to other forms of surgical construction. B. The common cause of mortality in contemporary practice is an associated cardiac anomaly. C. Hirschsprung disease is the result of a sex-linked dominant gene. D. Suction rectal biopsy is virtually always diagnostic if the specimen includes submucosa.

D. Suction rectal biopsy is virtually always diagnostic if the specimen includes submucosa.

Where are the common sites of metastasis for neuroblastoma? A. Bone marrow and cortical bone B. Lungs and liver C. Lungs and bone D. Lungs and lymph nodes

A. Bone marrow and cortical bone

A 2000-gram, 36-week gestation neonate is fed at 1 week of life. He develops abdominal distention and bilious vomiting. As a general physician, what would you recommend, if there was no pediatric surgeon in your institution? A. The child should have a nasogastric tube placed, broad spectrum intravenous antibiotics begun, and sequential plain and contrast abdominal films obtained. B. Transfer the patient immediately to the nearest hospital with a pediatric surgeon. C. Oral decompression should be initiated, broad spectrum intravenous antibiotics started and prepare to transfer to a higher center. D. An emergency barium upper GI series should be done.

C. Oral decompression should be initiated, broad spectrum intravenous antibiotics started and prepare to transfer to a higher center.

A 2.8-kg neonate with excessive salivation develops respiratory distress. Attempts to pass a catheter failed because the catheter coils in the back of the throat. A chest shows right upper lobe atelectasis and a gasless abdomen. What is the most likely diagnosis in this case? A. Esophageal atresia with both proximal and distal TEF B. "H-type" TEF C. Proximal esophageal atresia with a distal tracheoesophageal fistula (TEF) D. Proximal esophageal atresia without a fistula

D. Proximal esophageal atresia without a fistula

Among the following procedures, which would confirm the presence of esophageal atresia? A. CT scan of cranial, neck and chest B. Plain chest X-rays C. Ultrasound of the neck and chest D. OGT insertion

D. OGT insertion

A 1-day old newborn at 39 weeks' gestation who was delivered at home via normal spontaneous vaginal delivery was brought to the emergency room (ER) with an impression of imperforate anus. Which condition would allow for an immediate anoplasty? A. Recto-urethral prostatic fistula B. Recto-urethral bulbar fistula C. Meconium pearls D. Recto-vesical fistula

C. Meconium pearls

An infant is noted to have a left flank mass shortly after birth and an ultrasound examination demonstrates a mass in the left kidney. What is the most common cause of this finding? A. Multicystic dysplastic kidney B. Neonatal Wilms’ tumor C. Pyonephrosis D. Neuroblastoma

B. Neonatal Wilms’ tumor

In neonates with congenital diaphragmatic hernia, which factor most frequently relates to mortality rate? A. A defect on the right side B. Pulmonary hypoplasia C. Oligohydramnios D. Early administration of pulmonary vasodilators

B. Pulmonary hypoplasia

Which of the following approaches is considered standard care for most Wilms' tumor patients in the United States today? A. Primary surgical resection followed by chemotherapy B. Adriamycin and vincristine therapy followed by surgical resection C. Needle biopsy followed by either chemotherapy or resection depending upon the histology D. Radiation therapy if judged unresectable on CT or MRI imaging

A. Primary surgical resection followed by chemotherapy

Which procedure is most crucial in the surgical management of midgut volvulus? A. Counterclockwise twisting of the bowels B. Straightening of the duodenum C. Arranging the large bowels in the left hemi-abdomen D. Division of bands

A. Counterclockwise twisting of the bowels

What is the difference between an omphalocoele and gastroschisis? A. The abdominal wall defect in omphalocoele is less than 4cm and more than 4 cm in gastroschisis. B. Cantrell's pentalogy is associated with gastroschisis. C. Abdominal wall defect in omphalocoele is through the umbilical cord while in gastroschisis it is thru layers of abdominal wall to the right or left of umbilicus. D. The peritoneum and amniotic membranes cover viscera in gastroschisis and are absent in an omphalocoele.

C. Abdominal wall defect in omphalocoele is through the umbilical cord while in gastroschisis it is thru layers of abdominal wall to the right or left of umbilicus.

What is the management for a 2-day old male with high lying imperforate anus without fistula? A. Ileostomy B. Completely diverting sigmoid colostomy C. Transverse loop colostomy D. Posterior Sagittal Anorectoplasty

C. Transverse loop colostomy

Of the following statements, which is most descriptive of Hirschsprung disease? A. There are no ganglion cells seen in the Auerbach's plexus. B. There is an increased incidence of attention deficit hyperactivity disorder. C. It commonly presents with enterocolitis. D. It does not involve the small intestine.

A. There are no ganglion cells seen in the Auerbach's plexus.

A previously healthy 5-month-old girl presents to the ER with her parents with a 2-day history of decreased appetite and crampy abdominal pain with tenderness in the mid-abdomen. Her parents report that she has had no appetite and felt nauseous but has not vomited. She was able to sleep well for certain periods of time. Ten hours into her hospital stay, she passes copious amounts of bloody mucoid stools. She remains hemodynamically stable with normal vital signs and no change in her abdominal pain. What diagnostic tool will provide the most likely diagnosis? A. Chest X-ray B. X-ray of the Abdomen C. Ultrasound of the abdomen D. Upper GI series

C. Ultrasound of the abdomen

What kind of repair is performed on a huge omphalocele where the fascia is not closed but the skin is approximated primarily? A. Allow for 2-3 months of re-epithelialization. B. Surgical silo application C. Closure with prosthetic material D. Creation of ventral hernia

A. Allow for 2-3 months of re-epithelialization.

What sonographic finding would point to the diagnosis of Intussusception? A. Doughnut sign B. Kidney sign C. Coin-stacking appearance D. Double bubble sign

A. Doughnut sign

What data in the history and physical exam will point to a suspected Type IV sacro-coccygeal teratoma? A. Inspection of the perineum B. Rectal examination C. Abdominal Palpation D. Auscultation of the chest

B. Rectal examination

A 3-year-old, 20 kg patient was brought to ER due to 4-сm lacerated wound on his forehead extending from the medial aspect of the left eyebrow upward in the midline, obtained after falling face down on wooden floors from their bed. He was scheduled for suturing under sedation and an IV line was started. What is the maintenance fluid rate? A. 40ml/hr B. 100ml/hr C. 15ml/hr D. 60ml/hr

D. 60ml/hr

SURG LE3 Flashcards

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