Pediatric Surgery Practice Questions

Q: What is the treatment of choice for cystic hygroma?

Surgical excision. **Explanation:** **Cystic Hygroma** (Cystic Lymphangioma) is a congenital malformation of the lymphatic system, most commonly occurring in the posterior triangle of the neck. **Why Surgical Excision is the Correct Answer:** The treatment of choice is **complete surgical excision**. The primary goal is to remove the entire cyst wall while preserving vital neurovascular structures (such as the facial nerve or carotid sheath). Because these lesions are benign but infiltrative, "en bloc" resection is often impossible without damaging critical structures; therefore, meticulous dissection and excision are preferred. **Analysis of Incorrect Options:** * **A. Percutaneous aspiration:** This is only a temporary measure. The cyst invariably refills with lymph, and there is a high risk of introducing infection (which makes subsequent surgery much harder). * **B. Intralesional sclerosant injection:** Agents like OK-432 (Picibanil) or Bleomycin are used primarily for **macrocystic** lesions or in cases where surgery is contraindicated (e.g., high surgical risk or extensive infiltration). However, surgery remains the gold standard. * **C. En bloc resection:** While total removal is ideal, "en bloc" implies removing the lesion along with a margin of normal tissue. In the neck, this is avoided to prevent sacrificing essential nerves and vessels. **High-Yield Clinical Pearls for NEET-PG:** * **Transillumination:** Cystic hygromas are characteristically **brilliantly transilluminant** (unlike hemangiomas). * **Association:** Often associated with chromosomal abnormalities like **Turner syndrome** and Down syndrome. * **Complications:** Sudden increase in size usually indicates **intracystic hemorrhage** or infection. * **Timing of Surgery:** Usually performed around 2 years of age unless there is respiratory distress due to compression.

Q: Which of the following is NOT true regarding congenital hypertrophic pyloric stenosis?

Length of pyloric canal < 14 mm. **Congenital Hypertrophic Pyloric Stenosis (CHPS)** is a common cause of gastric outlet obstruction in infants, typically presenting between 3 to 6 weeks of life. ### **Explanation of the Correct Answer** **Option B** is the correct answer because it is a **false** statement. In CHPS, the pyloric canal is **thickened and elongated**. On ultrasonography (the gold standard investigation), the diagnostic criteria for CHPS are: * **Pyloric canal length:** > 14 mm (not less than 14 mm). * **Pyloric muscle thickness:** > 3 mm (or 4 mm). * **Pyloric diameter:** > 11 mm. ### **Analysis of Incorrect Options** * **A. Alkalosis:** This is a classic feature. Persistent vomiting of gastric acid (HCl) leads to **hypochloremic, hypokalemic, metabolic alkalosis** with paradoxical aciduria. * **C. Non-bilious vomiting:** Since the obstruction is proximal to the Ampulla of Vater (where bile enters the duodenum), the vomitus never contains bile. It is typically "projectile" in nature. * **D. Visible peristalsis:** Due to the stomach's effort to overcome the obstruction, left-to-right gastric peristaltic waves may be visible on the upper abdomen during feeding. ### **High-Yield Clinical Pearls for NEET-PG** * **Epidemiology:** Most common in **first-born male** infants; associated with **erythromycin** use in early infancy. * **Physical Exam:** A palpable, olive-shaped mass in the epigastrium (best felt after vomiting). * **Radiology:** On Barium swallow, look for the **"String sign"** (narrowed canal) or **"Beak sign."** * **Management:** The initial priority is **resuscitation** (correcting dehydration and alkalosis with 0.45% or 0.9% NS). The definitive surgery is **Ramstedt’s Pyloromyotomy**.

Q: Chordee is associated with which of the following conditions?

Hypospadias. **Explanation:** **Hypospadias** is a congenital anomaly characterized by the urethral opening being located on the ventral aspect of the penis. **Chordee**, which refers to the ventral curvature of the penis, is a hallmark association of hypospadias. It is caused by the presence of a fibrous band of tissue (rudimentary corpus spongiosum) or skin tethering distal to the ectopic urethral meatus. During an erection, this fibrous tissue does not expand, causing the penis to bend ventrally. **Analysis of Options:** * **Epispadias (Option A):** In this condition, the urethral opening is on the **dorsal** aspect of the penis. While it can be associated with dorsal curvature, the classic term "chordee" is specifically linked to the ventral curvature seen in hypospadias. * **Phimosis (Option B):** This is the inability to retract the prepuce (foreskin) over the glans penis. It is an anatomical issue of the skin, not the urethral development or corporal curvature. * **Posterior Urethral Valve (Option D):** This is an obstructive developmental anomaly in the urethra of male newborns. It presents with voiding dysfunction and hydronephrosis, but does not involve external penile curvature. **Clinical Pearls for NEET-PG:** * **Triad of Hypospadias:** 1. Ectopic urethral meatus (ventral), 2. Chordee (ventral curvature), 3. Hooded prepuce (deficient ventrally, redundant dorsally). * **Management:** Circumcision is **contraindicated** in these infants because the preputial skin is required for surgical reconstruction (Urethroplasty). * **Timing of Surgery:** Ideally performed between **6 to 12 months** of age. * **Commonest Type:** Glandular/Coronal (Distal) hypospadias.

Q: What is the most common type of anorectal malformation?

Anorectal agenesis. **Explanation:** Anorectal malformations (ARMs) are a spectrum of congenital defects resulting from the abnormal development of the urorectal septum. **Why Anorectal Agenesis is Correct:** Anorectal agenesis is the **most common type** of ARM overall. In this condition, the rectum ends blindly above the level of the levator ani muscle (High/Intermediate anomaly). It is frequently associated with a **fistula**: * **In Males:** Most commonly a rectourethral fistula. * **In Females:** Most commonly a rectovestibular fistula. **Analysis of Incorrect Options:** * **Imperforate Anus:** This is a general descriptive term for any ARM where the anal opening is absent, rather than a specific anatomical classification. * **Anal Agenesis:** This is a "Low" anomaly where the anal canal is absent but the rectum is normally developed. It is less common than the higher anorectal agenesis. * **Rectal Atresia:** This is a rare variant where the anal canal and rectum are present but separated by a membrane or a gap. It accounts for only about 1-2% of all ARMs. **NEET-PG High-Yield Pearls:** * **Most common ARM in Males:** Anorectal agenesis with **Rectourethral fistula**. * **Most common ARM in Females:** Anorectal agenesis with **Rectovestibular fistula**. * **Most common "Low" Anomaly:** Rectoperineal fistula. * **VACTERL Association:** Always screen for other anomalies (Vertebral, Anal, Cardiac, Tracheo-Esophageal, Renal, and Limb). Renal anomalies are the most frequent association. * **Initial Management:** Keep NPO, start IV fluids, and perform an **Invertogram** (or cross-table lateral X-ray) after 18–24 hours to allow gas to reach the distal pouch.

Q: A 15-year-old male presents with a long-standing complaint of difficulty in directing his urinary stream. Examination of his penis reveals the urethral meatus opening on the ventral side, proximal to the tip of the glans penis. What is the most common type of abnormality seen in this boy?

Glandular. ### Explanation The clinical presentation describes **Hypospadias**, a congenital anomaly where the urethral meatus is located on the ventral aspect of the penis rather than at the tip of the glans. It is characterized by a triad of: an ectopic urethral meatus, chordee (ventral curvature), and a hooded prepuce (deficient ventral foreskin). **Why Glandular is Correct:** Hypospadias is classified based on the anatomical location of the meatus. The **Glandular (or Distal)** type is the most common variety, accounting for approximately **60-70%** of all cases. In this type, the opening is located on the glans or at the coronal sulcus. Because it is the most frequent presentation in clinical practice, it is the correct answer. **Analysis of Incorrect Options:** * **B. Penile:** These are "mid-shaft" hypospadias. While common, they occur less frequently than distal/glandular types. * **C. Scrotal & D. Perineal:** These are classified as **Proximal** hypospadias. They are the most severe forms but are the least common (occurring in about 10-15% of cases). They are often associated with significant chordee and potential disorders of sexual development (DSD). **High-Yield Clinical Pearls for NEET-PG:** 1. **Contraindication:** Circumcision is **strictly contraindicated** in these patients because the foreskin is required for future surgical reconstruction (urethroplasty). 2. **Associated Anomalies:** Cryptorchidism (undescended testis) and inguinal hernias are the most common associated findings. 3. **Timing of Surgery:** The ideal age for surgical correction is between **6 to 12 months** of age. 4. **Embryology:** It results from the failure of the urethral folds to fuse on the ventral surface.

Q: Which of the following is not typically seen in patients with complete bladder exstrophy?

Hypospadias. **Explanation:** Bladder exstrophy is a complex congenital malformation resulting from the failure of the infraumbilical mesenchymal tissue to migrate, leading to a defect in the anterior abdominal wall and the anterior bladder wall. **Why Hypospadias is the Correct Answer:** In bladder exstrophy, the defect occurs on the **dorsal** aspect of the penis. Therefore, the associated penile anomaly is **Epispadias**, not hypospadias (which is a ventral urethral defect). In males, the penis is typically short, broad, and curved dorsally (chordee) with a bifid glans. **Analysis of Incorrect Options:** * **Umbilical Hernia:** The abdominal wall defect involves the rectus muscles being widely separated (diastasis recti). The umbilicus is displaced inferiorly, and an umbilical hernia is a very common associated finding. * **Visible Ureterovesical Efflux:** In complete exstrophy, the posterior wall of the bladder (trigone) is exposed to the exterior. Consequently, the ureteric orifices are visible, and urine can be seen spurting directly from them onto the abdominal surface. * **Waddling Gait:** Patients have a **widened symphysis pubis** (pubic diastasis) due to the failure of the pelvic bones to fuse in the midline. This lateral rotation of the innominate bones results in a characteristic "waddling gait" when the child begins to walk. **High-Yield Clinical Pearls for NEET-PG:** * **Most common associated malignancy:** Adenocarcinoma of the bladder (due to chronic irritation and glandular metaplasia of the exposed mucosa). * **Classic Radiological Sign:** "Molar tooth sign" on cystography (though more specific to Joubert syndrome, in urology, the widened pubic symphysis is the hallmark). * **Management:** The modern staged functional reconstruction (MSRE) or complete primary repair of exstrophy (CPRE) are the preferred surgical approaches.

Question 1

What is the treatment of choice for cystic hygroma?

Accepted Answer

Surgical excision

Answer

Percutaneous aspiration

Answer

Intralesional sclerosant injection

Answer

En bloc resection

Question 2

A 9-month-old girl presents with rectal bleeding, vomiting, a palpable mass, and colicky pain in the right lumbar region, accompanied by diminished liver dullness. The child is in shock. What is the initial management?

Accepted Answer

Insert nasogastric tube and administer IV fluids

Answer

Administer oxygen

Answer

Perform barium enema

Answer

Attempt saline reduction

Question 3

Regarding neonatal circumcision, which of the following statements is true?

Accepted Answer

General anesthesia should be administered to neonates for circumcision as they perceive pain similarly to adults.

Answer

It should be performed without anesthesia, as it is hazardous to administer anesthesia.

Answer

It should be performed without anesthesia, as neonates do not perceive pain like adults.

Answer

It should be performed under local anesthesia only.

Question 4

Which of the following is NOT true regarding congenital hypertrophic pyloric stenosis?

Accepted Answer

Length of pyloric canal < 14 mm

Answer

Alkalosis

Answer

Non-bilious vomiting

Answer

Visible peristalsis

Question 5

Chordee is associated with which of the following conditions?

Accepted Answer

Hypospadias

Answer

Epispadias

Answer

Phimosis

Answer

Posterior urethral valve

Question 6

A 7-year-old boy presents after a motorcycle crash sustained while unrestrained in the back of a minivan. His vital signs are stable, but he complains of left upper quadrant abdominal pain. A FAST scan reveals scanty fluid in the left colic gutter. An abdominal and pelvic CT scan with intravenous and oral contrast shows a splenic parenchymal blush (arterial extravasation) and a deep parenchymal tear, classifying the spleen as a grade III injury. The child remains hemodynamically stable. What is the recommended next step?

Accepted Answer

Continuous hemodynamic monitoring, celiac angiogram, and angioembolization of the splenic artery.

Answer

Immediate exploration in the operating room.

Answer

If hemodynamic instability develops, aggressive fluid resuscitation including a repeated bolus of 20 mL/kg lactated Ringer's solution, followed by a liver-spleen scan.

Answer

Monitoring only.

Question 7

What is the most common type of anorectal malformation?

Accepted Answer

Anorectal agenesis

Answer

Imperforate anus

Answer

Anal agenesis

Answer

Rectal atresia

Question 8

A 15-year-old male presents with a long-standing complaint of difficulty in directing his urinary stream. Examination of his penis reveals the urethral meatus opening on the ventral side, proximal to the tip of the glans penis. What is the most common type of abnormality seen in this boy?

Accepted Answer

Glandular

Answer

Penile

Answer

Scrotal

Answer

Perineal

Question 9

A six-year-old female presents with constipation and urinary retention. On examination, a presacral mass is noted. What is the most probable diagnosis?

Accepted Answer

Anterior sacral meningocele

Answer

Pelvic neuroblastoma

Answer

Rectal duplication cyst

Answer

Sacrococcygeal teratoma

Question 10

Which of the following is not typically seen in patients with complete bladder exstrophy?

Accepted Answer

Hypospadias

Answer

Umbilical hernia

Answer

Visible ureterovesical efflux

Answer

Waddling gait

Pediatric Surgery — MCQs

Pediatric Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?