Pediatric Surgery Practice Questions

Q: A young male patient presents with a condition similar to the given image. What is the surgery of choice?

Duhamel's procedure. ***Duhamel's procedure*** - This image shows a severe case of **Hirschsprung's disease** in a young male patient, characterized by an **aganglionic segment of the colon** leading to functional obstruction and proximal colonic dilation. - The **Duhamel's procedure** is a surgical option for Hirschsprung's disease where the aganglionic segment is bypassed, and a side-to-side anastomosis is created between the pulled-through normal colon and the rectum. *Delorme's procedure* - This procedure is primarily used for **rectal prolapse**, involving mucosal stripping and plication of the muscular layer of the prolapsed rectum. - It is not the appropriate surgical intervention for **Hirschsprung's disease**, which involves an absence of ganglion cells. *Anterior resection* - Anterior resection is a common surgical procedure for **rectal or sigmoid colon cancer**, involving removal of a segment of the bowel with re-anastomosis. - It does not address the underlying **pathophysiology of Hirschsprung's disease**, which is the absence of ganglion cells. *Abdominal rectopexy* - Abdominal rectopexy is a surgical procedure for **rectal prolapse** where the rectum is mobilized and fixed to the sacrum. - This procedure is not indicated for **Hirschsprung's disease**, as it does not correct the fundamental problem of aganglionosis.

Q: The image shows:

Bladder exstrophy. ***Bladder exstrophy*** - The image clearly displays an **exposed bladder mucosa** projecting from the lower abdominal wall, which is characteristic of bladder exstrophy. - This congenital anomaly results from a **failure of fusion of the anterior abdominal wall** and bladder during embryonic development. *Urachal anomalies* - Urachal anomalies involve persistent remnants of the **urachus**, connecting the bladder to the umbilicus, leading to cysts, sinuses, or fistulas. - They typically appear as lesions at or near the **umbilicus** and do not involve the direct exposure of the bladder. *Systolic bladder* - "Systolic bladder" is **not a recognized medical term** for a congenital anomaly. - Bladder function is described in terms of contraction (systole) and relaxation (diastole) but does not refer to a structural malformation. *Congenital adrenal hyperplasia* - This is an **endocrine disorder** affecting hormone production by the adrenal glands, leading to ambiguous genitalia in some cases. - It does not involve a **visible external defect of the bladder** or abdominal wall.

Q: The following image shows

Encephalocele. ***Encephalocele*** - The image shows a **protrusion (sac) on the scalp** of a child, suggesting a congenital defect where brain tissue and/or meninges herniate through a defect in the skull. This is characteristic of an **encephalocele**. - **Encephaloceles** often present as a skin-covered or membranous sac, typically found along the midline of the skull, as depicted in the image. *Dermoid cyst* - A dermoid cyst is a **benign tumor** that contains mature skin structures like hair follicles and sebaceous glands. - While they can occur on the scalp, they are typically **smaller, firmer, and do not communicate with the intracranial cavity**, unlike the large, soft-appearing protrusion in the image. *Sebaceous cyst* - A sebaceous cyst, or epidermoid cyst, is a **closed sac under the skin** filled with keratin and fatty material. - These are generally **firm, mobile, and do not represent a herniation of intracranial contents**, making them unlikely given the size and appearance of the lesion. *Neurofibroma* - A neurofibroma is a **benign tumor of nerve sheath cells** that can manifest as a skin lesion or subcutaneous nodule. - While they can vary in size, they usually appear as soft, fleshy growths and are **not associated with a skull defect or herniation of brain tissue**, which is the defining feature of the lesion shown.

Q: The picture shows a newborn with excessive salivation. Which of the following statements is NOT true regarding the condition shown?

Always associated with absence of gas shadows in abdomen. ***Always associated with absence of gas shadows in abdomen*** - While **tracheoesophageal fistula (TEF)** with **esophageal atresia** often leads to an absence of gas in the abdomen due to the complete obstruction of the esophagus, it is **not always** the case. - In situations where there is a **distal tracheoesophageal fistula (Type C)**, air can still pass from the trachea into the stomach and intestines, resulting in **gas shadows** in the abdomen. *Associated with polyhydramnios* - **Polyhydramnios** is a common association due to the inability of the fetus to **swallow amniotic fluid** because of the esophageal obstruction. - This leads to an excessive accumulation of amniotic fluid in the uterus. *Associated with VACTERL anomalies* - **Tracheoesophageal fistula** is a key component of the **VACTERL association**, which includes **Vertebral anomalies**, **Anal atresia**, **Cardiac defects**, **Tracheoesophageal fistula**, **Renal anomalies**, and **Limb abnormalities**. - These are often found together in affected newborns. *Surgical ligation of TEF and primary end-to-end anastomosis of esophagus is performed as definitive treatment* - The definitive treatment for **tracheoesophageal fistula (TEF)** with **esophageal atresia** is surgical repair. - This involves **ligation of the fistula** and a **primary end-to-end anastomosis** of the esophageal segments to restore continuity.

Q: All are true about the condition shown in the figure except:

Most common associated defect is Pulmonary hypoplasia. ***Most common associated defect is Pulmonary hypoplasia*** *(FALSE statement - correct answer for "except" question)* - **Pulmonary hypoplasia** is a direct consequence of CDH caused by compression from herniated abdominal contents, not an "associated defect." - True **associated defects** include **cardiovascular anomalies** (20-30% of cases), **chromosomal abnormalities**, and other congenital malformations. *Pulmonary artery hypertension is most important factor determining survival* *(TRUE statement)* - **Pulmonary hypertension** and its impact on **right ventricular function** are indeed the critical determinants of survival in CDH. - The elevated **pulmonary vascular resistance** leads to right-to-left shunting, exacerbating hypoxemia and determining prognosis. *Posterolateral left sided defect is the most common site* *(TRUE statement)* - **Left-sided Bochdalek hernias** (posterolateral defects) account for approximately **80-85%** of all CDH cases. - The chest X-ray shows bowel loops in the left hemithorax, confirming this typical presentation. *Scaphoid abdomen occurs due to herniation of contents into chest cavity* *(TRUE statement)* - **Scaphoid abdomen** is a classic clinical finding in severe CDH due to extensive herniation of abdominal contents. - The abdomen appears distinctly **sunken** because organs like stomach, intestines, and liver have herniated into the chest cavity.

Q: What is shown in the image below?

Pectus excavatum. ***Pectus excavatum*** - The image clearly depicts **pectus excavatum**, which is the direct and accurate identification of the congenital chest wall deformity shown. - This represents a **depression of the sternum** and costal cartilages, creating the characteristic caved-in appearance of the anterior chest wall. *Most common type of chest deformity* - While this is a factually correct statement about pectus excavatum being the most common congenital chest wall deformity, it describes a **general characteristic** of the condition rather than what is specifically shown in the image. - The question asks about the image itself, making direct identification more appropriate than stating epidemiological facts. *Displaced apex beat* - This is a potential **cardiovascular complication** that may occur in severe cases due to cardiac compression and displacement. - However, it cannot be definitively determined from the image alone and is **not universally present** in all cases of pectus excavatum, especially milder forms. *Reduced timed vital capacity* - This represents a potential **respiratory complication** that can result from lung compression in significant cases of pectus excavatum. - Like displaced apex beat, this cannot be assessed from the image and is **not invariably present**, depending on the severity of the chest wall deformity.

Q: A newborn male infant presents with the findings shown in the image. The clinical diagnosis is?

Epispadias. ***Epispadias*** - The image depicts a severe form of **epispadias**, characterized by the exposed **bladder mucosa (exstrophy)** and a penile shaft that is short, dorsally curved, and has the urethral opening on the dorsal surface. - This congenital anomaly results from a failure of the abdominal wall and bladder to close properly during fetal development, often presenting with a **widened pubic symphysis**. *Hypospadias* - **Hypospadias** is a condition where the **urethral opening** is located on the **ventral** (underside) surface of the penis, not the dorsal surface as seen in the image. - While it can involve chordee (penile curvature), it typically does not present with bladder exstrophy. *Micro-penis* - **Micropenis** refers to a penis that is **abnormally small** in length, but otherwise structurally normal. - It describes the size of the penis, not an anomalous opening or exposed internal organs, and is not consistent with the image. *Mauriac syndrome* - **Mauriac syndrome** is a rare complication of poorly controlled **Type 1 diabetes** in children, characterized by growth retardation, delayed puberty, hepatomegaly, and Cushingoid features. - It is an **endocrine disorder** and has no direct relevance to the anatomical abnormality shown in the image.

Q: A 2-month-old girl was brought with swelling just above the gluteal area with progressive increase in size. Which is the most probable diagnosis?

Sacrococcygeal teratoma. ***Sacrococcygeal teratoma*** - Sacrococcygeal teratomas are the **most common germ cell tumors in neonates and infants**, often presenting as a mass in the sacral region, as seen in the image. - They arise from pluripotent cells in the **Hensen's node** (primitive streak remnant) and can contain tissues derived from all three germ layers. *Rhabdomyosarcoma* - Rhabdomyosarcoma is a **malignant tumor of skeletal muscle origin** that can occur in various locations, including the gluteal area, but is less common in infants than SCT. - While it can present as a rapidly growing mass, a sacrococcygeal location in an infant points more strongly to teratoma. *Atypical Rhabdoid tumor* - Atypical rhabdoid tumor is a **highly malignant tumor** typically found in the brain and kidney, though it can occur in soft tissues. - It is rare and not typically the primary diagnosis for a large external gluteal mass in a 2-month-old. *Fibrosarcoma* - Fibrosarcoma is a **malignant tumor of fibroblasts**, rare in infants and usually occurring in older children or adults. - It would present as a soft tissue mass but is much less common than a sacrococcygeal teratoma in this age group and location.

Q: The image shows presence of:

Gastroschisis. ***Gastroschisis*** - The image shows **exposed abdominal organs** (intestines) protruding through a defect in the abdominal wall, typically to the **right of the umbilical cord**. - In gastroschisis, there is **no covering membrane** over the protruding organs, which is characteristic of the condition seen in the image. *Omphalocele* - An omphalocele involves the **protrusion of abdominal organs** through the umbilical cord, but they are contained within a **peritoneal-amniotic sac**. - The image clearly shows **uncovered intestines**, ruling out an omphalocele. *Necrotizing enterocolitis* - This condition is an **inflammatory bowel disease** affecting premature infants, characterized by bowel necrosis, not by external protrusion of organs. - Clinical signs would include abdominal distension, feeding intolerance, and bloody stools, which are not directly depicted or implied here. *Malformation of vitello-intestinal duct* - Malformations of the vitello-intestinal duct (e.g., Meckel's diverticulum or persistent vitelline duct) involve remnants of the embryonic yolk sac connection to the intestine. - These malformations do not typically present as a large external defect with exposed bowel loops as seen in the image.

Q: All investigations are useful in work up of this condition except:

Invertogram at 24 hours. ***Urine for meconium particles*** - **Urine for meconium particles** is actually a valuable and standard investigation in **anorectal malformations** to detect **rectourinary fistulas**. - The presence of meconium in urine indicates a **communication between the rectum and urinary tract**, which is crucial information for surgical planning and management. *Invertogram at 24 hours* - An **invertogram** is a plain X-ray taken with the infant inverted for 3-5 minutes, allowing gas in the rectum to rise to the highest point. - This helps determine the **level of rectal pouch termination** relative to the **pubococcygeal line**, which is essential for distinguishing between high and low anorectal malformations. *Ultrasound* - **Perineal ultrasound** can assess the **perineal body thickness**, presence of a **rectal pouch**, and help visualize **fistulous connections**. - It is particularly useful in **real-time assessment** of the anatomy and can identify associated **genitourinary anomalies** commonly seen with anorectal malformations. *Lateral pelvic radiography* - A **lateral pelvic radiograph** provides information about the **sacral anatomy** and helps assess the **level of anorectal malformation**. - It is crucial for identifying associated **sacral anomalies** (sacral dysgenesis, hemisacrum) which occur in up to 60% of patients with anorectal malformations and affect surgical outcomes.

Question 1

A young male patient presents with a condition similar to the given image. What is the surgery of choice?

Accepted Answer

Duhamel's procedure

Answer

Delorme's procedure

Answer

Anterior resection

Answer

Abdominal rectopexy

Question 2

The image shows:

Accepted Answer

Bladder exstrophy

Answer

Urachal anomalies

Answer

Systolic bladder

Answer

Congenital adrenal hyperplasia

Question 3

The following image shows

Accepted Answer

Encephalocele

Answer

Dermoid cyst

Answer

Sebaceous cyst

Answer

Neurofibroma

Question 4

The picture shows a newborn with excessive salivation. Which of the following statements is NOT true regarding the condition shown?

Accepted Answer

Always associated with absence of gas shadows in abdomen

Answer

Associated with polyhydramnios

Answer

Associated with VACTERL anomalies

Answer

Surgical ligation of TEF and primary end-to-end anastomosis of esophagus is performed as definitive treatment

Question 5

All are true about the condition shown in the figure except:

Accepted Answer

Most common associated defect is Pulmonary hypoplasia

Answer

Posterolateral left sided defect is the most common site

Answer

Scaphoid abdomen occurs due to herniation of contents into chest cavity

Answer

Pulmonary artery hypertension is most important factor determining survival

Question 6

What is shown in the image below?

Accepted Answer

Pectus excavatum

Answer

Displaced apex beat

Answer

Reduced timed vital capacity

Answer

Most common type of chest deformity

Question 7

A newborn male infant presents with the findings shown in the image. The clinical diagnosis is?

Accepted Answer

Epispadias

Answer

Hypospadias

Answer

Micro-penis

Answer

Mauriac syndrome

Question 8

A 2-month-old girl was brought with swelling just above the gluteal area with progressive increase in size. Which is the most probable diagnosis?

Accepted Answer

Sacrococcygeal teratoma

Answer

Rhabdomyosarcoma

Answer

Atypical Rhabdoid tumor

Answer

Fibrosarcoma

Question 9

The image shows presence of:

Accepted Answer

Gastroschisis

Answer

Omphalocele

Answer

Necrotizing enterocolitis

Answer

Malformation of vitello-intestinal duct

Question 10

All investigations are useful in work up of this condition except:

Accepted Answer

Invertogram at 24 hours

Answer

Urine for meconium particles

Answer

Ultrasound

Answer

Lateral pelvic radiography

Pediatric Surgery — MCQs

Pediatric Surgery — MCQs

On this page

Practice by Chapter

Want unlimited practice?