Pediatric Surgery Practice Questions

Q: What is the most common cause of craniosynostosis?

Scaphocephaly. **Explanation:** Craniosynostosis refers to the premature fusion of one or more cranial sutures, leading to an abnormal skull shape and potential restriction of brain growth. **Why Scaphocephaly is correct:** Scaphocephaly (also known as Dolichocephaly) is the **most common type of craniosynostosis**, accounting for approximately 50-60% of cases. It results from the premature fusion of the **sagittal suture**. Because the skull cannot grow laterally, it compensates by growing excessively in the anteroposterior direction, resulting in a long, narrow, boat-shaped head. **Analysis of Incorrect Options:** * **A. Plagiocephaly:** This refers to an asymmetrical skull shape. While it can be caused by unilateral coronal or lambdoid synostosis, it is most commonly "positional" (non-synostotic) due to external pressure. * **B. Brachycephaly:** This results from the bilateral premature fusion of the **coronal sutures**. It produces a wide, short skull and is frequently associated with syndromic conditions like Apert or Crouzon syndrome. * **C. Trigonocephaly:** This results from the premature fusion of the **metopic suture**, leading to a triangular-shaped forehead with a prominent midline ridge. **High-Yield Clinical Pearls for NEET-PG:** * **Most common suture involved:** Sagittal suture (Scaphocephaly). * **Second most common:** Coronal suture (Brachycephaly). * **Apert Syndrome:** Characterized by bilateral coronal synostosis + syndactyly ("mitten hands"). * **Crouzon Syndrome:** Characterized by bilateral coronal synostosis + midface hypoplasia + proptosis (no syndactyly). * **Management:** Primarily surgical (cranial vault remodeling) to prevent increased intracranial pressure and improve cosmesis.

Q: Intussusception usually begins from which anatomical location?

Terminal ileum. **Explanation:** Intussusception is the telescoping of a proximal segment of the bowel (intussusceptum) into an adjacent distal segment (intussuscipiens). **1. Why Terminal Ileum is Correct:** The most common type of intussusception is **Ileocolic (75-90% of cases)**. It typically originates at or near the **terminal ileum**, just proximal to the ileocecal valve. This area is anatomically prone to intussusception due to the abundance of lymphoid tissue (Peyer’s patches) in the terminal ileum. In children, viral infections often cause lymphoid hyperplasia, which acts as a "pathological lead point," allowing the terminal ileum to prolapse into the cecum. **2. Analysis of Incorrect Options:** * **Jejunum (A):** While jejuno-jejunal intussusception can occur, it is rare and usually associated with specific lead points like Henoch-Schönlein purpura or postoperative states. * **Colon (B):** Colo-colic intussusception is less common in children and, when present, is often associated with a distinct lead point like a polyp or malignancy. * **Rectum (D):** The rectum is a fixed retroperitoneal structure and is the endpoint of the intussusceptum (prolapse through the anus), not the site of origin. **3. Clinical Pearls for NEET-PG:** * **Classic Triad:** Intermittent abdominal pain, "currant jelly" stools, and a palpable sausage-shaped mass (usually in the right upper quadrant). * **Dance’s Sign:** Emptiness in the right iliac fossa. * **Diagnosis:** Ultrasound is the gold standard (**Target or Donut sign**). * **Treatment:** Non-operative reduction using **Air or Hydrostatic (Barium/Saline) enema** is the first-line treatment if there are no signs of peritonitis or perforation.

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

Visible peristalsis is always seen.. ### Explanation **1. Why Option D is the Correct Answer (The False Statement):** In medicine, "always" is a red flag. While **visible gastric peristalsis** (moving from left to right in the epigastrium) is a classic clinical sign of Hypertrophic Pyloric Stenosis (HPS), it is **not always present**. Its visibility depends on the timing of the examination relative to feeding and the thickness of the abdominal wall. The diagnosis is primarily clinical (palpating an "olive-shaped" mass) or confirmed via ultrasound. **2. Analysis of Other Options:** * **Option A (Electrolytes):** This is a high-yield fact. Persistent vomiting of gastric juice (HCl) leads to loss of H+ and Cl- ions. The kidney attempts to conserve sodium by exchanging it for H+ ions in the distal tubule (due to aldosterone activation from dehydration), resulting in **paradoxical aciduria** despite systemic alkalosis. * **Option B (Epidemiology):** HPS classically affects **first-born male infants** (Male:Female ratio of 4:1). There is also an association with maternal smoking and the use of erythromycin. * **Option C (Surgery):** The gold standard treatment is the **Ramstedt pyloromyotomy**, where the longitudinal and circular muscle layers of the pylorus are incised down to the mucosa. **3. NEET-PG High-Yield Pearls:** * **Age of Presentation:** Typically 3 to 6 weeks of life. * **Clinical Feature:** Non-bilious, projectile vomiting. * **Ultrasound Criteria:** Pyloric muscle thickness **>4 mm** or pyloric canal length **>14 mm**. * **Management Priority:** HPS is a **medical emergency, not a surgical one**. You must correct the dehydration and electrolyte imbalance (alkalosis) before taking the child to surgery.

Question 1

What is the most common cause of craniosynostosis?

Accepted Answer

Scaphocephaly

Answer

Plagiocephaly

Answer

Brachycephaly

Answer

Trigonocephaly

Question 2

Which of the following statements is NOT true regarding undescended testes?

Accepted Answer

The risk of developing testicular malignancy is about 20 times higher.

Answer

Surgery for undescended testes does not decrease the chances of developing testicular carcinoma.

Answer

Approximately 70% of cryptorchid testes descend by 3 months of age.

Answer

Patients typically have normal secondary sexual characteristics.

Question 3

Intussusception usually begins from which anatomical location?

Accepted Answer

Terminal ileum

Answer

Jejunum

Answer

Colon

Answer

Rectum

Question 4

What is the most common cause of urinary ascites?

Accepted Answer

Posterior urethral valves

Answer

Pelviureteral junction obstruction

Answer

Urethral stricture

Answer

None of the above

Question 5

What is most characteristic of congenital hypertrophic pyloric stenosis?

Accepted Answer

The pyloric tumor is best felt during feeding

Answer

Affects the first-born female child

Answer

The patient is commonly marasmic

Answer

Loss of appetite occurs early

Question 6

Which statement regarding congenital umbilical hernia is false?

Accepted Answer

Protrusion of abdominal contents through a paraumbilical defect

Answer

Covered by a peritoneal sac

Answer

Herniated viscera may include stomach and bowel

Answer

Occurs in term babies

Question 7

Which of the following is NOT true about hypertrophic pyloric stenosis?

Accepted Answer

Visible peristalsis is always seen.

Answer

The typical electrolyte abnormality is hypochloremic, hypokalemic, metabolic alkalosis with paradoxical aciduria.

Answer

First-born males are commonly affected.

Answer

Ramstedt operation is the surgical procedure performed.

Question 8

Recurrent intussusception occurs in about what percentage of cases?

Accepted Answer

5-10%

Answer

Less than 1%

Answer

1-5%

Answer

10-20%

Question 9

Which of the following statements is true about lymphangioma?

Accepted Answer

It is a congenital sequestration of lymphatics.

Answer

It is a malignant tumor.

Answer

Cystic hygroma is a lymphangioma.

Answer

Sclerotherapy is commonly done.

Question 10

What is the recommended treatment for an umbilical adenoma in a newborn?

Accepted Answer

None of the above

Answer

Occlusion with a coin

Answer

Strapping

Answer

Surgery

Pediatric Surgery — MCQs

Pediatric Surgery — MCQs

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