Pediatric Surgery MCQs

Surgery · 104 free questions with answers & explanations.

1. A 4-week-old male infant presents with non-bilious projectile vomiting after every feed. He is eagerly hungry after vomiting. Examination reveals visible peristalsis and a palpable olive-shaped mass in the right upper quadrant. Ultrasound confirms pyloric canal thickness of 4 mm and length of 18 mm. The diagnosis is:
2. A 2-year-old child presents with episodic inconsolable crying, drawing up of the knees, and passage of blood-stained mucus per rectum ('redcurrant jelly' stool). Abdominal examination shows a sausage-shaped mass in the right upper quadrant with absence of bowel in the right iliac fossa (Dance's sign). The most likely diagnosis is:
3. A 3-week-old male infant presents with projectile non-bilious vomiting after every feed, visible gastric peristalsis, and a palpable olive-shaped epigastric mass. Electrolytes show hypochloremic hypokalemic metabolic alkalosis. The definitive treatment is:
4. A 2-day-old neonate has failed to pass meconium, with abdominal distension and bilious vomiting. Suction rectal biopsy shows absence of ganglion cells in the submucosal (Meissner's) and myenteric (Auerbach's) plexuses with hypertrophied nerve trunks. The diagnosis is Hirschsprung disease. What determines the extent of surgical resection?
5. A neonate born at 35 weeks presents at 12 hours of age with bilious vomiting and abdominal distension. Plain X-ray shows a 'double bubble' sign with no distal gas. What is the most likely diagnosis and the associated chromosomal anomaly?
6. Hirschsprung's disease results from failure of craniocaudal migration of neural crest cells. The aganglionic segment always begins at the internal anal sphincter and extends proximally. The classic presentation is constipation from birth and failure to pass meconium in first 48 hours. What is the most accurate diagnostic investigation in a neonate?
7. A 3-week-old male infant presents with projectile non-bilious vomiting after every feed. He appears hungry after vomiting. Ultrasound shows pyloric muscle thickness of 4.5 mm and channel length of 18 mm. Pre-operative management before pyloromyotomy must include correction of which metabolic derangement?
8. A 2-day-old neonate presents with abdominal distension and failure to pass meconium. Plain abdominal X-ray shows dilated loops of bowel. Contrast enema reveals a transition zone in the rectosigmoid with a 'bird's beak' appearance. Rectal biopsy confirms absence of ganglion cells in the myenteric and submucosal plexuses. This patient has Hirschsprung disease. The pathological process is best explained by:
9. In a neonate with suspected Hirschsprung disease, which is the gold standard investigation for diagnosis and for delineating the extent of aganglionosis?
10. In pyloric stenosis, a 4-week-old infant presents with non-bilious projectile vomiting, visible peristalsis, and a palpable 'olive' in the right hypochondrium. Metabolic disturbance typically seen is:
11. In paediatric intussusception, which imaging modality is both diagnostic and therapeutic as first-line management in a haemodynamically stable child?
12. A 3-week-old male infant presents with projectile non-bilious vomiting after every feed. On examination, an olive-shaped mass is felt in the right upper quadrant during a test feed. Ultrasound confirms pyloric muscle thickness of 5 mm and pyloric channel length of 20 mm. What is the correct management sequence?
13. A 2-year-old girl presents with colicky abdominal pain, vomiting, currant jelly stools, and a sausage-shaped mass in the right iliac fossa. Ultrasound shows a target/pseudokidney sign. What is the correct first-line management?
14. A 3-week-old male infant presents with projectile non-bilious vomiting after feeds. Examination reveals a palpable 'olive' in the right upper quadrant. Ultrasound confirms pyloric muscle thickness of 4 mm and channel length of 18 mm. What is the electrolyte abnormality and the immediate preoperative priority before Ramstedt's pyloromyotomy?
15. In Hirschsprung's disease, the aganglionic segment is always contiguous and begins from the internal anal sphincter. The agangliosis results from failure of migration of neural crest cells. Most commonly, what is the extent of the aganglionic segment?
16. A neonate presents with bilious vomiting and abdominal distension on day 2 of life. X-ray shows a 'double bubble' sign with absence of distal gas. The most likely diagnosis and embryological basis is:
17. A 6-week-old male infant presents with progressively worsening non-bilious projectile vomiting after every feed. He is visibly hungry post-vomiting. Palpation reveals an olive-shaped mass in the right hypochondrium. Electrolytes show hypochloremic hypokalemic metabolic alkalosis. What is the mechanism of the metabolic derangement?
18. Tracheoesophageal fistula (TEF) most commonly occurs as which type in the Gross classification?
19. A neonate presents on day 2 with bilious vomiting and a 'double bubble' sign on abdominal X-ray. Laparotomy confirms duodenal atresia with a 'type III' complete atresia. Which associated anomaly must be ACTIVELY excluded before and during surgery due to its high co-occurrence?
20. A 6-week-old male infant presents with progressive non-bilious projectile vomiting, visible peristalsis, and an olive-shaped mass palpable in the epigastrium. Ultrasound shows a pyloric muscle thickness of 4.2 mm and pyloric canal length of 18 mm. Before pyloromyotomy, what metabolic abnormality must be corrected?
21. A 3-week-old male infant presents with projectile non-bilious vomiting after feeds, visible gastric peristalsis, and a palpable olive-like mass in the right hypochondrium. Ultrasound confirms hypertrophic pyloric stenosis (pyloric muscle thickness 4 mm, length 18 mm). Serum electrolytes show: Na 132, K 3.0, Cl 88, HCO3 32 mEq/L. What is the most critical step BEFORE definitive surgical treatment?
22. A 4-day-old full-term neonate presents with bilious vomiting and failure to pass meconium. X-ray shows 'double bubble sign' without distal gas. Ultrasound shows absence of the 'whirlpool sign'. Which diagnosis explains these findings and what is the definitive treatment?
23. A 3-day-old neonate presents with bilious vomiting. Abdominal X-ray shows a 'double bubble' sign with no distal gas. The most important preoperative investigation before surgical correction is:
24. A 4-week-old male infant presents with projectile non-bilious vomiting after every feed. A firm, olive-sized mass is palpable in the right upper quadrant. Ultrasound shows pyloric muscle thickness of 4.5 mm and pyloric channel length of 18 mm. The metabolic derangement expected is:
25. A 6-week-old male with anorectal malformation (imperforate anus) is found to have no fistula visible on perineum. Cross-table lateral X-ray taken at 24 hours of life shows rectal gas bubble 2 cm above the perineal skin. The Krickenbeck classification would categorize this as:
26. A 3-week-old male infant presents with bilious vomiting and distress. Upper GI contrast study shows the duodenojejunal junction (DJ flexure) to the right of the vertebral column and the small bowel loops predominantly in the right abdomen (malrotation). The condition known as midgut volvulus complicates malrotation. The surgical procedure to correct malrotation and reduce volvulus is the Ladd's procedure. Which step of Ladd's procedure specifically broadens the mesenteric base to prevent re-volvulus?
27. A 2-day-old neonate has failed to pass meconium and develops bilious vomiting and abdominal distension. Abdominal X-ray shows dilated bowel loops and 'ground glass' appearance in the right iliac fossa. Gastrografin enema reveals a microcolon and pellets of inspissated meconium in the terminal ileum. The diagnosis is meconium ileus. The condition most closely associated with meconium ileus is:
28. A full-term neonate presents at 36 hours of age with bilious vomiting, abdominal distension, and failure to pass meconium beyond 48 hours. X-ray shows a 'double bubble' sign. The most likely diagnosis and associated embryological defect is:
29. A 3-week-old male infant presents with non-bilious projectile vomiting immediately after feeding. He appears hungry after vomiting. A palpable 'olive-shaped' mass is felt in the right epigastrium. Electrolytes show hypochloraemic, hypokalaemic metabolic alkalosis. The appropriate pre-operative treatment before pyloromyotomy is:
30. In the VACTERL association, the 'R' component stands for:
31. A 3-week-old male infant presents with projectile non-bilious vomiting immediately after feeding for 10 days. Olive-shaped mass is palpable in the epigastrium. Ultrasound shows pyloric muscle thickness >4 mm and canal length >16 mm. Electrolytes reveal: Na 128 mEq/L, K 2.8 mEq/L, Cl 82 mEq/L, HCO3 32 mEq/L. What is the correct pre-operative management?
32. A 2-year-old girl is brought in with sudden onset colicky abdominal pain, vomiting, and passage of 'redcurrant jelly' stool. Ultrasound shows a 'target sign' in the right iliac fossa. Air enema reduction is attempted but fails. Laparotomy reveals ileo-colic intussusception. Which anatomical point on the ileum is used to determine safe manual reduction versus bowel resection?
33. A 2-day-old neonate presents with bilious vomiting and failure to pass meconium. AXR shows a 'double bubble' sign with no distal gas. The father had similar surgery as a neonate. Which genetic mutation is most strongly associated with familial Hirschsprung's disease?
34. A 4-week-old male infant presents with non-bilious projectile vomiting. Examination reveals a palpable olive-shaped mass in the epigastrium. ABG shows pH 7.55, Na+ 128 mEq/L, K+ 2.9 mEq/L, Cl- 82 mEq/L. Prior to Ramstedt's pyloromyotomy, which fluid and electrolyte correction is most appropriate?
35. A 3-year-old child is brought to casualty with a 2-hour history of sudden-onset colicky abdominal pain, drawing up of legs, and a jelly-like 'red currant jelly' stool. Abdominal ultrasound shows a 'target sign' (pseudokidney sign) in the right flank. Ileocolic intussusception is confirmed. Which is the recommended first-line treatment in a hemodynamically stable child without perforation?
36. A 3-week-old male infant presents with non-bilious projectile vomiting after every feed, visible left-to-right peristaltic wave, and a palpable 'olive-shaped' mass in the right upper quadrant. Ultrasound confirms pyloric channel length >16 mm and pyloric wall thickness >4 mm. Prior to surgical pyloromyotomy (Ramstedt procedure), which metabolic abnormality must be corrected?
37. A 2-day-old female neonate has bilious vomiting from birth, abdominal distension, and failure to pass meconium. X-ray shows a 'double bubble' sign. At surgery, a duodenal atresia is found at the level of the second part of the duodenum. The embryological basis of this defect is:
38. A 3-week-old male infant presents with projectile non-bilious vomiting, visible gastric peristalsis, and an olive-shaped mass in the epigastrium. Ultrasound shows pyloric muscle thickness of 4.5 mm and channel length of 18 mm. What is the metabolic derangement and definitive treatment?
39. Necrotizing enterocolitis (NEC) in a premature neonate is managed surgically when conservative measures fail. Which finding on abdominal X-ray is an absolute indication for surgery in NEC?
40. A 6-month-old girl with cystic fibrosis develops recurrent episodes of cramping abdominal pain with a 'target sign' and 'crescent sign' on ultrasound. Successful air enema reduction is performed. What is the most likely diagnosis and pathological lead point in this age group with CF?
41. A 3-week-old male infant presents with non-bilious, projectile vomiting after every feed. On examination a palpable 'olive' is felt in the epigastrium. Ultrasound confirms pyloric muscle thickness >4 mm and channel length >16 mm. After correcting hypochloraemic hypokalaemic metabolic alkalosis, the definitive treatment is:
42. In Hirschsprung's disease, the diagnosis is confirmed histologically by which finding on full-thickness rectal biopsy, and the colonic segment involved is always aganglionic to which proximal limit in classic (short-segment) disease?
43. In pediatric hypertrophic pyloric stenosis, which biochemical abnormality must be corrected before surgical pyloromyotomy?
44. Hirschsprung disease results from failure of neural crest cell migration. The length of aganglionic segment determines the clinical presentation. In which condition is Hirschsprung disease most commonly found as an associated anomaly?
45. A neonate born at 38 weeks presents with bilious vomiting and abdominal distension on day 2. X-ray shows a double-bubble sign without distal gas. What is the most appropriate surgical procedure?
46. A 3-week-old male infant presents with persistent, non-bilious projectile vomiting after every feed. On examination, a firm olive-shaped mass is palpable in the right upper quadrant. Ultrasound shows pyloric muscle thickness of 4.5 mm and channel length of 19 mm. The metabolic derangement expected and the surgical procedure of choice are:
47. A newborn presents with failure to pass meconium within 48 hours, abdominal distension, and bilious vomiting. A suction rectal biopsy confirms absence of ganglion cells in the submucosal and myenteric plexuses. Which imaging finding on contrast enema is pathognomonic?
48. A 4-month-old infant is brought with intermittent episodes of drawing up knees to the chest, inconsolable crying lasting 15–20 minutes, and passage of 'redcurrant jelly' stool. Abdominal ultrasound shows a target sign in the right upper abdomen. After initial stabilisation, the first-line treatment is:
49. A 3-week-old male infant presents with projectile non-bilious vomiting, weight loss, and a palpable 'olive-shaped' mass in the right upper quadrant. Ultrasound shows pyloric muscle thickness of 4.2 mm and pyloric canal length of 19 mm. The MOST appropriate immediate pre-operative management is:
50. A 2-day-old neonate is found to have abdominal distension and failure to pass meconium. Plain X-ray shows a 'soap bubble' appearance in the right iliac fossa. What is the MOST likely diagnosis?
51. In the Ladd's procedure for intestinal malrotation with midgut volvulus, what is the correct sequence of operative steps?
52. A 5-year-old child presents with intermittent abdominal pain, rectal bleeding, and a palpable abdominal mass. Ultrasound shows a lead point-associated intussusception. What feature on ultrasound is most commonly described?
53. A 3-week-old male infant presents with non-bilious projectile vomiting after every feed. On examination, a palpable olive-shaped mass is felt in the epigastrium. Ultrasound confirms pyloric muscle thickness of 5 mm and pyloric channel length of 20 mm. The Fredet-Ramstedt pyloromyotomy involves:
54. Hirschsprung's disease results from failure of neural crest cell migration. The RET proto-oncogene mutation accounts for 50% of familial cases. The most common form involves absence of ganglia in the:
55. A 3-week-old male infant presents with projectile non-bilious vomiting after every feed, with a palpable olive-shaped mass in the epigastrium. What is the investigation of choice and the definitive treatment?
56. A 2-year-old child presents with intermittent colicky abdominal pain, passage of 'redcurrant jelly' stools, and a sausage-shaped mass in the right upper quadrant. Abdominal ultrasound shows a target sign. What is the first-line treatment?
57. A neonate born at 35 weeks is found to have a large abdominal wall defect at the umbilicus with intact peritoneal sac covering the herniated intestines and liver. The umbilical cord inserts at the apex of the sac. What is the diagnosis, and what differentiates it from gastroschisis?
58. A 3-week-old male infant presents with projectile non-bilious vomiting after feeds, visible gastric peristalsis, and a palpable 'olive-shaped' mass in the right epigastrium. Electrolytes show: Na 132 mEq/L, K 2.8 mEq/L, Cl 88 mEq/L, HCO3 32 mEq/L. What is the MOST appropriate sequence of management?
59. A neonate born at 35 weeks has bilious vomiting from birth. Abdominal X-ray shows a 'double bubble' sign with no distal bowel gas. What is the MOST likely diagnosis and associated genetic condition?
60. A 6-year-old boy presents with a painless right-sided abdominal mass discovered incidentally. CT shows a large renal mass with heterogeneous enhancement. Which of the following is the MOST common histological finding and the chemotherapy used preoperatively in the UK/European protocol?
61. Hirschsprung's disease results from failure of neural crest cell migration to the distal bowel. The gene most commonly mutated in sporadic Hirschsprung's disease is:
62. The 'double bubble' sign on plain abdominal radiograph in a neonate is pathognomonic of:
63. A 6-week-old male infant presents with projectile non-bilious vomiting after every feed. Examination reveals a palpable olive-shaped mass in the right hypochondrium. Ultrasound confirms pyloric muscle thickness of 4.5 mm and canal length of 18 mm. The definitive treatment is:
64. A 3-week-old male infant presents with progressive non-bilious projectile vomiting after feeding. Serum electrolytes: Na+ 136, K+ 2.8, Cl- 88, HCO3- 32 mEq/L. What is the correct pathophysiology of the electrolyte disturbance?
65. A 2-day-old neonate has failure to pass meconium and progressive abdominal distension. X-ray shows multiple dilated bowel loops. Contrast enema reveals a transition zone at the rectosigmoid junction. Rectal suction biopsy confirms absence of ganglion cells. The definitive surgical procedure performed typically at 3–6 months is:
66. A 6-week-old female infant has a 4 cm right groin hernia that is reducible. She is otherwise healthy. When should elective inguinal hernia repair be scheduled?
67. In Hirschsprung's disease, the aganglionic segment is defined histologically by the absence of ganglion cells in which specific layer(s) of the bowel wall?
68. Kasai portoenterostomy (hepatic portoenterostomy) for biliary atresia achieves best outcomes when performed before which age?
69. A 6-week-old male infant presents with non-bilious projectile vomiting after every feed. He is eager to feed again after vomiting. On examination there is a palpable olive-shaped mass in the right hypochondrium. The investigation of choice to confirm the diagnosis is:
70. A 3-day-old neonate has not passed meconium and presents with bilious vomiting and abdominal distension. Rectal examination results in explosive passage of gas and liquid stool. Contrast enema shows a transition zone in the sigmoid colon. The definitive diagnosis is confirmed by:
71. A 4-month-old infant presents with intermittent paroxysmal abdominal pain, drawing up of knees, and a 'redcurrant jelly' stool. Abdominal ultrasound shows a 'target sign' in the right upper quadrant. Initial management is:
72. The Ladd procedure for malrotation with midgut volvulus consists of four specific steps. Which of the following is NOT part of the Ladd procedure?
73. Hirschsprung disease is confirmed on rectal suction biopsy. Which histological finding is diagnostic?
74. An 8-week-old male presents with bilious vomiting since day 1 of life, failure to thrive, and abdominal distention. X-ray shows a 'double bubble' sign without distal gas. What is the most likely diagnosis and the pathological basis?
75. A 3-week-old male infant presents with projectile non-bilious vomiting after feeds, palpable olive-shaped mass in the epigastrium, and hypochloraemic hypokalaemic metabolic alkalosis. What is the definitive surgical treatment?
76. A 2-year-old child presents with sudden onset of colicky abdominal pain, passage of 'redcurrant jelly' stools, and a sausage-shaped mass in the right iliac fossa. Which of the following is the preferred initial treatment?
77. Hirschsprung's disease (congenital aganglionic megacolon) presents as failure to pass meconium in the first 48 hours of life. What is the pathophysiological basis?
78. A 3-week-old male infant presents with projectile vomiting after feeds, visible left-to-right gastric peristalsis, and a palpable olive-shaped mass in the right hypochondrium. Ultrasound confirms pyloric muscle thickness of 4.2 mm and pyloric canal length of 19 mm. Which electrolyte abnormality is expected?
79. A 2-day-old neonate has failed to pass meconium and has a distended abdomen. Contrast enema shows a transition zone in the sigmoid colon. Rectal suction biopsy confirms absence of ganglion cells with increased acetylcholinesterase staining. This is consistent with Hirschsprung's disease. The level of aganglionosis determines surgery. What is the most common level affected?
80. A 4-year-old girl presents with a right-sided abdominal mass. CT abdomen shows a well-encapsulated renal mass with nephroblastomatous tissue. AFP and urine catecholamines are normal. What is the most likely diagnosis and the correct initial management in Europe (SIOPE/SIOP protocol)?
81. A 3-week-old male infant presents with non-bilious projectile vomiting occurring immediately after feeds, visible peristalsis, and a palpable olive-shaped mass in the right upper quadrant. The electrolyte finding expected on blood gas is:
82. A term neonate develops bilious vomiting on day 1 of life. Abdominal X-ray shows a 'double bubble' sign with no distal gas. Maternal history notes polyhydramnios and trisomy 21. The most likely diagnosis is:
83. A 5-year-old child is found on CT to have a large retroperitoneal mass with calcifications arising from the kidney. It shows areas of necrosis. The tumour shows loss of heterozygosity at chromosome 11p13 (WT1 locus). This diagnosis is best treated with which combination per current COG/SIOP protocols for stage III disease?
84. A 3-week-old male infant presents with progressive non-bilious projectile vomiting after every feed. Examination reveals visible peristalsis and a palpable 'olive' in the epigastrium. Ultrasound confirms pyloric muscle thickness of 4 mm and channel length of 18 mm. What metabolic abnormality is expected on blood gas?
85. A 6-year-old boy presents with an ileocaecal intussusception confirmed on ultrasound (target sign). There are no features of peritonitis or perforation. What is the first-line treatment?
86. A newborn presents with failure to pass meconium in the first 48 hours. Contrast enema shows a 'transition zone' at the rectosigmoid junction with a dilated proximal colon. Suction rectal biopsy confirms absence of ganglion cells in the submucosal and myenteric plexuses. What embryological failure underlies Hirschsprung's disease?
87. A 3-week-old male infant presents with non-bilious projectile vomiting after feeds. Examination reveals an olive-shaped mass in the epigastrium. Ultrasound shows pyloric muscle thickness of 5 mm and pyloric channel length of 20 mm. The appropriate surgical procedure is:
88. In neonatal intestinal atresia, Apple peel (Christmas tree) deformity is a variant of which type of jejuno-ileal atresia?
89. A 2-day-old male neonate fails to pass meconium. Contrast enema shows a transition zone at the rectosigmoid junction. Suction rectal biopsy confirms absence of ganglion cells in the Auerbach plexus. This is consistent with Hirschsprung disease. The definitive surgical procedure performed in the neonatal period is:
90. A 6-hour-old neonate has bilious vomiting and an abdominal X-ray showing the 'double bubble' sign with no distal gas. The most likely diagnosis and embryological basis is:
91. In paediatric inguinal hernia, the key anatomical distinction from adults is that indirect inguinal hernia in infants results from:
92. The Ladd procedure for malrotation and midgut volvulus involves four essential steps. Which step is unique to this operation and prevents recurrent volvulus?
93. Hirschsprung's disease (aganglionosis) is diagnosed by rectal suction biopsy. The definitive histological criterion is:
94. Necrotizing enterocolitis (NEC) modified Bell staging is used to guide management. Stage IIB NEC is defined by which specific criteria?
95. The Kasai portoenterostomy for biliary atresia is most likely to achieve bile flow and delay transplantation when performed before what age?
96. In pediatric intussusception, the most common type encountered and its lead point in children under 2 years is:
97. Hirschsprung's disease most commonly affects which segment of the colon, and what is the surgical principle of the Swenson pull-through procedure?
98. An 8-hour-old neonate has bilious vomiting and a 'double bubble' sign on plain abdominal X-ray. The most likely diagnosis and the associated condition to exclude urgently is:
99. In the operative correction of exomphalos major (omphalocele >5 cm), when primary closure is not feasible due to a giant defect, the preferred staged technique is:
100. A 1-day-old neonate presents with failure to pass meconium, abdominal distension, and bilious vomiting. Contrast enema shows a narrow rectosigmoid with proximal dilation. Suction rectal biopsy confirms the diagnosis. What will histology show?
101. A 2-day-old neonate with a prenatal diagnosis of left-sided congenital diaphragmatic hernia (CDH) is born. She has severe respiratory distress. What is the correct management sequence?
102. A 1-day-old neonate is noted to have bilious vomiting, a double-bubble sign on abdominal X-ray, and a distended upper abdomen. There is no distal gas. The most likely diagnosis is:
103. A 6-week-old male infant has a scrotal swelling that is soft, transilluminates, and is present since birth. It does not extend to the inguinal canal and does not change with crying. What is the most appropriate management?
104. A 2-day-old neonate presents with bilious vomiting and abdominal distension. AXR shows a 'double bubble' sign with no gas in the distal bowel. The most likely diagnosis and the embryological basis are: