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13.
E. Duodenal atresia
20. Which of the following is not a component of meconium disease of infancy?
A. Meconium ileus
B. Meconium peritonitis
C. Meconium plug syndrome
D. Meconium ileus equivalent (MIE)
E. Meconium stenosis syndrome
21. The conservative method of meconium ileus management is:
A. Gastrografin enema
B. Antibacterial therapy
C. Spasmolytic drugs
D. Intravenous infusion
E. Ultrasound therapy
22. Marked abdominal distention was noticed in the fifth day of life of a neonate female
with intestinal loops visible on the anterior abdominal wall. Meconium was discharged after an
enema. On a plain abdominal radiograph, the large intestine was found to be distended. What is
the most probable diagnosis?
A. Ladds syndrome
B. Ileal stenosis
C. Hirschsprungs disease
D. Portal hypertension
E. Intususception
23. A neonate in whom the anus was noted to be absent was observed to be occasionally
passing urine with traces of meconium, and clear urine on other occasions. Which type of
anomaly is present?
A. Anal atresia
B. Anal atresia with rectourethral fistula
C. Anal atresia with rectovesical fistula
D. Rectal atresia
E. Cloacal malformation
24. Which of the following is the most informative in diagnosis of HD?
A. Biopsy
B. Plain radiography
C. Contrast radiography
D. Endoscopy
E. Ultrasonography
25. Which of the following is not a method of surgical management in HD?
A. Duhamels operation
B. Swensons operation
C. Soaves operation
D. Ladds operation
E. Rehbeins operation
26. Which is not indicative of HD?
A. Aganglionic bowel on biopsy
B. Abnormal recto-anal inhibitory reflex
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C. Abdominal distention
D. Abdominal pain
E. Constipation
27. A child aged 5 months was fed carrots for the first time became irritated and there
was recurrent vomiting. The general state was moderately severe, the abdomen was not
distended and on palpation was soft. Rectal exam revealed a viscous mucoid bloody discharge.
Which of the following diagnoses comes to mind?
A. Ladds syndrome
B. Intestinal polyposis
C. Hirschsprungs disease
D. Portal hypertension
E. Intussusception
28. Which symptom is not characteristic of paralytic ileus?
A. Abdominal pain
B. Constipation
C. Increased peristalsis
D. Vomiting
E. Abdominal distention
29. Which of the following is the least informative in diagnosis of intussusception?
A. Endoscopy
B. Plain radiography
C. Contrast radiography
D. Biopsy
E. Ultrasonography
30. Which symptom is not characteristic of intussusception?
A. Abdominal pain
B. Constipation
C. Increased peristalsis
D. Abdominal distention
E. Vomiting
31. Which is not indicative of intussusception?
A. Aganglionic bowel on biopsy
B. Sausage-shaped abdominal mass
C. Target lesion and pseudo-kidney on ultra-sound investigation
D. Hyper-peristaltic rushes
E. Dilated loops of bowel and air fluid levels on plain abdominal radiograph
32. Which of the following is not a symptom of possible blood loss?
A. Pallor
B. Weakness
C. Tachycardia
D. Hypertension
E. Weak pulse
33. Which symptom is not characteristic of portal hypertension?
A. Intestinal perforation
B. Caput Medusae
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C. Hematemesis
D. Melena
E. Hypersplenism
34. Which of the following is not a sign of possible blood loss?
A. Low BP
B. Melena
C. Hematemesis
D. Bloody stool
E. Excessive vomiting
35. Which of the following is the most informative in the diagnosis of rectal polyps?
A. Radiography
B. Ultrasonography
C. Rectoscopy
D. CBC
E. CT scan
36. Which is not a possible complication of a Meckels diverticulum ?
A. Hemorrhage
B. Hypersplenism
C. Intussusception
D. Inflammation
E. Perforation
37. During inguinal herniotomy in a 12 year old the testis was found in the hernia sac. What type
of hernia is this?
A. Richters hernia
B. Congenital indirect hernia
C. Acquired direct hernia
D. Direct hernia
E. Femoral hernia
38. A hernia containing the vermiform appendix in its sac is known as:
A. Richters hernia
B. Amyands hernia
C. Littres hernia
D. Omentocele
E. Indirect hernia
39. An exomphalos is:
A. A strangulated umbilical hernia
B. Synonymous with an omphalocele
C. A strangulated femoral hernia
D. A strangulated inguinal hernia
E. A sliding hernia
40. Which of the following hernias is diaphragmatic?
A. Richters hernia
B. Bogdalechs hernia
C. Amyands hernia
D. Littres hernia
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Sclerosing osteomyelitis
Pagets disease
Albuminous osteomyelitis
Brodies abscess
Osteomyelitis antibiotica
A.
B.
C.
D.
E.
anorchia
monorchism
ectopia
dystopia
cryptorchidism
hemangioma
lymphangioma
fibroma
dermoid cyst
teratoma
A. hemangioma
B. nephroblastoma
C. carcinoma
D. seminoma
E. lipoma
63. Which of the following is the most rational in diagnosis of a palpated peritoneal
tumor stretching from the liver to the pelvic region?
A.
B.
C.
D.
E.
Excretory urography
Plain abdominal radiograph
biopsy
pneumoperitoneum
laparoscopy
hematuria
urethral trauma
prostate adenoma
neoplasm of the bladder
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E.
chronic cystitis
excretory urography
pneumocystography
voiding cystography
retrograde ureteropyelography
plain abdominal radiograph
E. coma
76. During a laproscopic examination of the deep surface of the lower anterior abdominal
wall (using a lighted scope on a thin tube inserted through the wall), the attending physician
noted something of interest and asked the young resident to look at the medial inguinal fossa. To
do so, the young doctor would have to look at the area between the:
A.
B.
C.
D.
E.
77. If one were to make an incision parallel to and 2 inches above the inguinal ligament,
one would find the inferior epigastric vessels between which layers of the abdominal wall?
Camper's and Scarpa's fascias
A.
B.
C.
D.
78. A man is moving into a new house and during the process lifts a large chest of drawers.
As he lifts he feels a severe pain in the lower right quadrant of his abdomen. He finds that he can
no longer lift without pain and the next day goes to see his physician. Surgery is indicated and
during the surgery the surgeon opens the inguinal region and finds a hernial sac with a small
knuckle of intestine projecting through the abdominal wall just above the inguinal ligament and
lateral to the inferior epigastric vessels. The hernia was diagnosed as:
A.
B.
C.
D.
79. An indirect inguinal herniaWhich structure passes through the deep inguinal ring?
A.
B.
C.
D.
E.
Iliohypogastric nerve
Ilioinguinal nerve
Inferior epigastric artery
Medial umbilical ligament
Round ligament of the uterus
80. A loop of bowel protrudes through the abdominal wall to form a direct inguinal
hernia; viewed from the abdominal side, the hernial sac would be found in which region?
A. Deep inguinal ring
B. Lateral inguinal fossa
C. Medial inguinal fossa
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Iliohypogastric nerve
Inferior epigastric artery
Ovarian artery and vein
Pectineal ligament
Round ligament of the uterus
82. While performing a routine digital examination of the inguinal region in a healthy
teen-aged male, the physician felt a walnut-sized lump protruding from the superficial inguinal
ring. She correctly concluded that it was :
A.
B.
C.
D.
E.
84. A 15-year-old boy was admitted to the emergency room for having large bowel
obstruction resulting from a left-sided indirect inguinal hernia. The most likely intestinal
segment involved in this obstruction is the:
A.
B.
C.
D.
E.
ascending colon
cecum
descending colon
rectum
sigmoid colon
85. Which nerve passes through the superficial inguinal ring and may therefore be endangered
during inguinal hernia repair?
A.
B.
C.
D.
E.
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86. During exploratory surgery of the abdomen, an incidental finding was a herniation of
bowel between the lateral edge of the rectus abdominis muscle, the inguinal ligament and the
inferior epigastric vessels. These boundaries defined the hernia as a(n)
A.
B.
C.
D.
E.
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91. A 10-month-old girl has had vomiting and diarrhea for 3 days. She has not had a wet
diaper in 18 hours, her heart rate is 140 beats per minute, her respiratory rate is 40 breaths per
minute, and her blood pressure is 75/35 mm Hg. Examination shows a minimally responsive
infant with cool extremities, 4-second capillary refill, parched lips, and very sunken eyes. Which
of the following best describes her state of hydration?
A: Mild dehydration
B: Moderate dehydration
C: Severe dehydration
D: Normal hydration
E: Hypervolemic
92: A 10-month-old girl has had vomiting and diarrhea for 3 days. She has not had a wet
diaper in 18 hours, her heart rate is 140 beats per minute, her respiratory rate is 40 beats per
minute, and her blood pressure is 75/35 mm Hg. Examination shows a minimally responsive
infant with cool extremities, 4-second capillary refill, parched lips, very sunken eyes, and a
currently weight of 8 kg. What is her estimated fluid deficit?
A: 300 mL
B: 500 mL
C: 900 mL
D: 1000 mL
E: 1200 mL
93. A 5-year-old presents to the clinic with a 1-week history of vomiting and a 3-day
history of abdominal pain. His mother notes a weight loss of approximately 10 pounds and
reports that he has been wetting the bed. Vital signs are heart rate (HR) 135 beats per minute,
respiratory rate (RR) 40 breaths per minute (deep), and blood pressure (BP) 90/54 mm Hg. He is
afebrile and sleepy. His mucous membranes are dry. Capillary refill is 4 seconds. Heart, lungs,
and abdominal examination findings are normal. Laboratory data include glucose of 560, sodium
of 140, potassium 5, chlorides 100, CO2 content 4, BUN 35, and creatinine 2.0. Arterial blood
gas shows pH of 7.02, PCO2 30, PO2 100 on room air, and HCO3 4. Evaluation of his blood gas
values indicates which of the following?
A: He has a respiratory alkalosis with metabolic compensation.
B: The low pH is due to a high blood sugar.
C: He has metabolic acidosis with inadequate respiratory compensation.
D: His blood gas is within the reference range.
E: He has severe hypoxemia.
94. A physician examines a 12-year-old girl with a 4-week history of intermittent lower
abdominal pain and rectal bleeding. Her laboratory workup reveals hemoglobin of 9.9 g/dL,
normal erythrocyte sedimentation rate and albumin, and normal stool studies (eg, culture and
Clostridium difficile toxins A and B). Her growth is adequate. The colonoscopy findings are
significant for the confluent moderate inflammation of the rectum, sigmoid, and distal
descending colon, and biopsies reveal chronic inflammation with crypt abscesses and
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architectural crypt changes. Findings from an upper GI series with a small bowel follow-through
are normal. What is the correct diagnosis?
A: Ulcerative colitis (UC)
B: Crohn disease
C: Viral colitis
D: Allergic colitis
E: Hemolytic-uremic syndrome
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98. Which of the following is the cause of predisposition for midgut volvulus in patients
with malrotation?
A: Twisting of the bowel on itself while the bowel is returning to the abdominal cavity
from physiologic herniation
B: Formation of a narrow-base mesentery as the gut lengthens on the superior
mesenteric artery without rotation
C: Improperly formed peritoneal bands that pull the bowel into a twisted position
D: Arrest in development at stage III of normal embryological gastrointestinal
development
E: None of the above
99. Which of the following does not cause bilious vomiting in an infant or child?
A: Intestinal malrotation and volvulus
B: Pyloric stenosis
C: Duodenal atresia
D: Small bowel obstruction
E: Ulcerative colitis with colonic obstruction
100. Which of the following statements is incorrect?
A: At the fourth week of gestation, the GI tract is a straight tube centrally located in
the fetal abdomen.
B: During the fifth week of gestation, the first stage of rotation begins and lasts until
the tenth week.
C: The superior mesenteric artery has its axis in line with the omphalomesenteric duct,
and the primitive gut normally rotates in a counterclockwise direction.
D: The second stage of rotation occurs between the tenth and twelfth weeks of
gestation and involves the return of the intestine to the fetal abdominal cavity.
E: At the completion of the normal rotation, the duodenojejunal junction is not fixed
to the left of the aorta and the cecum has loose attachments to the right abdominal
wall.
101. A 10-year-old boy presents with chronic recurrent abdominal pain. Which of the
following additional symptoms is not consistent with the diagnosis of irritable bowel syndrome
(IBS)?
A: Onset of symptoms at age 6 years
B: Mucus with stool
C: Diarrhea with pain attacks
D: Weight loss
E: Defecation associated with prolonged straining and a sense of incomplete
evacuation
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102. A 15-year-old girl is diagnosed with irritable bowel syndrome (IBS). What is the
long-term outcome of her illness?
A: Periodic abdominal pain and altered bowel habit
B: Resolution of symptoms and cure of illness with proper treatment
C: Inflammatory bowel disease
D: Higher risk to develop colon cancer
E: All of the above
103. A 15-month-old boy who was previously healthy presents with a 24-hour history of
cramping abdominal pain, bilious vomiting, and abdominal distention. His stools are heme
positive. Which of the following is the most likely diagnosis?
A: Midgut volvulus
B: Acute gastroenteritis
C: Idiopathic intussusception
D: Acute appendicitis
E: Gastroesophageal reflux disease
104. An 8-year-old boy presents with acute onset of cramping abdominal pain and
vomiting. He has multiple maculopapular rash spots on his lower extremities. Which of the
following is the most likely diagnosis?
A: Acute appendicitis
B: Henoch-Schnlein purpura
C: Kawasaki disease
D: Crohn disease
E: Sickle cell crisis
105. Which of the following is the most common type of ectopic tissue found in Meckel
diverticulum?
A: Pancreatic
B: Colonic
C: Endometrial
D: Gastric
E: Jejunal
106. Which of the following is the most common cause of intestinal obstruction in
patients with Meckel diverticulum?
A: Volvulus around vitelline duct remnants
B: Omphalomesenteric band
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108. What is the best diagnostic test for the assessment of inguinal hernia in children?
A: Ultrasonography
B: Plain radiography
C: CT
D: MRI
E: None of the above
109. Which of the following complications is known to occur in children or infants with
peptic ulcer disease (PUD)?
A: Perforation
B: Hemorrhage
C: Anemia
D: Obstruction
E: All of the above
110. Which of the following etiologic factors is not associated with an increased risk for
developing peptic ulcer disease (PUD)?
A: Use of nonsteroid anti-inflammatory drugs (NSAIDs)
B: Brain injury
C: Milk intake
D: Helicobacter pylori infection
E: Alcohol intake
111. A 1-month-old male infant is brought to the office with a 5-day history of
nonbilious vomiting. He has been otherwise healthy. Over the last 3 days, his parents have
switched formulas twice on the advice that the child has formula intolerance. The child now
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vomits 5-15 minutes after every feeding, usually forcefully. Skin turgor is decreased and the
fontanelle is depressed. What is the most likely diagnosis?
A: Gastroesophageal reflux
B: Lactose intolerance
C: Malrotation and midgut volvulus
D: Infantile hypertrophic pyloric stenosis
E: Sepsis
112. Persistent vomiting with hypertrophic pyloric stenosis usually causes what
electrolyte imbalance?
A: Metabolic acidosis
B: Metabolic alkalosis
C: Respiratory acidosis
D: Respiratory alkalosis
E: None of the above
113. A 12-year-old boy presents with a 3-week history of abdominal cramping, diarrhea,
and hematochezia. Stool culture results are negative. Fecal testing is negative for Clostridium
difficile toxins A and B. Findings on upper GI series with small bowel follow-through are
normal. Colonoscopy reveals a confluent colitis beginning in the rectum and extending
proximally to the splenic flexure. Biopsies reveal diffuse cryptitis. What is the most likely
diagnosis?
A: Crohn disease (CD)
B: Hemolytic-uremic syndrome
C: Ulcerative colitis (UC)
D: Meckel diverticulum
E: Appendicitis
114. A 16-year-old male adolescent with ulcerative colitis develops abdominal pain,
abdominal distention, high fever, and toxic appearance. Abdominal radiography shows dilated
loops of colon with multiple air/fluid levels. What is the next most appropriate step in the
treatment of this patient?
A: Barium enema
B: Surgical consultation
C: Colonoscopy
D: Intravenous steroids
E: Intravenous cyclosporin
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115. A 15-year-old adolescent boy has had gradual and persistent lymph node
enlargement for the last 5 months. Lymph nodes are firm, nontender, and located in the right
cervical area. Accompanying symptoms include weight loss, intermittent fever, and night sweats.
Which of the following causes of lymphadenitis is the most likely diagnosis?
A: Tuberculosis
B: Hodgkin lymphoma
C: Infectious mononucleosis
D: Non-Hodgkin lymphoma
E: Catscratch disease
116. A 6-year-old boy has a 2-day history of swelling in the right side of the neck and
fevers up to 101.5F. Examination of the right anterior cervical region shows a 4-cm firm tender
mass with erythema of the overlying skin. The child has no sick contacts that may explain
lymphadenitis. Which of the following initial procedures should be used in this patient?
A: Empiric antibiotic therapy
B: Throat swab for culture of the pharynx
C: Lateral neck x-ray
D: Incision and drainage
E: No action
117. A 15-month-old child recently adopted from China is brought in with septic arthritis
of the knee. After blood and aspirate cultures are obtained, the patient is started on cefazolin 100
mg/kg/d. Next-day laboratory results report gram-negative pleomorphic rods in the blood
culture. Which of the following is not appropriate management?
A: Perform a careful physical examination. If no new findings are present, continue
cefazolin.
B: Perform a careful physical examination. If no new findings are present, switch to
cefuroxime 200 mg/kg/d.
C: Patient and other siblings need chemoprophylaxis for Haemophilus influenzae type
b (Hib).
D: Report the case to the health department.
E: Immunize the patient with Hib vaccine after recovery.
118. A newborn presents with a scaphoid abdomen and bilious emesis. Massive intestinal
loss could occur if which one of the following causes of neonatal bowel obstruction is not
quickly identified and treated?
A: Pyloric stenosis
B: Malrotation with volvulus
C: Meconium ileus
D: Hirschsprung disease
21
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eye prophylaxis was administered, but no record of vitamin K dosing can be found. What is the
most appropriate next step?
A: Send out protein induced by vitamin K antagonism (PIVKA)-II and vitamin K
levels.
B: Administer 1 mg vitamin K IM.
C: Discharge with follow-up in 2 days.
D: Administer 1 mg vitamin K IV.
E: Discontinue breast-feeding and begin infant formula.
123. A 3-week-old, ex-27 week premature infant has increased abdominal girth and 10
mL of green-tinged gastric residual. The patient has been tolerating enteral feedings of 20-calorie
premature formula and was increased to a 24-calorie formula yesterday. The patient has had
slightly more bradycardia episodes with desaturation today. Bowel sounds cannot be appreciated
on auscultation, but results of serum electrolytes and CBC are within the reference range. The
abdominal radiograph is as shown. Which of the following is not part of the appropriate
immediate management of this infant?
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24
A: Chest radiograph
B: Biopsy
C: Lumbar puncture
D: Bone marrow aspirate and biopsy
E: Bone scan
130. Which of the following is the most common site of recurrence after treatment for
Wilms tumor?
A: Liver
B: Tumor bed
C: Lungs
D: Brain
E: Bone
131. Which of the following symptoms or signs is almost invariably observed in children
with bronchiectasis?
A: Headaches
B: Nightmares
C: Cough
D: Respiratory failure
E: Hemoptysis
132. Which of the following is the optimal study for the diagnosis of bronchiectasis?
A: Chest radiography
B: Sweat chloride test
C: Barium swallow
D: Chest computed tomography
E: Bronchography
133. Of all of the anomalies that constitute the exstrophy-epispadias complex, which is
the most common?
A: Cloacal exstrophy
B: Classic bladder exstrophy
C: Male epispadias
D: Female epispadias
E: Superior vesical fissure
134. Which clinical feature is not present in cloacal exstrophy?
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A: Spinal abnormality
B: Hemibladders adjacent to exposed cecum
C: Gastroschisis
D: Omphalocele
E: None of the above
135. Which of the following is not accurate regarding the repair of hypospadias?
A: Adjunctive hormonal therapy is sometimes used preoperatively.
B: Urethral stents are commonly used during healing.
C: Surgery is usually delayed until the patient is older than 3 years.
D: Penoscrotal transposition is usually repaired as a staged procedure.
E: Postoperative complications include bleeding, fistula formation, and meatal
stenosis.
C: Protect the airway and immediately remove the foreign body under general
anesthesia with esophagoscopy.
D: Remove the foreign body with a Foley catheter under sedation.
E: Flexible endoscopic removal in the emergency department with no sedation is
recommended.
143. A mother brings in her 3-year-old child because she witnessed her son swallow a
watch battery 1 hour ago. Which of the following is the most appropriate initial step in the
management of this toddler following a history and physical examination?
A: Obtain a barium swallow.
B: Proceed directly to the operating room to perform rigid esophagoscopy.
C: Perform bougienage immediately to dislodge the battery into the stomach.
D: Obtain an extended chest radiograph to determine the location of the foreign body.
E: Do nothing because watch battery ingestion is not worrisome; it seldom results in a
complication.
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