Pediatric Surgery Practice Questions

Question 1

A new mother expresses her concerns because her 1-day-old newborn has been having feeding difficulties. The child vomits after every feeding and has had a continuous cough since shortly after birth. The mother denies any greenish coloration of the vomit and says that it is only composed of whitish milk that the baby just had. The child exhibits these coughing spells during the exam, at which time the physician notices the child’s skin becoming cyanotic. The mother states that the child was born vaginally with no complications, although her records show that she had polyhydramnios during her last ultrasound before the delivery. Which of the following is the most likely cause of the patient’s symptoms?

Accepted Answer

Defective formation of the esophagus with tracheoesophageal connection

Answer

Failure of recanalization of duodenum

Answer

Obstruction due to failure of rotation of pancreatic tissue

Answer

Hypertrophy of the pyloric sphincter

Answer

Failure of neural crest cells to migrate into the myenteric plexus

Question 2

A 7-day-old male infant presents to the pediatrician for weight loss. There is no history of excessive crying, irritability, lethargy, or feeding difficulty. The parents deny any history of fast breathing, bluish discoloration of lips/nails, fever, vomiting, diarrhea, or seizures. He was born at full term by vaginal delivery without any perinatal complications and his birth weight was 3.6 kg (8 lb). Since birth he has been exclusively breastfed and passes urine six to eight times a day. His physical examination, including vital signs, is completely normal. His weight is 3.3 kg (7.3 lb); length and head circumference are normal for his age and sex. Which of the following is the next best step in the management of the infant?

Accepted Answer

Reassurance of parents

Answer

Evaluation of the mother for malnutrition

Answer

Admission of the infant in the NICU to treat with empiric intravenous antibiotics

Answer

Emphasize the need to clothe the infant warmly to prevent hypothermia

Answer

Supplementation of breastfeeding with an appropriate infant formula

Question 3

A 7-month-old boy is brought to the ED by his mother because of abdominal pain. Two weeks ago, she noticed he had a fever and looser stools, but both resolved after a few days. One week ago, he began to experience periodic episodes during which he would curl up into a ball, scream, and cry. The episodes lasted a few minutes, and were occasionally followed by vomiting. Between events, he was completely normal. She says the episodes have become more frequent over time, and this morning, she noticed blood in his diaper. In the ED, his vitals are within normal ranges, and his physical exam is normal. After confirming the diagnosis with an abdominal ultrasound, what is the next step in management?

Accepted Answer

Air contrast enema

Answer

Supportive care

Answer

Broad-spectrum antibiotics

Answer

Abdominal laparotomy

Answer

Abdominal CT scan

Question 4

A 15-month-old boy is brought to the pediatrician for immunizations and assessment. His parents report that he is eating well and produces several wet diapers every day. He is occasionally fussy, but overall a happy and curious child. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. On physical examination his vital signs are stable. His weight and height are above the 85th percentile for his age and sex. On chest auscultation, the pediatrician detects a loud harsh holosystolic murmur over the left lower sternal border. The first and second heart sounds are normal. An echocardiogram confirms the diagnosis of the muscular ventricular septal defect without pulmonary hypertension. Which of the following is the best management strategy for this patient?

Accepted Answer

Reassurance of the parents and regular follow-up

Answer

Surgical closure of the defect using cardiopulmonary bypass

Answer

Oral digoxin and regular follow-up

Answer

Antibiotic prophylaxis against infective endocarditis

Answer

Transcatheter occlusion closure of the defect

Question 5

A 4-month-old boy is brought to the physician for a well-child examination. He was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. He weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, he appears well. His pulse is 146/min, the respirations are 39/min, and the blood pressure is 78/44 mm Hg. He weighs 7.5 kg (16 lb 9 oz) and measures 65 cm (25.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?

Accepted Answer

Intentionally rolls over

Answer

Sits with support of pelvis

Answer

Grasps small objects between thumb and finger

Answer

Transfers objects from hand to hand

Answer

Bounces actively when held in standing position

Question 6

An 8-year-old boy is shifted to a post-surgical floor following neck surgery. The surgeon has restricted his oral intake for the next 24 hours. He does not have diarrhea, vomiting, or dehydration. His calculated fluid requirement is 1500 mL/day. However, he receives 2000 mL of intravenous isotonic fluids over 24 hours. Which of the following physiological parameters in the boy’s circulatory system is most likely to be increased?

Accepted Answer

Capillary hydrostatic pressure

Answer

Interstitial oncotic pressure

Answer

Interstitial hydrostatic pressure

Answer

Capillary wall permeability

Answer

Capillary oncotic pressure

Question 7

An 8-year-old boy presents to his pediatrician for a well visit. His parents state that he has been doing well in school and has many friends. The patient is a member of the chess club and enjoys playing video games. He has a past medical history of asthma which is treated with albuterol. The patient is in the 99th percentile for weight and 30th percentile for height. His temperature is 99.5°F (37.5°C), blood pressure is 122/88 mmHg, pulse is 90/min, respirations are 11/min, and oxygen saturation is 98% on room air. The patient's body mass index is 39.1 kg/m^2 at this visit. On physical exam, you note a young boy who maintains eye contact and is excited to be at the doctor's office. Cardiopulmonary exam is within normal limits. Abdominal exam reveals normal bowel sounds and is non-tender in all 4 quadrants. Neurological and musculoskeletal exams are within normal limits. Which of the following is the most likely outcome in this patient?

Accepted Answer

Slipped capital femoral epiphysis

Answer

Constitutional growth delay

Answer

Precocious puberty

Answer

Hypertension

Answer

Atherosclerotic heart disease

Question 8

A 3-week-old firstborn baby girl is brought to the pediatric emergency room with projectile vomiting. She started vomiting while feeding 12 hours ago and has been unable to keep anything down since then. After vomiting, she appears well and hungry, attempting to feed again. The vomitus has been non-bloody and non-bilious. The last wet diaper was 10 hours ago. The child was born at 40 weeks gestation to a healthy mother. On examination, the child appears sleepy but has a healthy cry during the exam. The child has dry mucous membranes and delayed capillary refill. There is a palpable olive-shaped epigastric mass on palpation. Which of the following is the most likely cause of this patient's condition?

Accepted Answer

Hypertrophic muscularis externa

Answer

Failure of neural crest cell migration into the rectum

Answer

Telescoping of the small bowel into the large bowel

Answer

Patent tract between the trachea and esophagus

Answer

Failure of duodenal lumen recanalization

Question 9

A 5-week-old infant boy presents to the pediatrician with intermittent vomiting for the last 2 weeks. The mother reports that the vomiting is non-bilious and immediately follows feeding. After vomiting, the baby is hungry and wants to feed again. The frequency of vomiting has been increasing progressively over 2 weeks. The vital signs are within normal limits. The examination of the abdomen reveals the presence of a firm mass of approx. 2 cm in length, above and to the right of the umbilicus. The mass is movable, olive-shaped, and hard on palpation. Which of the following is the most likely surgical treatment for this infant’s condition?

Accepted Answer

Pyloromyotomy

Answer

Duodenoduodenostomy

Answer

Surgical ligation of the fistula and primary end-to-end anastomosis of the esophagus

Answer

Diverticulectomy

Answer

Endorectal pull-through procedure

Question 10

A 16-year-old man presents to the emergency department with a 2-hour history of sudden-onset abdominal pain. He was playing football when his symptoms started. The patient’s past medical history is notable only for asthma. Social history is notable for unprotected sex with 4 women in the past month. His temperature is 99.3°F (37.4°C), blood pressure is 120/88 mmHg, pulse is 117/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is noted for a non-tender abdomen. Testicular exam reveals a right testicle which is elevated with a horizontal lie and the scrotum is neither swollen nor discolored. Which of the following is the most likely diagnosis?

Accepted Answer

Testicular torsion

Answer

Traumatic urethral injury

Answer

Seminoma

Answer

Appendicitis

Answer

Epididymitis

Pediatric Surgery

Study Resources

Lessons

Questions

Flashcards

Lessons

Biliary atresia and Kasai procedure

Congenital abdominal wall defects

Congenital diaphragmatic hernia

Congenital heart defects requiring surgery

Hirschsprung disease management

Intussusception reduction techniques

Necrotizing enterocolitis surgical management

Neonatal surgical emergencies

Pediatric fluid and electrolyte management

Pediatric trauma considerations

Pyloric stenosis diagnosis and pyloromyotomy

Tracheoesophageal fistula repair

Undescended testis and orchiopexy

Practice Questions

Flashcards

About Pediatric Surgery for USMLE

Lessons in Pediatric Surgery

Master Pediatric Surgery