PEDIA SURGERY

1. Normally the distance between the DL loop and the ileocecal segment is
a. Narrow
b. Lie Side by side
c. Variable in length
d. Wide based triangle

2. In malrotation the usual location of the cecum is

a. RLQ b. side by side with the duodenum c. LLQ d. away from the duodenum

3. Embryology of GIT
a. The 3rd part of the duodenum is to the left of the SMV
b. The DJ loop rotates 270 degrees counterclockwise around the ligament of Treitz
c. The ileocecal segment rotates clockwise around the SMV
d. The DJ loop rotates 270 degrees counterclockwise around the SMV

4. Clinical manifestation of malrotation

a. Bilous vomiting b. projectice vomiting c. abdominal distention d. loose stools

5. Incidence of Malrotation :
a. Will be symptomatic, vomiting green, at different times in their llives
b. Chronic abdominal pain at presentation in older patients
c. Usually presents late in childhood
d. All are symptomatic shortly at birth

6. The bilous vomiting in Malrotation , in contrast to other causes on intestinal obstruction is

usually associated with:
a. Marked abdominal distention
b. Visible intestinal loops
c. Managed urgently after limited resuscitation
d. Visible panstatic waves

7. In older children with Malrotation, the usual presenting symptom is often mistaken as
psychogenic and or cyclical in etiology
a. Obesity
b. Post prandial chronic abdominal pain
 c. Recurrent bilous vomiting
d. Frequent stooling

8. The typical radiographic picture of malrotation:

a. Massive distention of intentistinal loops
b. Bird’s beak
c. Double bubble sign with radiographic signs of twisting
d. Distended stomach and proximal duodenum with small gross

9. Aside from history/PE. Malrotation can best diagnosed by:

a. UGIS under fluoroscopy

b. Barium enema
c. Ultrasound
d. Laparoscopy

10 . The symptoms of malrotation is related to:

a. Duodenal compression by the SMV

b. Massive distention of intestinal loops
c. LADDS bands
d. Volvulus of the duodenum

11 . In the surgical management of Malrotation timing of intervention is of essence because of the

possibility of the complication:

a. Electrolyte imbalance
b. Dehydration
c. Sigmoid volvulus
d. Small intestinal volvulus

12 . The pathophysiology of intestinal atresia :

a. Exact cause is not known and an isolated anomaly

b. Localized vascular insult during the 1st trimester of pregnancy
c. Occur after the period of embryogenesis
d. Sealing off of a prenatal intestinal perforation

13. Intestinal atresia is usually an isolated problem. Type of atresia that is usually familial or associated
with other anomalies

a. web b. fibrous cord c. Mesenteric defect d. retrograde artery

14. Type of intestinal atresia is most likely associated with short bowel syndrome
a. web b. diaphragm c. v-shaped defect d. apple peel

15. Intestinal atresia in contrast to malrotation presents with bilous vomiting associated with

a. polyhydramnios b. pigeon stools c. GI bleeding d. in utero vomiting

16. plain radiographic findings in intestinal atresia shows distended

a. stomach and duodenum

b. presacral gas

c. small caliber colon in contrast to the small vegetations

d. distended small bowels with small flecks of gas distally

17. the most common cause of intussusception

a. mekel’s diverticulum

b. adenovirus

c. unknown

d. lymphoid hypertrophy

18. The most important clinical manifestation of intussusception

a. blood streaked stools

b. bilous projectice vomiting with abdominal distention

c. episodic crying with periods of wellness in between

d. intermittent abdominal pain and vomiting for few weeks

19. The treatment of choice in early cases of intussusception

a. IV hydration b. surgery c. air reduction d. manual reduction

20. Contraindication of hydrostatic reduction of intussusception

a. bilous vomiting b. disease of 24 hours duration c. bloody mucoid stools d. severly dehydrated
patient

A 1 year old male down’s syndrome presenting with sudden onset of intermittent abdominal pain with
vomiting. Several hours later he presented bloody stools. PE showed a heathy non-cooperative infant
with slightly full abdomen with voluntary muscle guarding
21. The most likely impression

a. late onset malabsorption with midgut volvulus

b. duodenal atresia with fenestrations

c. intestinal atresia

d. intussusception

22. The most common type of agangliosis

a. internal sphincter

b. rectum

c. rectosigmoid

d. distal – descending

23. Clinical evidence of a possible genetic causes of Hirschsprung disease

a. familial association in all cases

b. higher mode of transmission in male than female index patients tp their offspring

c.the longer the type of aganglinosia, the lesser the the chances of familial incidence

d. agangliosis in siblings

24. Chromosomal evidence of a possible genetic cause of Hirschsprung disease

a. deletion of the short arm of chromosome 10 locus 11.2 :21.2

b. deletion of the long arm of chromosome 10 locus 11:2: 21:2

c. MEN 2

d. RET – protoncogene

25. Incidence of Hirschsprung disease

a. no racial predilection

b. almost always associated with other anomalies

c. familial incidence seen in longer segments

d. 1:10,000

26. The usual clinical picture of a patient with Hirschsprung disease nowadays

a. almost are constipated once they enter school

b. majority of patients have delayed presentation

c. normal looking child with chronic constipation

d. should be the sole considearation when dealing with chronic constipation in older children

27. Hirschsprung disease should be considered in infants and children who presents with

a. explosive diarrhea

b. recent onset of constipation in late childhood

c. chronic constipation since birth

d. constipation in neurologically impaired

28. Diagnosis of Hirschsprung disease

a. History and PE alone will definitely diagnose the condition

b. presence of transition zone on barium enema at the recto sigmoid area

c. histologic analysis is ALWAYS required

d. history/PE + barium enema are required.

29. Finding in barium enema that suggests agangliosis?

a. saw-toothing

b. normal caliber distally with distended normal bowels proximally

c. apple core

d. redundant sigmoid

30. Definitive management of hIrschsprung disease

a. colonic washout b. laxatives and rectal suppositories c. laparomoty d. transatrial pushthrough

31. The total body water content in newborn babies is approximately?

a. 60 % b. 70% c. 80% d, 90%

32. The daily maintenance fluid requirement of a 15kg patient according to Holiday- Segar formula

a. 1250 cc

b . 1500 cc

c . 1,800 cc

d . 2000 cc

33. Important homeostatic difference between an adult and an infant

a. lesser fluid intake in children relative to size

b. more water loss from the skin in children

c. same metabolic rate

d. immature kidneys in children that requires less volume of fluid to excrete waste

34. True about ankyloglossia

a. occur in 30-50 % of the population

b. True incidence is not known due to under reporting

c. a benign condition that may or may not require any surgical intervention

d. if surgery is indicated, excision under local anesthesia is the preferred approach

35. The usual problem noted in neonates with tongue tie

a. delayed dentition b. regurgitation c. delayed speech d. problems in sucking

36. surgical indication in older children with tongue tie

a. vomiting of unchewed food particles

b. dental carries

c. LISP

d. pointed tongue

37. True about the lymphatic system

a. a closed system like the vascular system

b. flow is solely dependent on muscular contraction

c. Lymphatic system is slightly higher than the venous pressure

d. joins the vascular system via the jugular venous system

38. function of the lymphatic system

a. may sequester old RBC not cleared by the spleen

b. Its only function is to link the lymphatic nodal system

c. drains protein rich fluid that leaked from the vascular system

d. a sterile system

39. Indication for the surgical management branchial cleft remnants

a. malignant degeneration

b. bleeding

c. infection

d. cosmetic reasons
40. The tract of branchial cleft fistula

a. ends at the base of the tongue

b. near the epiglottis

c. courses in between the branches of the carotid artery

d. ends blindly just before the pharynx

41. The most common among the branchial remnants

a. 1st b. 2nd c . 3rd d. same incidence among the three

42. Multiloculated microcytic malformation

a. cystic hygroma b. branchial cyst c. Lymphangioma d. Hemangioma

43. Cystic hygroma

a. 80-90 % noted at birth

b. 75% are located in the posterior triangle of the neck

c. majority in the axillary area

d. incidence is 1:5000 live births

44.characteristics of cystic hygroma

a. a benign easily excised cystic tumor

b. usually small in size

c. high chance of malignant degeneration

d. locally infiltrative tumor

45. primary reason for for the surgical management of lymphangiomas

a. high chance of malignant degeneration if not excised totally

b. cervical cystic hygroma may produce respiratory distress

c. risk for auto-amputation

d. spontaneous rupture is common especially in large lesions

46. The prefered diagnostic tool for complicated lymphangiomas

a. hx and PE b. ultrasound c. CT/MRI d. Lymphangiogram

47. Treatment of choice for lymphangiomas.

a. observation b. sclerotheraphy with boiling water c. partial excision d. complete excision

48. hemangioma
a. semi malignant lesion of blood vessels

b. almost always associated with lymphangiomas

c. generally observed unless with complications

d. need to be excised ASAP due to risk of bleeding

49. Thyroglossal duct cyst

a. congenital in nature but generally not seen immediately at birth

b. associated with the development of hyoid bone

c. high incidence in the general population but majority are asymptomatic

d. a complication of thyroid maldevelopment

50. considerations in the thyroglossal duct cyst

a.excision with the complete removal of the hyoid bone

b. aspiration and antibiotics to avoid infection

c. sclerotheraphy with ok 432

d. the entire cyst and its tract should be entirely excised

URO SURGERY

1. The first abdominal branch of aorta is?

a. Left suprarenal artery b. inferior phrenic artery c. right suprarenal artery d. celiac trunk
2. The adrenals lie _____ the perirenal (gerota’s) fascia supero medial to either kidney
a. Outside b. within c. outside the pararenal fascia d. above
3. The major arterial source of the adrenal gland
a. Superior branch of inferior phrenic
b. Branch directly from the aorta
c. Ipsilateral renal artery
d. All of the above
4. The normal kidney in the adult male weighs approximately?
a. 170gm
b. 150gm
c. 135gm
d. 650gm
5. The structures occupying the renal sinus a space in which renal hilum opens, is/are
a. Urinary collecting structures
b. Renal vessels
c. Both a and b
d. Only pelvis of the kidney
6. This inter pyramidal extensions of the renal cortex through which renal vessels enter and leave
renal parenchyma are.
a. Pyramids b. renal colums of berlin c. dromedary hump d. columns of Drummond

7. The anterior and posterior leaves the gerota’s fascia become fused on three sides around the
kidney except
a. Laterally b. medially c. superiorly d.inferiorly

8. CT reveals a 3.2 cm left renal mass with well defined borders and numerous thin septa
surrounding low attenuation (16 HU) spaces. There is no enhancement. According to Bosnek
criteria this is a
A. Category 1 lesion b. category 2 lesion c. category 3 lesion d. category 4 lesion

9. Color Doppler sonography of the testis is helpful in differentiating testicular torsion cyst
 a. Tumor b. epididymo-orchitis c. fracture of the testis d.cysts

10. A 55 year old male has a family history of prostate cancer . His uncle was also diagnosed to have
prostate cancer. What is the risk probability of the patient having prostate cancer as compared
to general population
a. 3x b.. 5x c. 7x d. 9x

11. Which are perhaps the most common benign renal mass lesions?
a. Cortical adenoma b. renal cysts c. renal oncocytoma d. renal angiomyolipoma
12. Choice of investigation for a thorough staging of renal cell carcinoma
a. Ct scan b. ultrasonography c. IVU d. MRI
13. Squamous cell carcinoma of the urinary bladder common in all of the following conditions
except
a. Biharzial bladder b. intestinal urinary conduit c. recurrent UTI’s d. chronic infection from
urinary calculi

14. The most common symptom of bladder carcinoma presence of?

a. Painless local hematuria b. partial hematuria c. veniform clots d.suprapubic pain
15. Urethral carcinoma arise outside the bladder and histogically may be adenocarcinomas,
transitional cell carcinomas or rarely sarcomas. Which is the most common histologic type?
a. Adenocarcinoma b. squamous cell carcinoma c. transitional cell carcinoma

d . sarcoma

16. The most common presenting symptom of bladder cancer?

a. Frequency b. dysuria c. urgency d. painless hematuria
17. Long term exposure to analgesics induces nephropathy that is associated with up to 70 percent
incidence of upper urethral tract transitional cell carcinoma,. Which is probably the most
important etiologic agent?
a. Aspirin b. paracetamol c. ibuprofen d. phenacetin
18. The most common presenting symptom of upper urinary tract urothelial tumors?
a. Flank pain b. gross hematuria c. mostly asymptomatic d. frequency and dysuria
19. The most readily available and cheap diagnostic study employed in differentiating renal cysts
from solid masses

a.Computed tomography b. magnetic resonance imaging c. ultrasound d. positron emission tomography

20. a 28 year old G1P0 PU12 weeks patient suddenly complained hypogastric pains PE showed
positive CVA tenderness how would you work up this patient?

a. plain KUB x-ray b. CT scan c. ultrasound (KUB) d.radionuclide renal scan

21. a 70 year old complaing of low back pains. He was diagnosed to have prostate carcinoma. What
would be the sensitive test to demonstrate osseous bone metastasis
a.radionuclide bone scan b. radiographic skeletal x-ray c.CT scan d. MRI

22. a 24 year old man sustained a vehicular accident while riding his motorcycle . He was brought into
the ER. PE showed presence of blood coming out per urethral meatus.There was hematoma noted the
perineal area. What would your impression about the origin of the injury?

a. renal b. urinary bladder c. ureteral d. urethral

23. an excretory urography was done.. Senal x-rays at different time interval was done..Nephrotosis can
be demonstrated during?

a. plain film b. 15 minute film c.. 45 minute film d. post void film

24. voiding cystoutertography (VCUG) showed reflux of contrast material up to the upper calices. There
was calculi formation mild tortuously of the ureter .How would you grade the reflux?

a. I b. II c. III d. IV

25. the only genitourinary malignancy wherein it is more commonly encountered in female population

a. renal b. ureteral c. urinary bladder d. urethral

26. The most common histologic type of testicular tumor encountered in undescended testis?

a. seminoma b. yolk sac tumor c. choriocarcinoma d. leydig cell tumor

27. The narrowest portion of the ureter is

a. uteropelvic portion

b. where the ureter crosses over the iliac vessels

c. where it passes through the bladder wall

d. medially to the sacroiliac joint

28. costovertebral angle

a. below the 12th rib lateral to the sacrospinalis muscle

b. below the 12th rib medial to the sacrospinalis muscle

c.below the 11th rib lateral to sacrospinalis muscle

d. below the 11th rib medial to sacrospinalis muscle

29. Renal pain associated with GIT symptoms is due to

a. reflex stimulation of the celiac ganglia

b. due to the proximity of organs

c. peritoneal irritation

d. all of the above

30. most pathognomonic symptom of the cystolithiasis

a. irritative symptom

b. obstructive symptom

c. sudden stoppage of urine

d. membranoproliferative and obstruction

31. radiopaque stones

a. calcium b. uric acid c. can be seen as black in the film d. cannot be seen in ct scan

32. radiolucent stones

a. calcium b. uric acid c. can be seen as white in the film d. cannot be seen in the ct scan

33. diagnostic of choice to detect urinary stones is

a. ultrasound b. KUB xray c. cystosonogram d. MRI

34. bladder stones

a. cause lower urinary tract symptoms

b. can cause retention

c. diet related

d. all of the above

35. the length of the ureter

a. 10cm b. 30cm c. 120cm d. 1meter

36. the adult kidney weighs about

a. 10 grams b. 60 grams c. 150 grams d. 1 kilograms

37. The best examination to detect prostate cancer

a. PSA b. DRE c. PSA + DRE d. CT scan

38. the blood supply of the testis

a. cremasteric artery b. testicular artery c. differential artery d.all of the above

39. most common site of prostate malignancy

A. peripheral zone b. transitional zone c. anterior zone d. initiation zone

40. most common metastasis site in prostate cancer

a. bone b. liver c.lungs d. lymphatic vessels

41. patient complains of initial hematuria most common site of bleeding in the urinary tract is the?

a. urethra b. ureter c. bladder d. kidney

42. the normal urinary bladder capacity

a. 100-150 ml b. 350-500 ml c. 800-1000ml d. 1000-2000ml

43. The rare benign tumor of the kidney contains 3 histologic components of fat,smooth muscle cells
and blood vessels. The condition is called

a. renal osteocytoma b. angiomyocytoma c. lipoma d. hemangioma

44. the type of cancer accounts approximately 90% of bladder cancer

a. transitional carcinoma b. adenocarcinoma c. mixed type carcinoma d.squamous carcinoma

45. the normal prostate gland weighs about.

a. 10 grams b. 20 grams c, 30 grams d, 40 grams

46. contraindications of ESWL except

a. staghorn calculi b. pregnancy c. bleeding d. aneurysm

47. treatment options for urinary stones except?

a. ESWL

b. medical management

c. limit fluid intake

d. open stone surgery (OSS)

48. upper urethral pain in male can produce discomfort

A. scrotum b. testes c. suprapubic area d. perianal area

49. most common carcinoma with patients with undescended testis

a. embryonal carcinoma b.seminoma c.choriocarcinoma d. hematoma

50. the passage of lymphatic fluid noted by the patient as passage of milky white urine

a. hematuria b. chyluria c.proteinuria d.cloudy urine