General Surgery Pediatric Surgery: Review Questions Ramin Jamshidi, MD Dr. Jamshidi is a fifth-year surgery resident, University of California at San Francisco, and an adjunct professor of physics, University of San Francisco, San Francisco, CA. Choose the single best answer for each question.
	1. A male infant weighing 3 kg is born via spontaneous vaginal delivery at 37 weeks’ gestation. His Apgar score is 6/9 at 1 and 5 minutes. The patient is in no apparent distress. Physical examination reveals no anus. What is the most appropriate initial step in this patient’s management? Colostomy Continued observation for 24 hours Intubation and mechanical ventilation Magnetic resonance imaging (MRI) of the abdomen and pelvis Posterior sagittal anorectoplasty Click here to compare your answer. Questions 2 and 3 refer to the following case. A previously healthy 5-week-old boy born at 39 weeks’ gestation following an uncomplicated pregnancy is brought to the emergency department (ED) with a 3-day history of forceful vomiting after feeding. The vomitus looks like undigested food. On physical examination, a distinct 1-cm mass is palpable in the epigastrium. Surgical management is indicated. 2. Which of the following interventions is the most effective for reducing serious complications associated with the indicated operation? Concurrent fundoplication Perioperative antibiotics Postoperative food/fluid restriction for 36 hours Postoperative supplemental oxygen Preoperative fluid resuscitation Click here to compare your answer. 3. The patient undergoes pyloromyotomy. During the procedure, a deep mucosal injury is noted at the distal aspect of the incision. How should this patient’s mucosal injury be managed? Closure of the mucosal defect with the myotomy intact Closure of the mucosal and muscular defects with repeat myotomy at a later date Closure of the mucosal and muscular defects with repeat myotomy on another side of the pylorus Wide local drainage and antibiotics Wide local drainage, antibiotics, and 10 to 14 days of postpyloric tube feeding Click here to compare your answer. 4. A previously healthy 5-year-old girl presents to the ED with her parents with a temperature of 100.8°F (38.2°C) and a 2-day history of decreased appetite and persistent vague abdominal pain with tenderness in the mid-abdomen and right lower quadrant. Her parents report that she has had no appetite and felt nauseous but has not vomited. Laboratory results are unremarkable except for a white blood cell count of 16,000 cells/µL (normal, 4500- 11,000 cells/µL). Ultrasound of the abdomen and pelvis is inconclusive, and the patient is admitted to the hospital for observation. Eighteen hours into her hospital stay, she passes copious amounts of bloody stool. She remains hemodynamically stable with normal vital signs and no change in her abdominal pain. What is this patient’s most likely diagnosis? Appendicitis Colonic arteriovenous malformation Colonic diverticulitis Gastric stress ulcer Meckel’s diverticulitis Click here to compare your answer.		5. A previously healthy 2-month-old girl is brought to the ED with a 1-day history of abdominal pain and emesis that developed over the last several hours. The parents describe the vomitus as yellow-green and nonbloody. Physical examination reveals a fair-appearing child with moderate diffuse tenderness of the abdomen. Vital signs are normal. Laboratory results are unremarkable except for a white blood cell count of 14,000 cells/µL. What is the next step in this patient’s management? Empiric antibiotics and observation Immediate appendectomy Immediate exploratory laparotomy Ultrasound of the abdomen Upper gastrointestinal (GI) contrast study Click here to compare your answer. Figure 1 6. A 1-day-old male infant has been intolerant of oral feeds and is vomiting. The vomitus sometimes appears bile-colored. On examination, the patient’s abdomen is mildly distended and somewhat tympanitic but is nontender to palpation. A radiograph is performed (Figure 1). What is this patient’s most likely diagnosis? Annular pancreas Duodenal atresia Intestinal malrotation Jejunoileal atresia Pyloric stenosis Click here to compare your answer.
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