Part One - sample questions

1. At what prepubertal age is testosterone secretion at its highest level?

A. In the first days after birth

B. Around 12 months

C. At preschool age

D. Around 6 years of age

E. just before the start of puberty

 

2. Regarding the embryology of the urinary tract, please choose the correct answer:

A. ureteric bud derivatives give rise to the renal parenchyma

B. Urine production commences at around the 10th week of gestation.

C. Renal agenesis is caused by faulty blood supply from the aorta

D. Fetal urine accounts for approximately 50% of the amniotic fluid.

E. In complete ureteric duplication, the ureter of the upper pole usually enters the bladder cranially to the lower pole ureter

3. Congenital cardiac malformations are classified in cyanotic and non-cyanotic. Which one of the following cardiac conditions mentioned below is classified as cyanotic?

A. Ventricular Septal Defect

B. Aortic stenosis

C. Pulmonary atresia

D. Coarctation of the aorta

E. Atrial septal Defect

4. A typical pathogen in dog and cat bite wounds is

A. Neisseria meningitidis

B. Clamydia trachomatis

C. Streptococcus pyogenes

D. Pasteurella multocida

E. Bacillus antracis

 

5. The thrombocytopenia in idiopathic thrombocytic purpura results from

A. A genetic defect in platelet aggregation

B. Sudden toxic depletion of the megakaryocytes in the bone marrow

C. Autoimmune opsonization of platelets

D. Thrombotic consumption

E. An unknown pathomechanism

 

6. Regarding the immune defense mechanism; please choose the correct answer:

A. Higher gastric pH promotes a hostile environment for bacterial growth.

B. Intestinal mucus forms a thick barrier, which prevents bacterial attachment.

C. Immunoglobulin A facilitates attachment of the bacteria to intestinal mucosa.

D. Neutropenia enhances destruction of the microorganisms.

E. Monocytes and Macrophages are the predominant effector cells against intracellular organism.

7. Meckel’s diverticulum most often presents as:

A. Ileoileal intussusception.

B. Painless gastro-intestinal hemorrhage.

C. Painful gastro-intestinal hemorrhage

D. A patent omphalomesenteric duct.

E. Volvulus.

8. Which statement is true?

A. Arteriovenous malformations are often not visible at birth, then grow rapidly over the next 6 months until they reach a plateau.

B. GLUT-1 histochemical markers are found in infantile hemangiomas

C. Kasabach-Merritt-Syndrome is associated with increased platelets leading to thrombosis

D. Approximately 80% of lymphatic malformations respond to propranolol therapy

E. Interventional embolization is the treatment of choice for infantile hemangiomas

9. A Ladd procedure involves

A. dividing parietocecal bands, placing the bowel in nonrotation, widening the mesentary, performing an appendectomy

B. dividing the mesentery, placing the bowel in normal rotation, performing an appendectomy

C. dividing omphalomesenteric bands, placing the bowel in nonrotation, performing an appendectomy

D. dividing parietocecal bands, placing the bowel in normal rotation, leaving the appendix in place

E. Placing the bowel in nonrotation, performing an appendectomy

10. Prenatal tracheal occlusion is a treatment strategy for

A. Esophageal atresia

B. Diaphragmatic hernia

C. Gastroschisis

D. Congenital high airway obstruction syndrome (CHAOS)

E. Congenital pulmonary airway malformation (CPAM)

11. In describing the formation of a Stamm Gastrostomy which one of the following statement is correct?

A. Midline or paramedian incision in the abdominal wall, gastrotomy and a tube is placed into the stomach

B. Midline or paramedian incision in the abdominal wall, gastrotomy, single purse string around a tube which is placed into the stomach

C. Midline or paramedian incision in the abdominal wall, gastrotomy, double purse string around a tube which is placed into the stomach

D. Midline or paramedian incision in the abdominal wall, gastrotomy, double purse string around a tube which is placed into the stomach + stomach secured to the anterior abdominal wall

E. Midline or paramedian incision in the abdominal wall, gastrotomy, a tube is placed into the stomach + stomach secured to the anterior abdominal wall

12. Umbilical hernias

A. have a high chance of incarcerating

B. should be repaired in the neonatal period

C. can resolve spontaneously

D. are a reason for stigmatisation in school-age children

E. are indirect hernias

13. Which statement regarding electrical surgical equipment is correct?

A. Monopolar cautery is more likely to produce adverse burn injuries than biopolar cautery

B. The surface area of the monopolar grounding electrode should be as small as technically feasible

D. Modern bipolar vessel sealing equipment uses ultrasonic movement to produce heat

E. Spread of heat to adjacent structures during electrocauterization is negligible

F. High energy levels are generally safer than lower ones because cauterization is more effective

14. You are evaluating a 3 year old child with an inguinal hernia. The mother says that he has frequent nose bleeds. She herself tells you that she bruises easily. Laboratory PT/PTT/INR values are normal. What is the most likely hematologic disorder in this child?

A. Factor V Leiden

B. Hemophilia A

C. Hemophilia B

D. von Willebrand Disease

E. Idiopathic thrombocytopenic purpura

15. A one month old child was admitted with hypertrophic pyloric stenosis. The child was obviously dehydrated and lethargic. Which of the following biochemical findings would best indicate the severity of the patient’s condition?

A. hyponatremia

B. hypokalaemia

C. pH 7.50

D. Aciduria

E. Hypochloraemia

16. You are being consulted on a full-term newborn with obstipation. The primary team performed several normal saline enemas on the child. You order a contrast enema. Which of the following statements is correct?

A. Prior manipulation in the form of enemas may modify the radiologic imaging results.

B. If contrast enema suggests Hirschsprung disease, further preoperative workup is optional.

C. The transition zone in Hirschsprung disease on contrast enema is most often found in the descending colon

D. Full-strength Gastrografin is the most appropriate contrast agent in this indication.

E. The radiologist must always evaluate the entire colon in this type of presentation to rule out other anomalies.

17. Which of the following statements on acute appendicitis is correct?

A. It is a rapidly progressive disease, resulting in fatal outcome if not operated as soon as possible

B. It is a slowly progressive disease, leaving time for semi-elective operation in daytime, but likely to become chronic if not operated within 24 hours

C. There are two types of acute appendicitis, a perforating type and a simple, non-perforating type

D. The presence of a faecolith on ultrasound predicts a favorable outcome of non-operative treatment

E. Nonoperative treatment with antibiotics is associated with a recurrence risk of about 10% over the following 5 years.

18. A 6 year old child complains of persistent ballooning of his foreskin during micturition. The most likely diagnosis is:

A. Physiological phimosis.

B. Ballanitis xerotica obliterrans ( BXO)

C. Meatal stenosis

D. Paraphimosis

E. Pathological phimosis

19. A 16 year old boy with biopsy proven ulcerative colitis for two years comes to the emergency department with a two day history of severe abdominal distention, pain and bloody diarrhea. On exam, his temperature is 39.6 C and his abdomen is tense and tender. Hemoglobin is 6.6 gm/dl and white blood cell count is 36,000/mm3 with a shift to the left. Abdominal x-rays show a distended transverse colon to 7 cm. After several days of aggressive medical management with nasogastric decompression, intravenous resuscitation including transfusion, broad spectrum antibiotics and increased corticosteroids, his examination is essentially unchanged. The most appropriate management is

A. Ileostomy

B. Transverse colostomy

C. Colonoscopic decompression

D. Total abdominal colectomy and ileostomy

E. Total proctocolectomy and ileostomy

20. Normal testicular descent is associated with the following:

A. Prune Belly

B. Prader–Willi syndrome

C. Bladder Extrophy

D. Noonan syndrome

E. Epidermolysis bullosa simplex

21. In Hirschsprung’s disease, during balloon distension of the rectum, typical anorectal manometry will show:

A. Partial relaxation of the internal sphincter

B. Elevated external sphincter pressure

C. Failure of relaxation of the internal sphincter

D. Inhibition of contraction of the internal sphincter

E. Relaxation of the external sphincter

22. The half-life of Alpha-Feto-Protein is:

A. 12 hours

B. 1 day

C. 5 days

D. 2 weeks

E. 1 month

23. The prognosis in Wilm’s tumours is primarily dictated by:

A. Stage

B. Patient age

C. Resectability

D. Familial variant

E. Histology

24. Small left colon syndrome is commonly detected in newborns of diabetic mothers. Which is the underlying pathophysiological mechanism of this clinical condition?

A. Low level of insulin are responsible for the inspissated meconium and the lack of distension of the colon

B. High level of glucose reduce intestinal motility

C. High levels of glucagon decrease intestinal motility and hypoglicemia can cause vagal stimulation that increases intestinal motility in the area of the vagus nerve ending at splenic flexure

D. Low levels of glucagon decrease intestinal motility and hypoglicemia can cause vagal stimulation that decreases intestinal motility in the area of the vagus nerve ending at the splenic flexure

E. High levels of glucagon increase intestinal motility and hypoglicemia can cause vagal stimulation that increases intestinal motility in the area of the vagus nerve ending at splenic flexure

25. Suspected neonatal Hirschsprung disease is best confirmed by

A. Anorectal manometry.

B. Open myenteric biopsy and hematoxylin-eosin staining.

C. Submucosal rectal biopsy and enzyme histochemistry.

D. Barium enema study and delayed film.

E. Demonstration of gush of faeces on per-rectal examination

26. A newborn presents with respiratory distress and pleural effusion. A thoracostomy tube is inserted and produces 60 cc/day of cloudy fluid with a triglyceride content of 200 mg/dL and a lymphocyte predominate cell count. Which of the following is true?

A. Persistent drainage will not cause immunologic compromise

B. Non-operative management is effective in over half of affected infants

C. Octreotide administration is unlikely to affect chest tube output

D. Surgical intervention is unlikely to affect the outcome

E. The most common cause of this problem is lymphangectasia

27. The following statement is true concerning posterior urethral vales in a male:

A. Postnatal MAG3 (mercapto acetyl tri glycine) scintigraphy is confirmative

B. It is a rare cause of bladder outlet obstruction in boys

C. The presence of prenatal pop-off mechanisms worsen later renal function

D. End-stage renal failure is unusual

E. The keyhole sign on ultrasound is indicative of the condition

28. Children with solid abdominal organ injury treated in designated pediatric trauma centers have

A. a higher chance of being operated on early

B. a higher chance of undergoing embolization

C. no difference in mortality compared to those treated in rural community hospitals

D. a higher likelihood of being managed non-operatively

E. higher overall mortality than those treated in adult trauma centers

29. Nutrition in paediatric surgical patients is best described by the following statement:

A. Cycling of the TPN is a strategy to reduce complications in the gut.

B. Glutamine is used in all patients on parenteral nutrition to decrease the complication of infection from bacterial translocation.

C. The calorie requirement of a patient on parenteral nutrition is 10-20 % of the calorie requirement when he is on enteral feeds.

D. The optimum choice for nutrition is enteral feeding.

E. The recommended protein requirement for children is 2g/kg/day.

30. Which of the following variables is an example of categorical variables?

A. The number of episodes of a disease in a patient over a year

B. Serum bilirubin level

C. Incidence of wound infection post appendicectomy for perforated appendix.

D. Gastroesophageal reflux graded as mild/moderate/severe

E. Reduction in mean blood pressure in mmHg following antihypertensive treatment