#1.

A full term infant was born after a normal pregnancy, delivery, however, was
complicated by marginal placental detachment. At 12 hours of age the child, although
appearing to be in good health, passes a bloody meconium stool. For determining the cause
of the bleeding, which of the following diagnostic procedures should be performed first?
+A. Barium enema
-B. Gastric lavage with normal saline
-C. An Apt test
-D. An upper gastrointestinal series
-E. Platelet count, prothrombin time, and partial thromboplastin time

#2. Head circumference of a 1 month old boy with signs of excitement is 37 cm, prefontanel
is 2x2 cm large. After feeding the child regurgitates small portions of milk; stool is normal in its
volume and composition. Muscle tone is within norm. What is the most likely diagnosis?
-A. Meningitis
-B. Pylorostenosis
+C. Pylorospasm
-D. Microcephaly
-E. Craniostenosis

#3. A child was born with body weight 3250 g and body length 52 cm. At the age of 1,5 month
the actual weight is sufficient (4350 g), psychophysical development corresponds with the age.
The child is breast-fed, occasionally there are regurgitations. What is the cause of regurgitations?
-A. Acute gastroenteritis
-B. Aerophagia
-C. Pylorospasm
+D. Pylorostenosis
-E. Esophageal atresia

#4. An infant is 3 weeks old. Since birth there has been observed periodical vomiting within a
few minutes after feeding. The amount of vomited masses does not exceed that of previous
feeding. The infant has age-appropriate body weight. What is the most likely cause of this
symptom?
+A. Pylorospasm
-B. Esophageal chalasia
-C. Adrenogenital syndrome
-D. Pyloristenosis
-E. Esophageal achalasia

#5. In a 1,7 kg infant born at 34 weeks of gestation a abdomen retraction was observed. During
stomach and duodenum intubation the stomach contents with bile and meconium was got.
Abdominal and chest X-ray examination showed a double fluid level in the epigastrium with
otherwise gasless abdomen. Make a diagnosis?
-A. Esophageal atresia
-B. Diaphragmatic hernia
-C. Biliary atresia
+D. Congenital high intestinal ileus
-E. Congenital lower intestinal ileus

#6. 3,2 kg newborn was breast-fed in 4 hours after the delivery. In 30 minutes an abundant
vomiting with bile and meconium was observed. During gastric lavage the meconium was
obtained. What is the further tactics?
-A. Gastrointestinal endoscopy
-B. Contrast X-ray investigation of the gastrointestinal tract
-C. Enema
-D. Infusion and antibacterial therapy
+E. Cancel the enteric feeding, call a pediatric surgeon, begin the infusion therapy

#7. Within 6 hours after the birth a congenital high intestinal ileus was diagnosed (duodenum
atresia) in 2,8-kg infant. The infant was transported to the specialized neonatal intensive care
unit. How long should take a preoperative preparation?
-A. 1 hour
-B. 3-6 hours
+C. 12-24 hours
-D. 5 days
-E. 10 days

#8. An atresia of the jejunum was found in a 3,1 kg full-term infant on the operative table. Others
anomalies were absent. What operation is preferable in this situation?
-A. Gastrostomy
-B. Duodeno-duodenum anastomosis
+C. Duodeno-jejunum anastomosis
-D. Gastro-jejunum anastomosis
-E. Ileocecal angle resection

#9. An abundant vomiting, abdominal distention, visible loops of the bowel and no passage of
meconium are observed in 2,9 kg full-term infant on the 2 nd day of life. A mucous was got after
the rectal lavage. After abdominal X-ray an congenital lower intestinal ileus was diagnosed.
What is the further tactics?
+A. Stomach intubation, immediate transportation to the specialized unit for the preoperative
preparation
-B. Conservative therapy with the next pediatric surgeon consultation in 24 hours
-C. Artificial feeding through a tube and enema
-D. Endoscopy
-E. Laporoscopy

#10. A congenital lower intestinal ileus was diagnosed in a 3 day old infant. How long should a
preoperative preparation take?
-A. 1 hour
+B. 2-5 hours
-C. 24 hours
-D. 3 days
-E. 7 days

#11. In 4 weeks after a 3 year old boy drank an alkaline electrolyte the vomiting after each
feeding and weight loss were observed. What investigations are helpful in the diagnosis?
-A. Abdominal and chest X-ray
-B. Tracheobronchoscopy
-C. Computer tomography
+D. Esophageal endoscopy
-E. Thoracoscopy
#12. A child was breast-feeding till 1 month of age. After this age a curdy milk vomiting without
bile was observed. At 1,5 – month hypotrophy and a “sand-glass” symptom were diagnosed.
Make a praliminary diagnosis?
-A. Pyloric spasm
+B. Pyloric stenosis
-C. Ladd’s syndrome
-D. Foreign body of the stomach
-E. Intussusception

#13. A pyloric stenosis is suspected on the basis of the anamnesis, physical and laboratory
examination in a 1 month infant. What instrumental investigation is crucial in the diagnosis at
this age?
-A. Laparoscopy
+B. Gastrointestinal endoscopy
-C. Contrast gastrointestinal radioscopy
-D. Ultrasonography
-E. Computer tomography

#14. A high congenital intestinal obstruction is suspected in a newborn. What symptom must be
present on abdominal X-ray film?
-A. Distended loops of the bowel
-B. Alone fluid level
+C. Double fluid level
-D. Multiple fluid levels
-E. Gasless abdomen

#15. A 3 years old boy has been suffering from constipation since the 4-month of age, he has
abdominal distention, spreaded costal arches. Fecalithes are palpated. What investigations are
optimal for diagnosis?
-A. Abdominal X-ray
-B. Irrigoscopy
-C. Irrigoscopy anorectal manometry
-D. Laparoscopy
+E. Irrigoscopy anorectal manometry determination of acetylcholinesterase.

#16. Hirschsprung’s disease, decompensation stage, was diagnosed in the infant. What treatment
is indicated?
-A. Colostomy
-B. Radical operation
-C. Nonoperative treatment with siphon enemas
-D. Nonoperative treatment till 1 year of age with further radical operation
+E. Colostomy with radical operation at 6 month age

#17. A 2 year old child with Hirschsprung’s disease has undergone a radical operation, following
rectal demucousation, endorectal ascending of the colon and primary anastomosis. Who are
authors of this operation?
-A. Soave-Lenuschckin
-B. Svenson-Issacov
+C. Soave-Boly
-D. Rebein
-E. Duamel-Bairov
#18. A child suffering from Hirschsprung’s disease has explosive episodes of diarrhea
alternating with constipation, abdominal distention, fever. What the cause of the diarrhea?
-A. Irritation of the colon with siphon enemas
+B. Superimposed enterocolitis
-C. Ulcerative colitis
-D. Polyposis
-E. Salmonellosis

#19. A 3 day old infant developed bilious vomiting at first and then vomiting with intestinal
contents. His abdomen is distended, movable sausage-like mass is found at the right abdomen,
passage of the stool and gas is absent. Make a tentative diagnosis?
-A. Ileac atresia
+B. Meconium ileus
-C. High congenital intestinal ileus
-D. Enterocolitis
-E. Tumor of the abdomen

#20. An infant developed asphyxia at 5 days of age, vomiting, retention of the stool and gas,
became restless. There is abdominal distention and slight edema in the lower abdomen. Make
initial diagnosis?
-A. Congenital lower partial ileus
+B. Necrotizing enterocolitis, peritonitis
-C. Meconium ileus
-D. Mucous plugs
-E. Hirschsprung’s disease

#21. A 12 year old girl has been suffering from the chronic constipation for 2 years. She
complains of the pain in the left lower abdomen. Her stool looks like numerous small hard beads.
Sigma is firm, like cord on palpation of the abdomen. X-ray exqamination shows that the left
department of the transverse colon fills up with the contrast slowly, gaustration is increased.
Rectoromanoscopy is painful. What is your diagnosis?
-A. Hirschsprung’s disease
-B. Microcolon
+C. Chronic constipation by spastic type
-D. dolychosygma
-E. chronic constipation by atonic type

#22. A newborn boy 3 weeks old is vomiting during the week by “fountain” without sour smell,
without bile admixture, visible peristalsis in epigastrium, loss of the weight, constipations.
Appetite is preserved. What kind of pathology corresponds to this clinical picture?
+A. Congenital pyloric
-B. Pylorospasm
-C. Tumor of the stomach
-D. Aberrant vessel
-E. Internal membrane

#23. A mother of 1,5 months-child complains of daily non-frequent vomiting by "fountain"

immediately after feeding. The volume of vomit mass always exceeds the volume of eaten food.
Illness started since 2-week age. The skin of the child is flabby, pale, going into pleats which are
slowly smoothed out. Deficit of the body mass is 24%. Symptom of "sand-glass" is positive.
Appear constipations, decreases amount of the urinations. What is the most probable diagnosis?
-A. Cardiostenosis
-B. Pylorospasm
-C. Hypervitaminosis
-D. Adrenogenital syndrome
+E. Pylorostenosis

#24. A 2 years old child suffers from constipations during 9 months, abdominal distension. On
irrigogram there is a narrowed zone in distal part of large intestine with infundibuliform
transition into suprastenotic dilatation. What is the most probably diagnosis?
+A. Hirschsprung's disease
-B. Dolichosigmoid
-C. Megacolon syndrome of unknown aetiology
-D. Duplication of the bowels
-E. Crohn's disease

#25. A newborn, aged 2 days, was born with mass of the body 3200g. At the end of the 1-st day
of life appeared frequent vomiting with admixture of bile. Abdomen is not distended. It is
observed outpouching in epigastrium area that disappears after vomiting. Light mucus is
received after enema. Urination spontaneous. On X-ray picture two Kloybera caps are detected.
What is the most probable diagnosis?
-A. Low intestine obstruction
-B. Pylorostenosis
-C. Esophageal atresia
+D. Congenital high intestine obstruction
-E. Dynamic intestine obstruction

#26. A newborn boy within 24 hours can't get rid of meconium. The child is anxious, refuses
breast. The anus is located usually. The abdomen is evenly swelled, palpation causes anxiety and
crying. At x-ray overview of the abdominal cavity organs there are numerous bowels loops
swelled by gas with horizontal levels of liquids. What is your diagnosis?
-A. Birth paralysis of the right shoulder plexus
+B. Congenital low intestine obstruction
-C. Pylorospasm
-D. Congenital high intestine obstruction
-E. Hirschsprung's disease

#27. A 3-year-old boy complains of pain on defecation with hard consistency of feces. Stool are
with admixture of blood. Retention of stool is observed too. Make a diagnosis?
-A. Intussusception
-B. Hemorrhoids
+C. Anal fissure
-D. Dysentery
-E. Rectal polyp

#28. A baby was brought into the surgical department from the maternity home with a diagnosis
“Atresia of the rectum and anus”. What investigation is indicated for making a correct diagnosis?
-A. Ultrasonic investigation of the abdominal organs
-B. X-ray investigation of the abdominal cavity
+C. X-ray investigation by Vangestin
-D. Cystigraphy
E. Computer tomography of the pelvic organs
#29. A 3-week-old baby was brought to the reception ward with the tentative diagnosis of
“Congenital pylorostenosis”. What diseases you should differentiate it with?
-A. Intestinal intussusceptions
-B. Pseudopylorostenosis
-C.Meconium ileus
+D. Pylorospasm
-E. Gastroenterocolitis

#30. A newborn has vomiting with bile, abdominal distension in the epigastrium, retraction of
the lower abdomen. These signs developed in the first day. Double fluid level in the upper part of
abdomen was found on the X-ray investigation of the abdomen. What is your preliminary
diagnosis?
-A. Atresia of the ileum
+B. Duodenal atresia
-C. Adhesive ileus
-D. Rectal atresia
-E. Intussusception

65. An infant is 3 weeks old. Since birth there has been observed periodical vomiting within a few
minutes after feeding. The amount of vomitive masses does not exceed the volume of previous feeding.
The infant has age-appropriate body weight. What is the most likely cause of this symptom?
+A. Pylorospasm
B. Esophageal chalasia
C. Adrenogenital syndrome
D. Pyloristenosis
E. Esophageal achalasia

148. A 3-month-old child presents with saffron-yellow coloring of the skin, sclera, and mucous
membranes. The abdomen is enlarged, hepatomegaly and splenomegaly are observed. In blood
there is conjugated bilirubin-induced hyperbilirubinemia. On intravenous
cholangiocholecystography: opacified bile is discharged into the intestine. Transaminase activity
is normal. What is the most likely diagnosis?
+A. Biliary atresia
B. Physiologic jaundice
C. Hemolytic disease of newborn
D. Crigler-Najjar syndrome
E. Congenital hepatitis