these features are unique to children except

.Children have wider abdomen shallow pelvis, and flexible mobile ribs

..All maintenance fluid should be given as, normal saline + 5% glucose

.Children have less subcutaneous tissue, immature vasomotor center

. Non cuffed tubes are better in children as the narrowest area in respiratory passages is
.subglottic

Regarding trauma in a child .

.e. Urine output /kg/hour should be kept at a higher rate compared to adults

.a. Rib fracture in a child is less serious than in adult

.Intra-peritoneal rupture of urinary bladder is rare in pediatrics

.Spleen preservation is less mandatory in a child than adults

.Vertical incisions are better to transverse incisions in laparotomy for trauma in pediatrics

Multisystem injury is more common in children

.
?Which of the following statements is true .3

.Calorie requirement of a child per kilo decrease as the child gets older

The extracellular water content related to intracellular water of an infant decrease as the
.infant grows older

.An infant's head accounts for 9% of the body surface area

In metabolic acidosis in children 4.2 % HCO3 sol is preferred than 8.4 solution as it contains
.more Na

A&B only

Regarding Meckel's diverticulum in children .

.Risk of symptoms increase as the child gets older

.Is the most common congenital anomaly of GIT tract

.About 25% of those who become symptomatic are under the age of 2 years

.The mast common presentation in children is diverticulitis

.None of the above is true

Regarding intussusception:

.It is common cause of intestinal obstruction between 7and 9 month

.Usually occurs in the upper jejunum in children

Lead point that draws proximal intestine inward is identified in50% of cases

Triad of intussusception in pediatrics include red currant jelly stool abdominal pain, and
.bilious vomiting

Immediate decompression and trial of reduction is indicated in Unstable Patients

Varicocele in Pediatric patients all are true except _.6

.Are common above 10 year of age

.primary Varicocele is more common than secondary Varicocele in children

.Affect left testis in SO-90 of cases

.. Grade III means presence of mass like lesion.

.The Right angle of fusion of the left testicular vein to IVC is an important etiological cause

A2-month-old Down's syndrome baby has been brought in with abdominal distension and
bilious vomiting with a history of delayed passage of meconium. The parents feel that the
baby is unduly constipated. Examination shows a baby that has not been thriving normally,
with a hugely distended abdomen and gross dehydration, there is air in bowel wall in plain x-
ray. most likely cause is

.Necrotizing enterocolitis

Congenital diaphragmatic hernia

Duodenal atresia

Hirschsprung's disease

Intestinal malrotation

Which is the most likely cause of hemodynamically significant lower gastrointestinal bleeding
.in a 6-month-old male child

Henoch-Schönlein purpura

Meckel's diverticulum
C. Crohn's colitis

.Upper GIT bleeding cause

Small bowel volvulus

Regarding Inguinoscrotal swellings in pediatrics .9

.Complications is more common in indirect inguinal hernias than direct ones

.Sliding hernia is when all of hernia sac is formed by viscus

.Inguinal hernia in neonates should be repaired at three month of age

Soft hydrocele needs an operation after three month of life

egarding Inguinoscrotal swellings in pediatrics

.Complications is more common in indirect inguinal hernias than direct ones

.Sliding hernia is when all of hernia sac is formed by viscus

.Inguinal hernia in neonates should be repaired at three month of age

.Soft hydrocele needs an operation after three month of life

A&B only

Regarding fluid and electrolytes balance in a child .10

.Na requirement in infants is less per kilo body weight than in older children

.Maintenance Fluid in children better given as sol 0.9NaCI + 5% dextrose W

.Deficit fluid is better given as 0.9% NaCL

.Keep urine output at 0.5ml/ kg hour in children

Blood in infants is given at 5 ml/Kg

Dehydration in a child leads to

.Increase (wide) pulse pressure

.Tachycardia and decreased urine output

.Reduced skin turgor and bulging fontanels

.Hunger pain, and good appetite

Hypotension is an early sign

Nine year old boy weighing 30 kilos is brought to A&E with Repeated vomiting and .4
absolute constipation he was operated for perforated appendix one year ago X-Rays showed
dilated loops of bowel with multiple fluid levels, he is markedly dehydrated tachycardic,
though his abdomen is soft lax but centrally distended his initial fluid ant electrolyte therapy
as maintenance and replacement is
ml as replacement fluid daily given as ½ strength normal saline and 600 ml of normal 1700
.saline as bolus can be repeated

ml as replacement fluid given daily as 1/5 strength pediatric saline and 1700

.ml of normal saline as bolus can be repeated 600

ml as replacement fluid given daily as normal saline and 600 ml of ½ strength normal 1700
.saline as bolus can be repeated

ml as replacement fluid daily given as ½ strength normal saline and 1500

.ml of 0.45 % as bolus can be repeated 500

ml as replacement fluid daily given as normal saline and 600 ml of ½ strength 0.9 1500
saline as bolus can be repeated

The Na, and K requirement of that child as daily maintenance is .5

.mmol of Na, and 30 mmol of K bolus 60

.mmol of Na, and 30 mmol of K infusion 100

.mmol of Na and 30 mmol of K as infusion 60

.mmol of Na and 50 mmol of K as bolus 90

.mmol of Na and 60 mmol of K as infusion 90

Calorie requirement of that child is about

k calorie 2100

k calorie 3000

k calorie 2700

....k calorie 1500

Most likely the child has

.Large bowel obstruction

Adhesive small bowel obstruction

.Intussusception ot small bowel

Small bowel lymphoma

.Fecal impaction
A 5-week-old baby has 5-day history of vomiting and weight loss, examination child has .18
depressed fontanelles and dry mucus membranes his Na is 132, K3.2 C1 91 Hco3 is 28

PH is 7.48 which of the following regarding the infant is false

.It is very important to determine whether emesis is bilious or not

.Palpation of abdomen may help in diagnosis

.Ultrasound of abdomen may reveal diagnosis

.The diagnosis is infantile pyloric stenosis

.The condition showed be corrected promptly by operation

Regarding hydrocele in infants and young children .19

.Tense hydrocele should be repaired once diagnosed

.Encysted hydrocele of cord present as a cystic lump in scrotum

.In acute hydrocele treatment is usually conservative

.Soft hydrocele is repaired at 3 months of age

.Hydrocele in pediatric population is repaired through scrotal incision

Hirschsprung's disease all are true except .20

.Endo-anal pull through is one of the best one stage operation

.Cause of death in Hirschsprung's disease is necrotizing enterocolitis

In newbor period, infants affected with HD may present with abdominal distention, failure of
.passage of meconium within the first 48 hours of life

.A family history of is present in about 10% of cases

Older infants and children typically present with chronic constipation and rectal examination
commonly reveals empty rectum

egarding meconium ileus all are true except

.Is a common cause of neonatal intestinal obstruction

.Is commonly associated with cystic fibrosis

.Distal to the level of the obstruction the bowel is collapsed and the col empty

.Obstruction usually occurs in the proximal jejunum

.Presents with neonatal bilious vomiting and abdominal distension

Regarding vomiting in infancy all are true except .22

.Vomiting immediately after food is due to esophageal reflux

.Vomiting ½ an hour after food is due to pyloric obstruction

.Bilious vomiting is less alarming than non-bilious vomiting

.Vomiting of old food may denotes pyloric stenosis

Duodenal atresia usually causes bilious vomiting

The most alarming cause of bilious vomiting in first few weeks of life and baby's abdomen .3
must be operated within 6 hours for fear of

Ileocolic intussusception

Mid gut volvalus

Duodenal atresia

.Hirschsprung's disease

Imperforate anus

Confirmation of diagnosis of Hirschsprung's disease is made by .24

Rectal biopsy

Barium enema

Contrast CT scan

Genetic analysis

Inability to pass meconium after 48h of birth

In pediatric trauma all are true except .5

.Cervical spines injury can occur without plain-Ray findings

.Overextension of head opens the airways

.Lung contusion is common without rib fracture

.FAST ultrasound is very accurate in diagnosis intraperitoneal blood less than 400 ml

Isolated liver or splenic injury can usually be managed non-operatively

Branchial cyst all are true except

.Appear at any age mostly teens

Appears behind the anterior margin of the sternomastoid muscle at Junction of upper 1/3
and lower 2/3 of the muscle

.Hard, smooth, painless swelling, not very mobile

.Full of yellowish golden material, cholesterol crystals and cannot be reduced or compressed

I&D is done if infected

A 3-month healthy baby boy with firm mass I cm in the middle of sternomastoid muscle .27
the most appropriate next step is

Stretching of the muscle with physiotherapy

Ultrasound to muscle

FNAC

True cut biopsy

Surgical excision

Laboratory finding in baby with pyloric stenosis are .28

Hyperchloremia, and high urine PH

Hypocholeremic and high urine PH

Hyperchloremia, and, low urine PH

Regarding appendicitis in children all are true except .29

.The highest incidence is in second decade of life

In children, obstruction of appendix usually results from lymphoid hyperplasia of the

.submucosal follicles

.The rate of perforation is 90 % for children younger than 2 years of age

.Base of appendix is retroceacal in 213 of cases

e. Blumberg sign is very helpful in diagnosis appendicitis in children

.1
Regarding duodenal atresia

.Prognosis is usually good

Feeding intolerance and non bilious vomiting in the first 24 to 48 hours of life are
.characteristic

.Infants with congenital duodenal obstruction have rarely Trisomy 21 30%-of cases

.Bilious vomiting is rare because the obstruction is usually proximal to the ampulla of Vater

Has characteristic single bubble appearance in plain X-Ray

What is the operation for congenital hypertrophic pyloric stenosis called

...?
Hartmann's

Whipple's

Heller's

Ramstedt's

'Ivor-Lewis

Dance sign is present in .33

Congenital diaphragmatic hernia

Duodenal atresia

Hirschsprung's disease

Intestinal malrotation

Intussusception

In pediatric trauma I .34

.Multisystem injuries are rare in children trauma

.Head tilt chin lift should be used for ET intubation in cases with sus cervical spine injury

.Hypotension in children usually occurs early after trauma

.Fluid boluses in children are 10-20 ml /Kg repeated twice

Signs of correction of shock in children include narrowing of pulse

Regarding hemorrhagic shock in children all are true except

.I The blood volume in a child is approximately 8-9% of body weight, 80-90 ml/kg

.Hypotension is a late sign and the deterioration is often rapid and precipitous

Clinical manifestations of shock may not occur till there has been a loss of more than 20% of
circulating blood volume in pediatric trauma

. CT scan of abdomen and chest adds value especially in detecting the sourc of Bleeding and
is preferred as a diagnostic modality when there is hemodynamically unstable child

Splenic injuries is found in the largest proportion of pediatric blunt abdominal trauma

Inguinal hernia in children .36

Inguinal herniotomy and stengnthing of posterior wall of inguinal canal is best surgical
.option

.Inguinal hernia usually repaired at any age once diagnosed

.Complications of hernia are less common than in adults due to wide hernia neck

.Left side is double more common than right side

None of the above is true

In childhood appendicitis .8

.WBC count is often very high within the first 24 hours of symptoms

The best treatment for perforated appendicitis is good antibiotic cover, follow up and interval
.appendectomy

.Shift to the right with normal total WCC is common in children

.CT scan has no rule in diagnosis of appendicitis

Appendicitis cannot be treated with antibiotics alone

A 2-year-old boy has been sent in as an emergency with vomiting for 24 hours. .39
According to the parents, the vomitus was greenish to start with but over the past fer hours
has consistency of dirty brownish fluid. There has been no bowel action. On examination the
child looks toxic and is dehydrated - sunken eyes, depressed fontanelles, loss of skin turgor
there is a tympanic abdomen with a red, irreducible swelling in the left groin not noticed by
parents. Best line of management is

Infant should be resuscitated with intravenous fluids, nasogastric suction and Prophylactic
.antibiotics

Infant should be resuscitated with intravenous fluids, nasogastric suction and Prophylactic
antibiotics followed by immediate surgery.
An emergency operation should be carried out.

d Infant should he resuscitated with intravenons fluids nasnoastric suction

nfant should be resuscitated with intravenous fluids, nasogastric suction and Prophylactic
.antibiotics followed by surgery in next elective list

Correct of dehydration followed by trial of manual reduction

A 10-year-old boy with swollen scrotum but no impulse on cough, elevation of scrotu makes
pain worse the pain, he has similar attach 4 month ago which eased spontaneously,
examination revealed tender swollen testis and mild leukocytosis, and WCCS in urine
examination was normal most likely diagnosis is

.Urinary tract infection

Torsion testis

Epidydimo-orchitis

Non-specific abdominal pain

Acute appendicitis

Regarding pediatric trauma all are true except

.Trauma is the leading cause of death in children between 1-15 years

Interosseous access is an acceptable means for IV fluids administration in children less than 6
.years old

.If hypovolemic shock persists after two boluses of crystalloid blood transfusion is needed

.Indication for operative intervention include CT documentation of injury t liver and spleen

Interosseous needle is usually inserted in anteromedial surface of tibia 1-2em below tibial
tuberosity

Neck masses in children all are true except

.I a. 90% of children between 4-8 y has cervical lymphadenopathy

.The best way to diagnose lymphoma is excisional biopsy of lymph node

Viral infection lead to unilateral enlarged tender cervical lymph nodes

Enlarged tender lymph nodes are usually the result of bacterial infection usually staph or
.strep

Malaise, weight loss, pallor, pruritus, fever, night sweat with neck multipl masses denotes
primary neck lymphoma
Testicular torsion

.Common at 4-8 years

.Once diagnosed operation should be done within 6 hours

All patients should have Doppler ultrasound

.All patients should have Doppler ultrasound

.Is a rare cause of acute scrotum

None of the above is true

During history and physical examination in emergency room a 2-month-old boy is found .45
to have an acute non reducible swelling in the right groin all the following coul be the cause
except

Incarcerated inguinal hernia

Testicular torsion

Acute hydrocele

Inguinal lymphadenopathy

Testicular teratoma

Vectral syndrome may include all these anomalies except .46

.Tracheossophageal fistula'

Cardiac anomaly

C. Renal anomalies

d. Limb anomalies

c. Central nervous system anomalies

:Regarding neuroblastoma

Is of neural crest origin

.Most common extra-cranial solid tumor in infants

Is the leading cause of cancer death in children less than 5 years old

have bad prognosis %90

All of the above are true

?What is gold standard method of diagnosis of intussusception .8

.Ultrasound, and ultrasound guided biopsy

CT scan

Barium enema

Plain X-ray

Barium meal

A 2-month-old Down's syndrome baby has been brought in with abdominal distensio and
bilious vomiting with a history of delayed passage of meconium. The parents feel that the
baby is unduly constipated. Examination shows a baby that has not been thriving normally,
with a hugely distended abdomen and gross dehydration, there is air in bowel wall in plain x-
ray. most likely cause is

.Necrotizing enterocolitis

Congenital diaphragmatindneia

Duodenal atresia

.Hirschsprung's disease

Intestinal malrotation

Regarding infantile hypertrophic pyloric stenosis all are true except

.Child age is 3 weeks - 3 months 95 % of cases

.Commonest cause of vomiting in pediatric surgery

.Presents with bile-stained projectile vomiting

.Causes a functional gastric outlet obstruction

Nitrous oxide synthase deficiency (most accepted etiological theory)