| Post Name | Assistant Professor in Paediatric Surgery- Medical Education |
|---|---|
| Question Paper Code | 040/2024/OL |
| Category Code | 338/2023 |
| Date of Test | 6 April 2024 |
| Exam Type | Online Examination |
| Total Questions | 100 |
1
All the following served as President of Indian Association of Pediatric Surgery except
Answer
A. Professor RR Nair
2
A 30 yr old primi at 20 wk pregnancy underwent evaluation. The Maternal serum AFP is more than 1000 ng/ml. All the following are associated with the above except
Answer
D. Phenytoin
3
A Neonate in the post-operative period is started on parenteral nutrition. The glucose content is gradually increased to achieve optimal weight gain. It is noticed that the glucose content in the parenteral ļ¬uid is >18g/kg/day. This is likely to cause
Answer
D. decrease in net fat oxidation
4
A 12 day old neonate underwent primary closure of Exstrophy bladder. At the end of the procedure, the temperature was noted to be 32 degrees C. All are associated eļ¬ects except
Answer
B. vasodilatation
5
Parents of a 2 yr girl with known Hirschsprung's disease involving hepatic ļ¬exure come for counselling as the mother is anxious to conceive. Choose the correct statement for counselling.
Answer
C. The risk is higher if the next child is a boy
6
A 1 yr old child with closed space burns is brought with respiratory distress. Among the following identify the correct precaution to be observed while intubating this child.
Answer
B. The epiglottis is shorter and tilted posteriorly over the glottis, requiring straight blade laryngoscope
7
In the calculation of the burn involvement, which part of the body remains the same across all ages of children?
Answer
D. Neck
8
A 2 yr old girl child from a low socio economic status is brought with fracture Rt Femur following trivial trauma. She has 2 elder sisters. All the following are relevant in the diagnosis and management of this child except
Answer
B. evaluation of spine fractures
9
A neonate is brought with lack of motion of right shoulder. History revealed shoulder dystocia at birth. What is the correct statement in this scenario?
Answer
C. Phrenic nerve paralysis to be investigated
10
A 5 yr old boy with history of trauma is brought with abdominal wall bruising. All the following are indicative of bowel injury except
Answer
A. intraluminal air
11
A 10 yr old girl with blunt injury abdomen on ventilation for 5 days with conservative management developed progressive abdominal distension. All the following are consequences except
Answer
C. Inferior vena caval distension
12
A 8 yr old boy with blunt injury chest on observation is noted to be in distress with paradoxical chest wall movement and SpO2 88%. The chest X ray showed evidence of multiple rib fractures. All are relevant in the management except
Answer
A. Ventilation perfusion scan
13
A 9 yr old girl with motor vehicle accident was referred to the district headquarters hospital with respiratory distress and left shoulder tip pain. Initial chest X ray was reported normal at the peripheral centre. In view of vomiting and worsening distress, a nasogastric tube was placed. A repeat chest X ray showed ng tube in the left chest. All are features of diaphragmatic injury on CT chest except
Answer
C. Depressed hemidiaphragm
14
A 6 yr old boy is being followed up after conservative management of renal trauma. The likely sequel known to occur in the long term is
Answer
A. Hypertension
15
A 10 yr old boy with renal trauma undergoes CT, which shows evidence of renal laceration extending 1 cm in depth contained within the Gerota's fascia. What is the recommended management?
Answer
D. Watchful waiting
16
A 2 yr old girl is brought with a solitary, well-circumscribed, alopecic plaque in the temporal region of scalp. The Surgeon recommended excision in view of progression to Basal cell carcinoma. What is the diagnosis?
Answer
C. Sebaceous nevus
17
A 9 yr old girl presents with multiple neck nodes. In diļ¬erentiating reactive lymph nodes from neoplastic involvement on sonography, all the following favour non neoplastic etiology except
Answer
B. Long to short axis ratio < 2
18
A 16 year old boy, tall for his age was noted to have mass on a chest X ray. CT chest revealed an anterior mediastinal mass. Histology of the resected mass is likely to show
Answer
A. Schiller Duval body
19
A 9 yr old boy with right scrotal mass on sonography was identiļ¬ed to be paratesticular. CT abdomen/chest did not identify any additional abnormality. All the following are indicated except
Answer
A. Retroperitoneal lymph node dissection
20
A 10 yr old girl with intussusception, was noted to have a lead point with mass involving the Ileo cecal region. After histological diagnosis which showed a starry sky appearance, she received chemotherapy. What would have been the recommended procedure, undertaken by the surgeon?
Answer
D. Biopsy
21
A 3 yr old girl with abdominal pain, distention and jaundice after work up underwent biopsy followed by chemotherapy and radiotherapy. On follow up at 1 year, she is well. The likely diagnosis is
Answer
C. Botryoid Embryonal RMS
22
A 4 yr old girl with Cushingoid features on evaluation was found to have a right adrenocotical tumour. What is the management?
Answer
B. Surgery
23
A 15 yr old girl with primary amenorrhoea on work up was noted to have 45X/46XY karyotype. She is at risk for development of
Answer
C. Gonadoblastoma
24
A 11 yr old girl with pain abdomen on investigations was identiļ¬ed to have cystic left Ovarian mass with negative tumour markers. Preferred option is
Answer
D. Ovarian sparing cystectomy
25
A 4 yr old with asymptomatic right upper quadrant mass underwent a CT which showed multiple lesions with centripetal enhancement. Of the following, the relevant test is
Answer
B. Thyroid function test
26
A 15 month old child with liver mass, after work up underwent surgery. The tumor was of pure fetal histology with negative margins. Child requires
Answer
A. Observation
27
A 3 yr old with abdominal Neuroblastoma is taken up for surgery. All are relevant surgical principles except
Answer
B. En bloc contiguous resection
28
Among the following, which requires chemotherapy as part of mangement?
Answer
A. Cystic Partially diļ¬erentiated Nephroblastoma
29
A 2 yr old child is on follow up after completion of treatment for right stage III Wilm's tumor as per NWTS protocol. All are late eļ¬ects of Radiotherapy except
Answer
C. Pectus carinatum
30
A 2 month old baby was brought with large tongue and umbilical hernia. The child weighed 4.5 kg at delivery and required glucose infusions for low sugar levels. As part of the follow up, sonographic screening is advised until ___________ years of age.
Answer
D. 8
31
Most common acquired cause of end stage renal disease in children
Answer
D. Focal Segmental Glomerulo Nephritis
32
Second branchial cleft anomalies reach up to
Answer
C. Tonsillar fossa
33
Thoracic duct crosses at the level of
Answer
C. Thoracic Vertebra
34
In 46XX DSD, most common mutation is at
Answer
A. CYP21 gene
35
TENCKHOFF catheter is used for
Answer
C. Peritoneal dialysis
36
Pre auricular sinus occur due to
Answer
A. Incomplete fusion of and Branchial arches
37
Congenital lobar emphysema most commonly aļ¬ects
Answer
A. Left Upper lobe
38
Antenatal treatment of congenital Adrenal hyperplasia
Answer
C. Dexamethazone is started before week of gestation and continued, as per sex determined later
39
Heteropagus twins means
Answer
B. Parasitic twin with no deļ¬nite internal connection
40
Not true about Kassebach-Merritt syndrome
Answer
B. Elevated ļ¬brinigen
41
Congenital cyst adenoid malformation Stocker type I- All are true except
Answer
A. Multiple small cysts (<2cm)
42
Treatment of A/C graft rejection in renal transplant includes all EXCEPT
Answer
C. Basiliximab
43
Prognosis is good in congenital diaphragmatic hernia, if
Answer
D. Modiļ¬ed Ventilatory index less than 40
44
Extralobar sequestrations (i) Not connected with foregut (ii) May be seen both above and below the diaphragm (iii) Frequently associated with other congenital anomalies (iv) AV shunting and congestive cardiac failure (v) Communicates with neighbouring alveoli via abnormal air spaces
Answer
B. ii, iii, iv correct
45
Reļ¬ux Index for GE reļ¬ux in children means
Answer
B. Percentage of time pH of oesophagus is <4 in 24 hours
46
Torticollis is managed by all except
Answer
C. Surgical division of sternocledomastoid heads before six months
47
University of Wisconsin solution is
Answer
A. Hyperkalemic hyper osmolar
48
Epignathus-- All are true EXCEPT
Answer
A. Arises from Tonsillar fossa
49
Morgagni Hernia (i) Presents in older children (ii) Occurs through embryonic space of Larry (iii) Usual content is stomach with no sac (iv) Barium meal is diagnostic (v) Associated with cardiac defects
Answer
B. i, ii, v correct
50
In Live donor liver transplant in children, part of liver used is
Answer
B. Segments ii, iii
51
Most common Anterior mediastinal tumour in children
Answer
D. Lymphoma
52
All are true about Ovotesticular DSD except
Answer
D. High levels of Testosterone present
53
Progression of advanced stages of Empyema is suspected if pleural ļ¬uid demonstrates (i) Presence of pus (ii) pH >7.2 (iii) LDH>1000 (iv) Glucose less than 40 (v) Bacteria visible in Gram stain
Answer
C. i, iii, iv, v correct
54
Achalasia cardia ---- All are true except
Answer
C. Balloon dilatation is the best treatment in younger children
55
Los Angels grading is used for
Answer
A. Reļ¬ux oesophagitis
56
Perļ¬urocarbons are used in treatment of
Answer
C. Congenital Diaphragmatic Hernia
57
Shortest route for oesophageal replacement
Answer
C. Posterior mediastinal
58
Gross Type A Oesophageal Atresia --- All are true EXCEPT
Answer
A. Commonest Type of OA + TEF
59
True about Gastric tube Oesophagoplasty (i) Right gastro epiploic artery is divided at origin (ii) Long anastomotic line (iii) Splenectomy may be necessary as short gastric arteries are divided (iv) Trans pleural is the preferred route (v) Gastrotomy done
Answer
C. i, ii, v correct
60
Incorrect statement about etiology of cleft lip/palate
Answer
B. Intake of retinoic acid during pregnancy decreases the incidence
61
All of the following are Adenomatous polyposis syndromes EXCEPT
Answer
D. Cowden syndrome
62
APC gene which is implicated in FAP is located on
Answer
B. Long arm of chromosome 5
63
All of the following may contribute to the development of gastric volvulus EXCEPT
Answer
B. Hyperplasia of left lobe of liver
64
A baby with gastroschisis was taken up for primary closure after reduction of the bowel. Which of the following will prompt you to create a silo on postoperative day 2?
Answer
D. Central venous pressure of 6 mm Hg
65
Which of the following contributes to the development of Necrotizing enterocolitis in preterm newborns? (i) Immature motility of the intestines (ii) Decreased pancreatic and gastric secretions (iii) Decreased bile acid level (iv) Decreased nutrient digestion and absorption
Answer
D. i, ii and iv only
66
Which of the following ļ¬ndings is NOT suggestive of stage IIB NEC according to Modiļ¬ed Bell's classiļ¬cation?
Answer
C. Abdominal wall erythema
67
Which of the following is FALSE regarding instestinal atresias?
Answer
A. Familial multiple intestinal atresia has an autosomal dominant transmission
68
All of the following have a score of '2' on HAEC (Hirschsprung Associated Enterocolitis Score) EXCEPT
Answer
C. Diarrhea with bloody stool
69
Which of the following statements are true regarding acute appendicitis? (i) Appendicectomy increases the risk of developing clostridium diļ¬cile associated colitis (ii) Incidence of appendicitis increases during summer (iii) Increased right lower quadrant pain with coughing is called 'Dunphy sign' (iv) Pediatric Appendicitis score of more than 6 suggests appendicitis
Answer
D. All are correct
70
Which of the following statement is FALSE regarding Meckel's Diverticulum?
Answer
B. Omphalomesenteric duct involutes between seven to nine weeks of gestation
71
Kimura's procedure in short bowel syndrome refers to
Answer
C. Transverse bowel lengthening procedure
72
White's technique was described in
Answer
B. Gastric duplication
73
A 11 yr old boy presented with rectal bleeding, diarrhea and weight loss. His colonoscopy revealed cobblestone appeareance of mucosa with skip lesions. Microscopy showed noncaseating granulomas. Laboratory parameters of this patient may show all of the following EXCEPT
Answer
A. Thrombocytopenia
74
All of the following have been used in the drug management of Crohn's disease and its extra intestinal manifestations EXCEPT
Answer
B. Aspirin and NSAIDs
75
Regarding Alum Precipitated Toxoid test which of the folloiwng is False
Answer
C. Maternal blood gives a pink colour with sodium hydroxide
76
Persistent posterior ledge is a complication of which of the following procedures?
Answer
B. Anterior sagittal Anorectoplasty
77
Whose classiļ¬cation of pouch colon is based on the adequacy or inadequacy of the colonic length for pull through?
Answer
D. Krickenberg et al
78
What is Type IV Rectal atresia?
Answer
B. Rectal atresia with a gap between 2 ends
79
Which of the following is/are true regarding pathological classiļ¬cation of mesenteric cyst by Losanoļ¬ and Colleagues? (i) Type 1-Sessile within the leaves of the mesentery (ii) Type 2-Pedicled type (iii) Type 3-Extending into retroperitoneum (iv) Type 4-Multicenric type
Answer
D. (iii) and (iv) are correct
80
What is 'Gross Theory' of development of mesenteric cyst?
Answer
C. Proliferation of ectopic lymphatics in the mesentery which lack communication with the rest of the lymphatic system
81
8 yr old female child awaiting reimplantation for left grade IV vesicoureteral reļ¬ux with history of urinary tract calculus which procedure would you like to avoid
Answer
B. Cohen cross trigonal technique
82
Which of the following is true regarding antenatal intervention in a 24 wk fetus with lower urinary tract obstruction with severe oligohydramnios and favorable fetal urine biochemistry?
Answer
A. Will improve perinatal and early survival only by improving pulmonary function
83
4 yr old male child presents with haematuria was found to have a horse shoe and Wilms tumor involving right kidney. The treatment of choice is
Answer
B. Preoperative chemotherapy followed by excision of the right kidney with tumor including isthmus
84
Following are part of Prune Belly Syndrome except
Answer
D. Epispadias
85
11 month old male infant who presents with right absent testis on examination was found to have no palpable testis in groin or inguinal canal on right side and descended testis on left side. What is the next step in the management?
Answer
A. Diagonstic laparoscopy and proceed according to ļ¬ndings
86
7 yr old female child is having urinary incontinence since birth. Clinical examination showed urethral meatus just inside vaginal introitus (female hypospadias) which was diļ¬cult to catheterize and distended bladder. On evaluation the child is having distended bladder with signiļ¬cant residual urine and bilateral VUR with cortical scarring. Urodynamic study showed good capacity bladder with poor bladder contractility and low ļ¬ow rates with abdominal straining during micturition. The best possible treatment that can be oļ¬ered is
Answer
C. Bilateral ureteric reimplantation with Mitrafanoļ¬ appendicovesicostomy for CIC
87
The best option available for Bladder augmentation in a 6 yr old child under treatment for cloacal exstrophy is
Answer
A. Stomach
88
An asymptomatic female baby with antenatally suspected renal anomaly was found to have left duplex system with upper moiety hydroureteronephrosis and ureterocele. The upper moiety had diļ¬erential function of 11%. Next treatment which should be oļ¬ered is
Answer
C. Cystoscopy and incision of ureterocele
89
Which procedure among the following gives best results for ureteropelvic junction obstruction?
Answer
D. Dismembered pyeloplasty with dependent anastomosis
90
The best option in management of a 6 yr old boy with suspected torsion testis with symptoms of 3 hr duration is
Answer
C. Scrotal exploration
91
A 4-week old male baby with antenatally suspected renal anomaly presented with a mass on Rt side of abdomen. USS revealed right gross hydronephrosis with pelvic APD of 60 mm, parenchymal thickness of 2-3 mm, non- visualized ureter, normal bladder and normal left kidney. Next evaluation is best done with
Answer
B. Tc99 EC or Tc99 MAG3 renogram
92
2 yr old boy presented with hypospadias. On examination he is having a mid-penile hypospadias with 8 mm urethral plate, wide grooved glans, no chordee and bilateral undescended testis. He is best treated with
Answer
C. Tubularised incised plate (Snodgrass) urethroplasty
93
The indication for upper urinary diversion (ureterostomy) in a child with posterior urethral valve is
Answer
D. Urosepsis with hydroureteronephrosis not responding to antibiotics and bladder drainage
94
Treatment of primary Vesicoureteral reļ¬ux include all except
Answer
C. Cystoscopic injection of botulinum toxin into detrusor
95
4 yr old child reared as female presented with bilateral inguinal hernia. Evaluation revealed bilateral inguinal testis, karyotype 46 XY, no mullerian structures and normal external female genitalia. The best treatement is
Answer
B. Retain testis to adolescence for normal breast development followed by orchiectomy and hormonal treatment
96
3 yr old male child developed rhabdomyosarcoma of bladder underwent chemotherapy followed by cystectomy with bilateral ureterostomy for residual disease. Now at 10 yrs of age he is doing well with preserved renal function and no reoccurence of malignancy. He and parents want social urinary continence. Which is the best treatment that can be oļ¬ered?
Answer
A. Penn Pouch (ileocecal pouch) with CIC
97
6 month old asymptomatic baby with antenatally diagnosed renal anomaly was evaluated and found to have left multicystic dysplastic kidney. Management includes all except
Answer
D. Immediate nephrectomy to avoid follow-up
98
The rationale behind 'Top-Down approach' for evaluation of urinary tract infection in children is
Answer
A. UTI which doesn't aļ¬ect kidneys/with normal DMSA won't have signiļ¬cant VUR/anomalies that require treatment
99
1 yr old boy with lumbar myelomeningocele operated in newborn period is having adequate capacity bladder with grade III VUR on left side and signiļ¬cant post void residue. Urodynamic study revealed hyperactive detrusor. DMSA is showing normal kidneys. Treatment required at present is
Answer
C. Antibiotic prophylaxis, Oxybutynin and CIC
100
Asymptomatic 3 yr old male child with history of antennal hydronephrosis was found to have primary obstructed mega ureter on right with relative function of 35% and normal left kidney. The best possible treatment is
Answer
A. Right ureteric reimplantation
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