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Course 451 MCQs (best answer)

For neonatal intestinal obstruction and respiratory distress

Dr A Alzahem


Neonatal respiratory distress:


  1. Which one of the following entities characteristically manifests with respiratory distress at birth:


    1. Diaphragmatic hernia                                                        Answer key: a
    2. Pulmonary sequestration
    3. Tracheoesophageal fistula
    4. Pneumatocele
    5. Submucus cleft palate



  1. Eight hours after birth, an infant exhibits excessive drooling and mild respiratory distress. An abdominal x-ray shows complete lack of air in the gastrointestinal tract. Which is the most likely diagnosis:


    1. Tracheoesophageal fistula, H type                                   Answer key: e
    2. Pyloric atresia
    3. Choanal atresia (bilateral)
    4. Esophageal atresia with distal tracheoesophageal fistula
    5. Isolated esophageal atresia



  1. All the following may be required in the treatment of an infant with congenital diaphragmatic hernia except:


    1. Hyperventilation                                                               Answer key: d
    2. Nitric oxide
    3. Extracorporeal membrane oxygenation (ECMO)
    4. Immediate operation
    5. Repair via abdominal approach


 Neonatal upper intestinal obstruction:


  1. A 4-week old boy has a history of nonbilious vomiting for 5days and a weight loss of 0.4 kg (from 4kg to 3.6 kg). On examination, his anterior fontanelle is found to be flattened, his mucous membranes are dry, and he is passing urine. Upper abdominal small mass is felt to the right of midline. Laboratory data are as follows:


Na  132, K  3.2, Cl  91, CO2  28, and pH 7.48


Which of the following solutions is appropriate for initial intravenous therapy of this baby:


a.       Lactated Ringer’s solution at 25 ml/hour                                    Answer key: d

b.      D5/W, 0.5% normal saline + 20 mEq/liter of KCl at 15 ml/hour

c.       D5/W, 0.25% normal saline + 30 mEq/liter of KCl at 30 ml/hour

d.      D5/W, 0.5% normal saline + 30 mEq/liter of KCl at 25 ml/hour

e.       D5W + 0.1% normal hydrochloride (HCl) at 30ml/hour



  1. A 3-week old girl, apparently well, exhibits sudden onset of bilious vomiting. Which of the following is the most likely diagnosis:



    1. Pyloric stenosis                                                                     Answer key: e
    2. Tracheoesophageal fistula, H type
    3. Hirschsprung’s disease
    4. Duodenal atresia
    5. Malrotation of midgut


  1. The cardinal feature to distinguish between the lower and the upper intestinal obstruction in neonates is:


    1. Color of vomitus                                                                  Answer key: d
    2. Weight loss
    3. Abdominal pain
    4. Abdominal distention
    5. Obstipation


  1. “Double bubble" sign on the plain abdominal x-ray can be seen in the following conditions except:


    1. Duodenal atresia                                                                   Answer key: e
    2. Annular pancreas
    3. Midgut Volvulus
    4. Duodenal web
    5. Duodenal diverticulum


 Neonatal lower intestinal obstruction:


  1. With regard to Hirschsprung’s disease, all the following statements are true except:


    1. It is more common in females                                             Answer key: a
    2. It may be complicated by enterocolitis
    3. Barium enema studies may be normal
    4. It is best diagnosed by rectal biopsy
    5. Associated anomalies are not common


9. With regard to anorectal malformations, which of the following statements is true:


                                                                                                Answer key: b


    1. This anomaly is defined as high or low, according to the relationship between the rectum and the external sphincter
    2. High anomalies are commonly associated with genitourinary abnormalities
    3. Initial colostomy is required in infants with  perineal fistula
    4. Pull-through techniques are highly successful in preserving continence
    5.  Sacral hypodevelopment has no prognostic value  


 10. Which of the following conditions is the most common cause of colon obstruction in infants:


    1. Anorectal malformations                                                    Answer key: c
    2. Hirschsprung’s disease
    3. Functional constipation
    4. Meconium plug syndrome
    5. Small left colon syndrome



  1. A 1-month old preterm (33 weeks gestation) boy is brought to the emergency room with a history of an acute, nonreducible mass in the right groin. All of the following are possible diagnoses except:


    1. Testicular torsion                                                                  Answer key: d
    2. Hydrocele of the cord
    3. Incarcerated inguinal hernia
    4. Testicular teratoma
    5. Inguinal lymphadenopathy





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