MCQ bank · 34 questions · free
Paediatric surgery MCQs with answers
34 single-best-answer questions on pyloric stenosis, intussusception, malrotation, undescended testis and neonatal emergencies. Try each one, then open the answer to see the explanation, why the other options are wrong, and the guideline or trial behind it.
A 5-week-old boy has projectile, non-bile-stained vomiting after every feed and is hungry straight afterwards. Ultrasound confirms pyloric stenosis. His blood gas shows pH 7.52, chloride 86 mmol/L, potassium 3.0 mmol/L and bicarbonate 34 mmol/L. What is the next step?
- Pyloromyotomy tonight, before the electrolytes are corrected
- Barium meal to confirm the diagnosis
- Intravenous fluid with sodium chloride, glucose and added potassium until the electrolytes and bicarbonate are corrected, then pyloromyotomy
- Intravenous sodium bicarbonate
- Restart feeds and observe
Show the answer and explanation
Answer: C. Intravenous fluid with sodium chloride, glucose and added potassium until the electrolytes and bicarbonate are corrected, then pyloromyotomy. Losing gastric acid by vomiting causes a hypochloraemic, hypokalaemic metabolic alkalosis. Pyloric stenosis is not a surgical emergency: anaesthesia with an uncorrected alkalosis risks postoperative apnoea, so the infant is resuscitated first and Ramstedt’s pyloromyotomy follows once chloride and bicarbonate are normal.
Why not the others? Bicarbonate would worsen the alkalosis. Ultrasound has replaced contrast studies for diagnosis.
References
A 4-day-old baby, previously feeding well, starts vomiting bright green fluid. The abdomen is soft and not distended. What is the most urgent concern and next step?
- Reflux: thicken the feeds
- Malrotation with midgut volvulus: urgent upper GI contrast study, or straight to theatre if unwell
- Cow’s milk allergy: change the formula
- Pyloric stenosis: ultrasound of the pylorus next week
- Viral gastroenteritis: oral rehydration
Show the answer and explanation
Answer: B. Malrotation with midgut volvulus: urgent upper GI contrast study, or straight to theatre if unwell. Bilious vomiting in a newborn is a surgical emergency until proven otherwise. Volvulus can strangulate the entire midgut within hours, and a soft abdomen does not exclude it. The upper GI contrast study shows an abnormal duodenojejunal flexure position or a “corkscrew” duodenum, and Ladd’s procedure is performed urgently.
Why not the others? Pyloric stenosis causes non-bilious vomiting and presents at 2–8 weeks.
References
A 9-month-old has episodes of screaming and drawing up his legs, with pallor between episodes, and has passed a stool of blood and mucus. Ultrasound shows a “target” sign in the right upper quadrant. He is well perfused with no peritonitis. What is the treatment?
- Colonoscopy
- Laxatives
- Antibiotics and observation
- Resuscitation, then image-guided air (or liquid) enema reduction
- Immediate laparotomy
Show the answer and explanation
Answer: D. Resuscitation, then image-guided air (or liquid) enema reduction. Ileocolic intussusception is reduced non-operatively by a pneumatic or hydrostatic enema in most children. Surgery is needed if the enema fails, or if there is peritonitis, perforation or shock, which are contraindications to enema reduction.
Why not the others? Laparotomy is not the first step in a stable child.
References
A 6-month-old boy has a right testis that is palpable in the groin and cannot be brought down into the scrotum. The left testis is normal. What do you advise?
- Refer to a paediatric surgeon for orchidopexy, ideally completed by 12–18 months of age
- Ultrasound before referral in every case
- Orchidectomy
- Hormone (hCG) injections as the main treatment
- Wait until puberty, as it may descend
Show the answer and explanation
Answer: A. Refer to a paediatric surgeon for orchidopexy, ideally completed by 12–18 months of age. Spontaneous descent after 6 months is unlikely. Early orchidopexy, between 6 and 18 months, improves fertility potential and allows the testis to be examined for later cancer. Ultrasound is not needed for a palpable testis and does not change management.
Why not the others? Hormone therapy has low success and is not recommended. Waiting until puberty damages the testis.
References
A 14-year-old boy has had sudden, severe left testicular pain for 3 hours with vomiting. The testis is high and horizontal and the cremasteric reflex is absent. What do you do?
- Manual detorsion and discharge without surgery
- Antibiotics for epididymo-orchitis
- Doppler ultrasound and review in the morning
- Analgesia and discharge
- Urgent scrotal exploration, with fixation of both testes if torsion is confirmed
Show the answer and explanation
Answer: E. Urgent scrotal exploration, with fixation of both testes if torsion is confirmed. Testicular torsion is a clinical diagnosis, and salvage falls sharply after about 6 hours. When suspicion is high, the boy goes straight to theatre; ultrasound must not delay surgery. The contralateral testis is also fixed because the anatomical abnormality is usually bilateral.
Why not the others? Manual detorsion can relieve ischaemia while theatre is prepared, but exploration and fixation are still required.
References
A term newborn has not passed meconium by 48 hours and has a distended abdomen. On rectal examination there is an explosive gush of stool and gas. Which test confirms the most likely diagnosis?
- Abdominal ultrasound
- Rectal suction biopsy
- Barium meal
- Sweat test only
- CT of the abdomen
Show the answer and explanation
Answer: B. Rectal suction biopsy. Delayed meconium with an explosive rectal “blast” suggests Hirschsprung’s disease. Rectal suction biopsy confirms it by showing absent ganglion cells and hypertrophied nerve fibres. A contrast enema shows the transition zone and helps plan surgery.
Why not the others? A sweat test is relevant for meconium ileus (cystic fibrosis) but does not diagnose Hirschsprung’s disease.
References
A 4-week-old breastfed baby is still jaundiced. The stools are pale and the urine is dark. Conjugated bilirubin is 90 µmol/L. What is the key concern?
- Biliary atresia: urgent referral to a specialist liver centre, because the Kasai operation works best before 60 days of age
- Physiological jaundice: phototherapy
- Breast-milk jaundice: reassure
- Stop breastfeeding for a week
- Repeat bilirubin at 3 months
Show the answer and explanation
Answer: A. Biliary atresia: urgent referral to a specialist liver centre, because the Kasai operation works best before 60 days of age. Jaundice beyond 14 days (21 in preterm babies) needs a conjugated (split) bilirubin. Conjugated jaundice with pale stools means biliary atresia until proven otherwise. Kasai portoenterostomy restores bile flow most often when done early; untreated, the disease progresses to cirrhosis.
Why not the others? Breast-milk jaundice is unconjugated and the stools are normal. Phototherapy does not treat conjugated jaundice.
References
A 3-year-old swallowed a button battery 1 hour ago. X-ray shows a round object with a double-ring (“halo”) outline in the upper oesophagus. What is required?
- Laxatives
- Repeat X-ray in 1 week
- Removal only if symptoms develop
- Emergency endoscopic removal, ideally within 2 hours
- Wait 24 hours for it to pass
Show the answer and explanation
Answer: D. Emergency endoscopic removal, ideally within 2 hours. A button battery in the oesophagus generates an electric current that causes liquefactive burns within 2 hours, leading to perforation, fistula or fatal bleeding from the aorta. It must be removed urgently. Honey or sucralfate given before removal can reduce injury in children over one year old.
Why not the others? Waiting allows deep tissue damage even when the child has no symptoms.
References
A baby born at 29 weeks, now 2 weeks old, develops abdominal distension, bilious aspirates and blood in the stool. X-ray shows gas in the bowel wall (pneumatosis intestinalis) but no free air. What is the initial management?
- Immediate laparotomy
- Barium enema
- Rectal washouts
- Stop feeds, nasogastric decompression, intravenous fluids and broad-spectrum antibiotics, with close monitoring
- Continue feeding with a different formula
Show the answer and explanation
Answer: D. Stop feeds, nasogastric decompression, intravenous fluids and broad-spectrum antibiotics, with close monitoring. This is necrotising enterocolitis. Without perforation, it is treated medically with bowel rest, decompression, antibiotics and supportive care, with serial X-rays and examinations. Pneumoperitoneum or clinical deterioration despite medical treatment are indications for surgery or a peritoneal drain.
Why not the others? A contrast enema risks perforating fragile bowel.
References
An 18-month-old boy, born at term, has a reducible right inguinal hernia noticed by his parents. What is the correct plan?
- Lichtenstein mesh repair
- Elective herniotomy (ligation of the hernial sac) soon, without mesh
- Repair only if it becomes irreducible
- Wait until he is 5 years old
- A truss
Show the answer and explanation
Answer: B. Elective herniotomy (ligation of the hernial sac) soon, without mesh. Childhood inguinal hernias are due to a patent processus vaginalis and do not close by themselves. The risk of incarceration is highest in infants, so repair is arranged soon after diagnosis. Herniotomy (open or laparoscopic) is the operation; mesh is not used in children.
Why not the others? This differs from umbilical hernias in children, which often close and can be observed.
References
A 3-year-old girl has a smooth, painless mass in the left flank that does not cross the midline. She has hypertension and microscopic haematuria. What is the most likely diagnosis?
- Hydronephrosis from pelviureteric junction obstruction
- Intussusception
- Splenomegaly
- Neuroblastoma
- Wilms tumour (nephroblastoma)
Show the answer and explanation
Answer: E. Wilms tumour (nephroblastoma). Wilms tumour is the commonest renal tumour of childhood, typically at ages 2–5, presenting as a smooth flank mass that is often found by a parent. Hypertension and haematuria may be present. Avoid repeated palpation, which risks rupture. Ultrasound and CT or MRI confirm it, and treatment combines nephrectomy and chemotherapy.
Why not the others? Neuroblastoma is more often irregular, crosses the midline, contains calcification and causes systemic illness.
References
A 9-year-old boy has 24 hours of periumbilical pain moving to the right iliac fossa, with vomiting and a low-grade fever. What is the first imaging test if imaging is needed?
- Abdominal ultrasound
- CT of the abdomen as the first test
- Plain abdominal X-ray
- Barium enema
- MRI in every child
Show the answer and explanation
Answer: A. Abdominal ultrasound. In children with suspected appendicitis, ultrasound is the first-line imaging, combined with clinical scores (such as the Paediatric Appendicitis Score) and blood tests. CT is reserved for unclear cases to limit radiation, and MRI is an alternative where available.
Why not the others? Plain X-rays add little.
References
A 10-year-old boy has had gradually increasing pain at the top of the right testis for a day. There is a tender, small blue-black spot on the upper pole (“blue dot sign”); the testis itself is normal in position and the cremasteric reflex is present. What is the likely diagnosis and treatment?
- Testicular torsion; immediate orchidectomy
- Epididymo-orchitis; intravenous antibiotics
- Inguinal hernia; herniotomy
- Torsion of the appendix testis; analgesia and rest, exploring only if testicular torsion cannot be excluded
- Testicular tumour; inguinal orchidectomy
Show the answer and explanation
Answer: D. Torsion of the appendix testis; analgesia and rest, exploring only if testicular torsion cannot be excluded. Torsion of the appendix testis is common in prepubertal boys and settles with analgesia in a few days. The blue dot sign, localised tenderness and a preserved cremasteric reflex support it. If there is any doubt about torsion of the testis itself, the scrotum must be explored.
Why not the others? Antibiotics are not needed, and epididymitis is uncommon before puberty without urinary tract abnormalities.
References
A 3-year-old boy has a tight foreskin that cannot be retracted. He has no pain, infection or scarring, and passes urine normally. What do you advise?
- Forcible retraction in clinic
- Reassure: this is physiological phimosis; do not force retraction, and consider topical steroid cream if it causes problems
- Circumcision now
- Ultrasound of the kidneys
- Antibiotics
Show the answer and explanation
Answer: B. Reassure: this is physiological phimosis; do not force retraction, and consider topical steroid cream if it causes problems. A non-retractile foreskin is normal in young boys and usually resolves with age. Forced retraction causes scarring. Topical steroids help if treatment is wanted. Circumcision is indicated for pathological phimosis such as balanitis xerotica obliterans (lichen sclerosus) or recurrent balanoposthitis.
Why not the others? Ballooning during voiding is usually harmless.
References
A newborn has frothy saliva and chokes during the first feed. A nasogastric tube will not pass and X-ray shows it coiled in the upper chest, with gas in the stomach. What is the immediate management?
- Stop feeds, place a Replogle tube on continuous suction, keep the baby head-up, screen for associated anomalies (VACTERL), and refer for surgery
- Try feeding with a different teat
- Barium swallow
- Push the tube harder
- Discharge home
Show the answer and explanation
Answer: A. Stop feeds, place a Replogle tube on continuous suction, keep the baby head-up, screen for associated anomalies (VACTERL), and refer for surgery. This is oesophageal atresia with a distal tracheo-oesophageal fistula (gas in the stomach). The upper pouch is kept empty to prevent aspiration. Echocardiography (also to check the side of the aortic arch), renal ultrasound and spinal imaging look for VACTERL anomalies before repair.
Why not the others? Contrast in the upper pouch risks aspiration.
References
A newborn is cyanosed with a scaphoid abdomen. Heart sounds are heard on the right, and the X-ray shows bowel loops in the left chest. How should the airway be managed?
- Emergency surgery in the delivery room
- Immediate intubation and gentle ventilation, with a nasogastric tube to decompress the bowel; avoid bag-and-mask ventilation
- Feed and observe
- Chest drain into the left chest
- Bag-and-mask ventilation for 10 minutes
Show the answer and explanation
Answer: B. Immediate intubation and gentle ventilation, with a nasogastric tube to decompress the bowel; avoid bag-and-mask ventilation. In congenital diaphragmatic hernia, bag-and-mask ventilation inflates the stomach and bowel in the chest, further compressing the lungs. The baby is intubated, ventilated gently to avoid lung injury, and the stomach decompressed. Surgery is delayed until the baby is physiologically stable.
Why not the others? A chest drain into herniated bowel causes perforation.
References
A baby is born with loops of bowel protruding through a defect to the right of a normal umbilical cord, with no covering membrane. What is the immediate care?
- Leave the bowel exposed to air
- Push the bowel back immediately
- Wrap the bowel in dry gauze
- Feed orally
- Cover the bowel in a sterile bowel bag or cling film, keep the baby warm, support the bowel to avoid kinking, pass a nasogastric tube and give intravenous fluids
Show the answer and explanation
Answer: E. Cover the bowel in a sterile bowel bag or cling film, keep the baby warm, support the bowel to avoid kinking, pass a nasogastric tube and give intravenous fluids. This is gastroschisis. Exposed bowel loses heat and fluid quickly and its blood supply can be compromised by twisting. It is protected, the baby is kept warm and decompressed, and intravenous fluids are started before transfer to a surgical centre.
Why not the others? Exomphalos, unlike gastroschisis, has a covering sac and is more often associated with other anomalies.
References
A 2-month-old girl has a rapidly growing infantile haemangioma on the upper eyelid that is starting to close the eye. What is the treatment?
- Laser for every case
- Topical antibiotics
- Reassurance, because all haemangiomas resolve
- Surgical excision as first-line
- Oral propranolol, started promptly with specialist input
Show the answer and explanation
Answer: E. Oral propranolol, started promptly with specialist input. Most infantile haemangiomas need no treatment, but those threatening vision, the airway or function, or causing ulceration or disfigurement, need treatment during the growth phase. Oral propranolol is first-line. A periocular haemangioma can cause amblyopia within weeks.
Why not the others? Waiting during rapid growth can cause permanent visual loss.
References
A 1-year-old boy has an empty right scrotum and the testis cannot be felt in the groin, even under anaesthesia. What is the next step?
- Ultrasound and CT to find the testis before surgery
- Diagnostic laparoscopy to find an intra-abdominal testis, followed by orchidopexy (sometimes staged) or removal of a non-viable remnant
- No action
- Hormone injections
- Wait until puberty
Show the answer and explanation
Answer: B. Diagnostic laparoscopy to find an intra-abdominal testis, followed by orchidopexy (sometimes staged) or removal of a non-viable remnant. For a non-palpable testis, laparoscopy is both diagnostic and therapeutic: it shows whether the testis is intra-abdominal, absent, or a vanished remnant. Ultrasound and other imaging rarely change management and are not recommended.
Why not the others? If both testes are impalpable, or there is hypospadias, a disorder of sex development must be considered.
References
A 4-year-old swallowed a coin 2 hours ago. He is well, eating and drinking, with no drooling or pain. X-ray shows the coin in the stomach. What do you advise?
- Laparotomy
- Emergency endoscopy
- Allow it to pass naturally; return if symptoms develop, with a follow-up X-ray if it has not been seen to pass
- Induce vomiting
- Laxatives every day for a week
Show the answer and explanation
Answer: C. Allow it to pass naturally; return if symptoms develop, with a follow-up X-ray if it has not been seen to pass. Most blunt objects that reach the stomach pass without problems. Asymptomatic coins in the stomach are managed expectantly. Coins in the oesophagus need removal, and button batteries, magnets and sharp objects need specific urgent management.
Why not the others? Always check the X-ray carefully to tell a coin from a button battery (which shows a double ring).
References
A 2-year-old has passed a large amount of dark red blood per rectum without pain. He is pale, and his haemoglobin has dropped. Upper and lower endoscopy are normal. What is the most useful test?
- Stool culture
- Colonoscopy repeated weekly
- Barium enema
- Abdominal X-ray
- Technetium-99m pertechnetate (“Meckel’s”) scan
Show the answer and explanation
Answer: E. Technetium-99m pertechnetate (“Meckel’s”) scan. Painless rectal bleeding in a young child suggests a Meckel’s diverticulum containing ectopic gastric mucosa, which secretes acid and causes ulceration of the adjacent ileum. The pertechnetate scan detects gastric mucosa. Treatment is resection.
Why not the others? The “rule of 2s”: about 2% of people, about 2 feet from the ileocaecal valve, about 2 inches long, often presenting before age 2.
References
A 6-month-old boy has a soft, painless scrotal swelling that transilluminates and that varies in size during the day. The testis is normal. What do you advise?
- Observation; most infant hydroceles resolve, and surgery is considered if it persists beyond about 1–2 years or a hernia develops
- Immediate surgery
- Ultrasound every month
- Aspiration of the fluid
- Antibiotics
Show the answer and explanation
Answer: A. Observation; most infant hydroceles resolve, and surgery is considered if it persists beyond about 1–2 years or a hernia develops. Infant hydroceles are common and usually close spontaneously. A hydrocele that varies in size is communicating (the processus vaginalis is open), and if it persists, it is repaired through a groin incision, like a hernia.
Why not the others? Aspiration risks infection and recurrence.
References
Antenatal scans in a boy showed bilateral hydronephrosis and a thick-walled bladder. After birth, he has a poor urinary stream. What is the suspected diagnosis and first step?
- Circumcision
- Normal variant; discharge
- Wilms tumour
- Pyloric stenosis
- Posterior urethral valves; bladder drainage with a catheter, then confirm with a micturating cystourethrogram and arrange endoscopic valve ablation
Show the answer and explanation
Answer: E. Posterior urethral valves; bladder drainage with a catheter, then confirm with a micturating cystourethrogram and arrange endoscopic valve ablation. Posterior urethral valves obstruct the bladder outlet in boys, causing kidney damage that can begin before birth. Early bladder drainage, confirmation and endoscopic ablation, with long-term monitoring of kidney and bladder function, are needed.
Why not the others? Delay worsens kidney damage.
References
A newborn girl has no visible anus. A small opening is seen in the vestibule passing meconium. What is the management?
- Discharge and review at 1 year
- Close the fistula immediately
- Anorectal malformation (vestibular fistula); screen for associated (VACTERL) anomalies and plan definitive repair (posterior sagittal anorectoplasty), with or without a colostomy first
- No investigation needed
- Daily dilatation forever
Show the answer and explanation
Answer: C. Anorectal malformation (vestibular fistula); screen for associated (VACTERL) anomalies and plan definitive repair (posterior sagittal anorectoplasty), with or without a colostomy first. Anorectal malformations are associated with cardiac, renal, spinal and limb anomalies, so these are screened for. The type of malformation determines whether a colostomy is needed first. Long-term follow-up includes bowel management.
Why not the others? Missing associated anomalies, especially renal and spinal, harms long-term outcomes.
References
A 4-year-old has a painless 1.5-cm midline neck lump just below the hyoid that moves up when she sticks out her tongue. What is the diagnosis and operation?
- Lymph node; antibiotics
- Thyroglossal duct cyst; Sistrunk procedure (excision of the cyst, tract and central part of the hyoid bone)
- Branchial cyst; simple excision
- Ectopic thyroid; removal without imaging
- Dermoid cyst; observation
Show the answer and explanation
Answer: B. Thyroglossal duct cyst; Sistrunk procedure (excision of the cyst, tract and central part of the hyoid bone). A thyroglossal cyst arises from the remnant of the thyroid’s descent and moves with tongue protrusion. Removing the central hyoid with the tract (Sistrunk) reduces recurrence. Ultrasound before surgery confirms a normal thyroid gland, so the only thyroid tissue is not removed by mistake.
Why not the others? Simple cyst excision without the hyoid has high recurrence.
References
A 4-month-old baby, who cannot yet roll over, is brought in with several bruises on the face and chest. The parents give no clear explanation. What should you do?
- Reassure the parents and discharge
- Wait for a second episode
- Tell the parents to buy softer toys
- Order a coagulation screen only and discharge
- Suspect non-accidental injury: carry out a full assessment and follow local safeguarding procedures, including a skeletal survey as indicated
Show the answer and explanation
Answer: E. Suspect non-accidental injury: carry out a full assessment and follow local safeguarding procedures, including a skeletal survey as indicated. Bruising in a child who is not independently mobile is unusual and should raise concern for maltreatment. Clinicians must document carefully, follow safeguarding processes, and investigate (including blood tests to exclude a bleeding disorder, and skeletal survey where indicated).
Why not the others? Safeguarding is a duty for every clinician who sees children, including surgeons.
References
A 12-year-old girl has sudden severe right lower abdominal pain with vomiting. Ultrasound shows an enlarged right ovary with reduced flow. What is the management?
- Antibiotics
- Urgent laparoscopy and detorsion, preserving the ovary even if it looks dark
- Discharge with analgesia
- Oophorectomy whenever the ovary looks dusky
- Observation for 48 hours
Show the answer and explanation
Answer: B. Urgent laparoscopy and detorsion, preserving the ovary even if it looks dark. Ovarian torsion in children and adolescents needs urgent surgery. Detorsion with ovarian preservation is recommended even if the ovary looks black, because most recover function. Doppler flow may appear normal in torsion, so clinical suspicion matters.
Why not the others? Removing a dusky ovary sacrifices fertility potential unnecessarily.
References
A 3-year-old has scald burns of 12% of body surface area. Which statement about fluid resuscitation is correct?
- Use adult volumes without adjustment
- Give 4 litres in the first hour
- Children with burns over about 10% need intravenous resuscitation fluid plus maintenance fluid containing glucose, titrated to urine output (about 1 mL/kg/h)
- Oral fluids alone are always enough
- Fluid is given only if the child is hypotensive
Show the answer and explanation
Answer: C. Children with burns over about 10% need intravenous resuscitation fluid plus maintenance fluid containing glucose, titrated to urine output (about 1 mL/kg/h). Children have greater body surface area relative to weight and less glycogen, so the threshold for IV fluids is lower (about 10% body surface area) and maintenance fluids with glucose are added. The target urine output is higher than in adults.
Why not the others? Hypotension is a late sign in children.
References
A 5-year-old boy’s left testis is in the groin when he is cold but can be brought fully into the scrotum, where it stays when released. What is the management?
- Immediate orchidopexy
- Hormone injections
- Retractile testis: no surgery, but annual review because a minority ascend later
- Ultrasound every month
- Orchidectomy
Show the answer and explanation
Answer: C. Retractile testis: no surgery, but annual review because a minority ascend later. A retractile testis can be brought down and stays in the scrotum, so it is not undescended. It does not need surgery, but some ascend to become truly undescended (“ascending testis”), so follow-up is advised.
Why not the others? A testis that springs back immediately after release is undescended.
References
A child with known Hirschsprung’s disease awaiting surgery has fever, abdominal distension and foul-smelling explosive diarrhoea. What is the likely diagnosis and treatment?
- Appendicitis; appendicectomy
- Viral gastroenteritis; oral fluids
- Hirschsprung-associated enterocolitis; resuscitation, rectal washouts, and antibiotics including metronidazole
- Lactose intolerance; change diet
- Constipation; laxatives
Show the answer and explanation
Answer: C. Hirschsprung-associated enterocolitis; resuscitation, rectal washouts, and antibiotics including metronidazole. Enterocolitis is the leading cause of death in Hirschsprung’s disease and can occur before or after surgery. It is treated with fluids, decompression by rectal washouts and antibiotics. Recurrent episodes need assessment for obstruction.
Why not the others? Antidiarrhoeal drugs are dangerous here.
References
A 2-year-old has an irregular abdominal mass that crosses the midline, with bruising around the eyes, irritability and weight loss. What test helps diagnosis?
- Serum amylase
- Stool culture
- Thyroid function
- Urinary catecholamine metabolites (VMA and HVA), with imaging and biopsy, for suspected neuroblastoma
- Sweat test
Show the answer and explanation
Answer: D. Urinary catecholamine metabolites (VMA and HVA), with imaging and biopsy, for suspected neuroblastoma. Neuroblastoma arises from neural crest cells, often in the adrenal gland. It is irregular, crosses the midline, often calcifies, and can spread to bone and the orbits (causing “raccoon eyes”). Raised urinary catecholamine metabolites support the diagnosis.
Why not the others? Wilms tumour is usually smooth and does not cross the midline.
References
A stable 8-year-old has a grade III splenic injury after a fall from a bicycle. What is the management?
- Laparotomy and splenorrhaphy
- Non-operative management with observation; children have very high success rates, and activity is restricted for several weeks
- Splenectomy
- Discharge home immediately
- Angioembolisation for every child
Show the answer and explanation
Answer: B. Non-operative management with observation; children have very high success rates, and activity is restricted for several weeks. Non-operative management of solid organ injuries in haemodynamically stable children succeeds in over 90% of cases. Guidelines (APSA) use clinical status, not CT grade alone, to guide length of stay and activity restriction. Preserving the spleen avoids lifelong infection risk.
Why not the others? Blood transfusion needs and instability, not CT grade, drive the decision to operate.
References
A 6-year-old has chronic constipation with soiling of the underwear. Examination shows a palpable faecal mass, and there are no red flags. What is the first-line treatment?
- Loperamide for the soiling
- Disimpaction with an oral polyethylene glycol (macrogol) regimen, then maintenance laxatives with toileting routine and diet advice
- Stop all fluids
- Surgical manual evacuation as first-line
- Rectal biopsy for every child
Show the answer and explanation
Answer: B. Disimpaction with an oral polyethylene glycol (macrogol) regimen, then maintenance laxatives with toileting routine and diet advice. Soiling in a constipated child is usually overflow around impacted stool. Oral macrogol disimpaction followed by maintenance treatment for months, with behavioural measures, works for most children. Red flags (onset from birth, delayed meconium, abnormal neurology) prompt further tests.
Why not the others? Loperamide would worsen the constipation.
References
A 3-year-old swallowed several small magnets from a toy 3 hours ago. X-ray shows them in the stomach. What is the management?
- Laxatives
- Wait for them to pass
- Repeat X-ray in 2 weeks
- Urgent endoscopic removal while they are still within reach, because multiple magnets can attract across bowel walls and cause perforation or fistula
- Induce vomiting
Show the answer and explanation
Answer: D. Urgent endoscopic removal while they are still within reach, because multiple magnets can attract across bowel walls and cause perforation or fistula. Multiple magnets (or a magnet with another metal object) can attract each other through loops of bowel, causing pressure necrosis, perforation and fistulas. They should be removed urgently if within endoscopic reach; if they have passed beyond, close monitoring and surgery may be needed.
Why not the others? Single coins can pass, but multiple magnets are dangerous.
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