CME Pretest PEDIATRIC SURGERY VOLUME

Transcription

1 CME Pretest PEDIATRIC SURGERY VOLUME A pretest is mandatory to earn CME credit on the posttest. The pretest should be completed BEFORE reading the overview. Both tests must be completed online. Print subscribers: To login to the test site, click on CME Test Login from the left-side navigation at srgs. SRGS Connect (online) subscribers can login to the CME test site seamless from the Test Your Knowledge tab after logging in to SRGS Connect. For further information, go to 1. Which of the following drugs has been associated with accelerated neuronal apoptosis? a) Ethyl ether b) Rocuronium c) Midazolam d) Ketamine e) Propofol 2. Congenital diaphragmatic hernia is usually diagnosed by? a) Physical examination b) Prenatal ultrasound c) Amniotic fluid sampling d) Magnetic resonance imaging during the second trimester of pregnancy e) Chest radiograph immediately after birth 3. All of the following statements about patients with congenital diaphragmatic hernia are true except which one? 4. All of the following statements regarding patients with congenital diaphragmatic hernia are true except which one? a) 1% of patients have associated gastroesophageal reflux b) 18% of patients are treated with extracorporeal membrane oxygenation c) Overall mortality is 10.4% d) Median hospital charges are more than $115,000 e) 70% of patients are diagnosed with respiratory distress 5. Which of the following ventilator strategies has led to improved outcomes in patients with congenital diaphragmatic hernia? a) Tidal volumes of ml/kg b) FiO2 of 1 c) Mean airway pressure of 28 cm H2O d) Permissive hypercapnia e) Respiratory rates of 6 8 breaths/minute a) Evidence of herniation of the liver into the right thorax is predictive of poor outcomes b) Defects that can be closed primarily are associated with survival rates of 95% c) Diaphragmatic agennesis is associated with survival rates of 57% d) Herniation of the colon into the left chest has a lung protective effect e) Compression of the lung is the process leading to respiratory distress in patients with congenital diaphragmatic hernia iv American College of Surgeons SRGS Vol

2 Pretest PEDIATRIC SURGERY 6. A neonate weighing 900 gm is on ventilator support. Enteral nutrition has not been tolerated. The patient has abdominal distention and pneumoperitoneum on abdominal radiographs. Which of the following statements is true about this patient? a) Placement of an abdominal drain is associated with a survival rate of 60% b) Abdominal drainage and early salvage laparotomy is the best approach for this patient c) Nasogastric suction and total parenteral nutrition will lead to resolution of the pneumoperitoneum d) When draining the peritoneal cavity, two drains are required e) Survival rates are equivalent for drainage and laparotomy, with intestinal resection as needed 7. Which of the following is associated with improved outcomes for extracorporeal membrane oxygenation in patients with congenital diaphragmatic hernia? a) Caesarian section delivery at weeks of gestation b) Birth weight < 1200 gm c) Associated atrial septal defect d) Primary repair of diaphragmatic defect e) Extracorporeal membrane oxygenator support for more than 5 weeks 8. Which of the following is the correct criterion for ultrasound diagnosis of hypertrophic pyloric stenosis? a) Pyloric muscle thickness of 1.8 mm b) Pyloric muscle thickness of < 3 mm c) Pyloric muscle thickness of 0.6 mm d) Pyloric muscle thickness of 1 mm e) Pyloric muscle thickness of > 3.5 mm 9. Which of the following statements is true about radiation exposure from computerized tomography scans? a) Higher image quality is associated with lower radiation doses b) Faster imaging speed is associated with higher radiation doses c) Computerized tomography manufacturers market equipment based on the lowest possible radiation dose d) Marketing of computerized tomography equipment has no effect on choice of imaging modality for diagnosis of surgical disease in children e) Well-recognized and broadly accepted evidencebased guidelines are available to determine the appropriate imaging approach for children with surgical diseases 10. At what point during gestation does final gonadal descent occur? a) weeks b) weeks c) weeks d) 4 6 weeks e) weeks 11. All of the following statements about inguinal hernia in children are true except which one? a) The incidence of inguinal hernia ranges from 0.8% 4.4% b) Boys are more commonly diagnosed with inguinal hernia than girls c) Gonadal descent is the developmental event most commonly associated with inguinal hernia d) Prematurity is a risk factor for inguinal hernia e) Weakness of the inguinal floor is required for hernia development in children 12. Complications of inguinal hernia repair with high ligation of the hernia sac in the child include all but which one of the following? a) Latrogenic cryptorchidism b) Recurrent hernia c) Testicular atrophy d) Subsequent direct hernia due to inguinal floor injury e) Femoral nerve injury American College of Surgeons SRGS Vol v

3 Pretest PEDIATRIC SURGERY 13. A one-year-old patient with a right inguinal hernia undergoes unilateral groin exploration with high ligation of the hernia sac. Laparoscopic examination of the opposite inguinal area discloses a patent processus vaginalis. The surgeon decides not to explore the left groin. The risk of hernia incarceration and/or strangulation over the next five years is? a) 2% b) 33% c) 70% d) 25% e) 12% 14. Which of the following factors predicts failure of hydrostatic reduction of an ileocolic intussusception in a four-year-old child? a) History of premature birth b) History of nausea and vomiting c) History of prior inguinal hernia repair d) Lead point of the intussusception beyond the splenic flexure e) History of a prior attempt at hydrostatic reduction 15. All of the following are true of patients with total colonic aganglionosis except which one? a) Neonatal enterocolitis is a common presenting symptom b) Severe constipation is the third most common presenting symptom c) The terminal ileum is rarely aganglionic d) After resection of the colon and ileoanal anastomosis, 50% of patients will have persistent problems with continence e) Less than 10% of patients will opt for a diverting stoma because of incontinence 16. First branchial cleft anomalies are anatomically associated with which of the following structures? a) Parotid gland and facial nerve b) Trigeminal nerve c) Supratonsillar fossa d) Hyoid bone e) Carotid artery 17. The distal extent of the thyroglossal duct is? a) The sternal notch b) The thoracic duct c) The hyoid bone d) The foramen cecum e) The pyramidal lobe of the thyroid 18. Microorganisms causing enlarged cervical lymph nodes include all of the following except which one? a) S. pyogenes b) Y. pestis c) M. tuberculosis d) S. aureus e) Y. enterocolitica 19. Risk factors for failure of chest tube drainage for parapneumonic effusion include which of the following? a) Viral etiology of the pneumonia b) Presence of effusion for more than 7 days c) Age < 1 year d) Male gender e) History of hemoptysis 20. An 11-year-old boy is injured in a bicycle crash and there is evidence of handlebar impact in the mid-upper abdomen. The patient is stable in the emergency department and has localized epigastric tenderness. Computerized tomographic imaging of the abdomen shows fluid and edema in the area of the distal third of the pancreas. All of the following statements regarding management of this patient are true except which one? a) Endoscopic retrograde pancreatography will accurately show ductal injury b) For grade IV pancreatic injury, operation and distal pancreatectomy are associated with excellent results c) Post-injury fluid collections can usually be managed with percutaneous drainage d) Nonoperative management will fail in 3% 4% of patients such as this one e) Pancreas injuries are seen in < 10% of pediatric blunt abdominal trauma patients 2014 American College of Surgeons vi American College of Surgeons SRGS Vol

4 CME Posttest PEDIATRIC SURGERY VOLUME The posttest should be completed AFTER taking the pretest and reading the overview. Both tests must be completed online. Print subscribers: To login to the test site, click on CME Test Login from the left-side navigation at SRGS Connect (online) subscribers can login to the CME test site seamless from the Test Your Knowledge tab after logging in to SRGS Connect. For further information, go to 1. Data cited in the reviewed article by Reddy confirm which of the following statements about neuronal development? a) Neuronal development is complete by the end of the first trimester of pregnancy b) Enhanced neuronal apoptosis is common even in normally developing fetuses c) Neuronal development continues into the neonatal period d) Neuronal development abnormalities involve only the spinal cord e) Neuronal development is completed earlier in female fetuses compared with male fetuses 2. Neuronal development is stimulated by which of the following? a) Extracellular fluid ph < 7.0 b) Tumor necrosis factor c) Feedback from synaptic connections d) Maternal estradiol e) Amniotic fluid alpha fetal protein 3. All of the following are factors associated with successful use of extracorporeal membrane oxygenator (ECMO) support for patients with congenital diaphragmatic hernia except which one? a) Higher birth weight b) Small diaphragmatic defect c) Shorter intervals of ECMO support d) Maternal age < 35 years e) Absence of cardiac anomalies 4. According to data presented by Kays and coauthors, long-term survival of patients with congenital diaphragmatic hernia treated with surgical repair and ECMO support is which of the following? a) 22% b) 9% c) 90% d) 45% e) 77% 5. Which of the following statements concerning gastroschisis is true? a) The hernia usually occurs to the right of the umbilicus b) The hernia is more common in children of Asian descent c) Maternal age < 25 years is a risk factor for gastroschisis d) A thick membrane covers the herniated abdominal contents e) Surgical repair is usually not required for gastroschisis 6. Clinical characteristics of pyloric atresia include all of the following except which one? a) Non-bilious emesis b) Single bubble sign on abdominal radiographs c) Lethal-associated anomalies are common d) Females are affected more commonly than males e) Pyloroplasty is an effective surgical approach 70 American College of Surgeons SRGS Vol

5 Posttest PEDIATRIC SURGERY 7. Elements of the Ladd procedure for correction of intestinal malrotation include all of the following except which one? a) Counterclockwise detorsion of the bowel b) Tube gastrostomy c) Appendectomy d) Division of Ladd s bands e) Placement of the colon on the left side of the peritoneal cavity 8. A nine-year-old female is diagnosed with Graves disease. On examination, the thyroid gland is twice normal size. Thyroidectomy is the preferred approach for this patient because: a) The cosmetic outcome is better than nonoperative therapy b) The disease can be adequately treated with hemithyroidectomy c) The long-term risks of radioactive iodine therapy are highest in this type of patient d) There is lower risk of postoperative hyperparathyroidism in patients with Graves disease who are treated surgically e) There is no risk of recurrent laryngeal nerve injury in children < 12 years of age 9. The most common location of neuroblastoma is which of the following? a) Middle mediastinum b) Left hemithorax c) Lower extremity d) Adrenal gland e) Retrorectal space 10. Which of the following sarcomas is the most common sarcoma of the head and neck in children? a) Osteosarcoma b) Fibrosarcoma c) Kaposi sarcoma d) Rhabdomyosarcoma e) Liposarcoma 11. Data reported by Pearce and coauthors document an increased risk of brain tumor in children undergoing what number of head CT examinations? a) 1 head CT examination b) 2 3 head CT examinations c) 5 7 head CT examinations d) 8 10 head CT examinations e) No increased risk was identified 12. For patients with cystic fibrosis who enter a conventional CT imaging protocol before age 6, the cumulative risk of developing radiation-induced cancer by age 65 is which of the following? a) 0.2% b) 1% c) 3.5% d) 13% e) 20% 13. According to data presented by Wang, the incidence of inguinal hernia in preterm infants is which of the following? a) 2% b) 7% c) 50% d) 18% e) 33% 14. Involution of the processus vaginalis is mediated by signaling from which of the following nerves? a) Femoral nerve b) Genitofemoral nerve c) Obturator nerve d) Lumbar sympathetic nerve e) Lateral femoral cutaneous nerve American College of Surgeons SRGS Vol

6 Posttest PEDIATRIC SURGERY 15. Which of the following is required before scheduling an eight-year-old boy for elective inguinal hernia repair? a) Observation of a bulge in the groin b) Palpation of a patent processus vaginalis c) Ultrasound evidence of patent processus vaginalis d) History of premature birth e) Family history of inguinal hernia 16. The reported recurrence rate for inguinal hernia treated in a five-year-old boy by high ligation of the hernia sac is? a) 5.5% b) 10% c) 2.4% d) 15% e) 0% 17. Which of the following is one of the most common surgical problems of the head and neck in children? a) Cystic hygroma b) Thyroglossal duct cyst c) Metastatic adenocarcinoma d) Thyroid nodule e) Kaposi sarcoma of the parotid gland 18. Branchial cleft anomalies present at the border of which of the following structures? a) Thyroid gland b) Sternomastoid muscle c) Omohyoid muscle d) Hyoid bone e) Inferior mandible 19. Which of the following is a common condition accompanying esophageal atresia? a) Hypothyroidism b) Cystic hygroma c) Chylothorax d) Hirschsprung s disease e) Gastroesophageal reflux 20. Moderately strong evidence supports the use of which of the following as the first-line treatment for documented empyema in children? a) Needle thoracostomy b) Chest tube drainage c) Injection of tissue plasminogen activator d) Open thoracotomy and pleurectomy e) Long-term antibiotic therapy The following four questions are required by the American College of Surgeons for accreditation purposes. You must complete these four questions before submitting your answers. 21. This issue met the stated learning objectives. a) Strongly agree b) Agree c) Neutral d) Disagree e) Strongly disagree 22. The content was relevant to my educational needs and practice environment. a) Strongly agree b) Agree c) Neutral d) Disagree e) Strongly disagree 72 American College of Surgeons SRGS Vol

7 Posttest PEDIATRIC SURGERY 23. There are potential barriers to incorporating what I have learned from this issue into my practice. a) Strongly agree b) Agree c) Neutral d) Disagree e) Strongly disagree 24. The content was fair, objective, and unbiased. a) Strongly agree b) Agree c) Neutral d) Disagree e) Strongly disagree 2014 American College of Surgeons American College of Surgeons SRGS Vol

8 Purchase a previously published issue Back issues of SRGS, published in 2013, 2012, and 2011, are available for sale at a discount to current subscribers. For pricing and an order form: topic list is available: Send us comments and suggestions For answers to frequently asked questions: For editorial questions or concerns: Lewis Flint, MD, FACS, Editor-in-Chief Phone: lflint@facs.org For questions about CME credit: Lynanne Feilen, Managing Editor Phone: lfeilen@facs.org For questions about login, subscriptions, renewal, or to place an order: Aleisha Gardner, Project Assistant Phone: agardner@facs.org Manage your subscriptions If you are an ACS member, go to the My Page tab in the ACS Web Portal at to manage your SRGS subscription. Check SRGS CME credit earned (My CME) Update your address (My Profile) Change your address (this change will affect your official ACS record) (My Profile) 74 American College of Surgeons SRGS Vol