TOPIC№2: Congenital anomalies of front abdominal wall. Hernia. Cryptorchidism.

Variant№8
1.An exomphalos is:
A. A strangulated umbilical hernia
B. Synonymous with an omphalocele
C. A strangulated femoral hernia
D. A strangulated inguinal hernia
E. A sliding hernia

2.A patent processus vaginalis can lead to all of the following, except:
A. Funiculocele
B. Omphalocele
C. Bubonocele
D. Scrotal hernia
E. Hydrocele

3.The earliest way to diagnose an anterior abdominal wall defect is:

A. by physical exam
B. by history
C. by fetal ultrasound
D. by fetal CT scan
E. None of the above

4.The following are correct regarding omphaloceles except:

A. is usually covered by a translucent membrane
B. is frequently associated with other congenital malformations
C. is lateral to the umbilical stump
D. is within the umbilical ring
E. It is a congenital disease

5.The following are true about gastroschisis:

A. occurs lateral to the umbilical stump
B. can be diagnosed antenatally
C. at birth often have edematous matted intestinal loops
D. all of the above
E. none of the above

6.Treatment of abdominal wall defects includes:

A. immediate surgical repair
B. pushing the intestines back into the abdominal cavity while still in the delivery room
C. provide immediate optimal resuscitation and stabilization first, and then surgery
D. always do primary closure in both lesions
E. conservative treatment only

7.Which of the following is not part of the differential diagnosis of an inguinal-scrotal swelling in children?
A. Varicocele
B. Undescended or retracted testis
C. Volvulus
D. Testicular torsion
E. Testicular cancer

8.Which of the following is not a risk factor for development of an inguinal hernia?
A. Presence of a ventriculoperitoneal shunt
B. Congenital heart disease

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 C. Prematurity
D. Cystic fibrosis
E. Family history of inguinal hernias

9.A14-year-old boy presents with sudden onset of pain and swelling of his right testicle. There was no
history of trauma, he is not sexually active, and denies any history of penile discharge. On examination, the
scrotum is swollen and tender. The cremasteric reflex is absent. A testicular flow scan shows a “cold spot”
or absent flow to the affected side. Which of the following is the most likely cause?
A. inguinal hernia
B. hydrocele
C. epididymitis
D. testicular torsion
E. torsion of the appendix testis

10.A 18-year-old previously healthy man is scheduled for elective inguinal hernia repair under general
anesthesia. After induction of anesthesia and initial inguinal incision, the patient develops tachycardia,
muscle rigidity, fever of 38.5°C, and elevated end-tidal carbon dioxide. Which of the following is the most
likely diagnosis?
A. pneumonia
B. atelectasis
C. urinary tract infection
D. myocardial infarction
E. malignant hyperthermia

11.The most common source of bacteria in wound infection after groin hernia repair is:
A. the patient’s skin
B. the patient’s nasopharynx
C. operating room air
D. surgical instruments
E. operating room staff

12.Howship-Romberg sign is characteristic of:

A. femoral hernia
B. Spigelian hernia
C. obturator hernia
D. lumbar hernia
E. epigastric hernia

13.The most common hernia in women is:

A. femoral hernia
B. obturator hernia
C. inguinal hernia
D. umbilical hernia
E. spigelian hernia

14.A pediatrician has diagnosed a newborn baby of having right-sided cryptorchidism (undescended testis).
The testis may have been trapped in any site EXCEPT:
A. At the deep inguinal ring
B. Just outside the superficial inguinal ring
C. Pelvic brim
D. Perineum
E. Somewhere in the inguinal canal

15.At what age is surgical orchiopexy recommended for a child with a unilateral undescended testis?
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 A. Promptly upon discovery, regardless of age
B. 1 year
C. 5 to 6 years
D. Any time prior to puberty
E. 6 to 7 years

16.Congenital absence of one of the testes is known as:

A. cryptorchidism
B. anorchia
C. monorchism
D. ectopia
E. dystopia

17.Cryptorchidism is most frequently found:

A. on the left side
B. bilaterally
C. on the right side
D. retroperitoneally
E. in the abdomen

18.All are possible complications of an undescended testis except:

A. malignization
B. acute scrotum
C. torsion and trauma
D. hypoplasia
E. sterility

19.Which of the following is not part of the differential diagnosis of an inguinal-scrotal swelling in children?
A. Varicocele
B. Undescended or retracted testis
C. Volvulus
D. Testicular torsion
E. Testicular cancer

20.A newborn male is brought to you in the neonatal intensive care unit (NICU). On physical examination,
you notice that the infant has deficient abdominal musculature and undescended testes. Your suspicion is
high for a certain condition. You presumptively diagnose the child with which of the following?
A. VATER association
B. Cushing’s triad
C. Potter’s syndrome
D. Jones criteria
E. Eagle-Barrett syndrome

21.Upon further imaging, what associated finding would be expected?

A. posterior urethral valves on a voiding cystourethrogram (VCUG)
B. hydrocephalus on head ultrasound
C. cardiomegaly on chest x-ray (CXR)
D. bilateral adrenal enlargement on abdominal ultrasound
E. tracheoesophageal fistula on an upper gastrointestinal (UGI) series

22.A 17 year old patient presents for the first time with a small palpable testis in the inguinal region.
Orchidectomy is performed. The histological appearances of these testis are most likely to show:
A. Germ cell hyperplasia
B. 'Sertoli cell only' appearances

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 C. Normal appearances
D. Well-differentiated seminoma
E. Ley dig cell hyperplasia
23.A three year old boy is referred with a unilateral impalpable testis. The most reliable means of
confirming the presence or absence of the testis is:
A. Abdominal ultrasonography
B. MRI
C. CT scan
D. Retrograde venography
E. Laparoscopy

24. Which of the following statements is false?

A. Each testis descends through the inguinal canal into the scrotum within the processus vaginalis.
B. A hydrocele can result from incomplete fusion of the processus vaginalis.
C. A scrotal hydrocele, or simple hydrocele, is a type of non-communicating hydrocele.
D. A communicating hydrocele can develop into an inguinal-scrotal hernia. Some use the terms
interchangeably.
E. A hernia sac can contain intestine, omentum, testis/ovary or fallopian tube.

Question:

Explain the relationship between cryptorchidism and inguinal hernias. How does the presence of an
undescended testis impact the surgical management of inguinal hernias?