1. Surgical repair for congenital inguinal hernias in 2.

Inguinal Hernia once diagnosed in children is

children is indicated for surgical repair
A. Mesh a. False b. True
B. Marcy
C. McVay Answer: b. True
D. Bassini Rationale: The presence of an inguinal hernia in a
child is an indication for surgical repair.
Answer: B. Marcy Source: Schwartz 11th Ed p. 1743
Rationale:
" The repair of a pediatric inguinal hernia can be 3. Incidence of omphalocele associated with
extremely challenging, particularly in the premature child prematurity is
with incarceration. A small incision is made in a skin

23
a. A 20%-40%
crease in the groin directly over the internal inguinal ring. b. A 60%-70%
Scarpa’s fascia is seen and divided. The external
c. A 20%
oblique muscle is dissected free from overlying tissue,
d. A 10%-50%
and the location of the external ring is confirmed. The
external oblique aponeurosis is then opened along the
direction of the external oblique fibers over the inguinal Answer: d. A 10%-50%
canal. The undersurface of the external oblique is then
cleared from surrounding tissue. The cremasteric fibers
are separated from the cord structures and hernia sac,
and these are then elevated into the wound. Care is
taken not to grasp the vas deferens. The hernia sac is
then dissected up to the internal ring and doubly suture
20 Rationale: Omphalocele is associated with
prematurity (10–50% of cases) and intrauterine
growth restriction (20% of cases).
Source: Schwartz. Chap 39: p.1741

4. Which of the following is not true for inguinal

ligated. The distal part of the hernia sac is opened widely
hernia in children?
to drain any hydrocele fluid. When the hernia is very
A. Infant high risk to incarceration
H
large and the patient very small, tightening of the internal
inguinal ring or even formal repair of the inguinal floor B. More common in the right
may be necessary, although the vast majority of children C. More common in male
do not require any treatment beyond high ligation of the D. None of the above
TC

hernia sac."
"Mesh is not used to repair hernias in younger children, Answer: D. None of the above
but can be necessary to repair muscle weakness in Rationale: Inguinal hernias occur more commonly
teens who undergo strenuous activity." in males than females (10:1) and are more
"Modified Marcy hernia repair is a safe and effective common on the right side than the left. Infants are
procedure for inguinal hernia in children with excellent
at high risk for incarceration of an inguinal hernia
outcomes and a low incidence of recurrence."
because of the narrow inguinal ring.
"Group 1 hernia repairs (Bassini, McVay and Shouldice
BA

techniques) involve opening the external oblique
aponeurosis and freeing the spermatic cord. The
transversalis fascia is then opened, facilitating inspection
of the inguinal canal, the indirect space and the direct
space. The hernia sac is usually ligated, and the canal
floor is subsequently reconstructed
The techniques in the open anterior repair group differ
somewhat in their approach to reconstruction, but they
all use permanent sutures to approximate the
surrounding fascia and repair the floor of the inguinal
canal. When performed by skilled surgeons, these
repairs provide reliable, satisfactory results and have
similar recurrence rates. With very large defects or with
fascia of marginal quality, the tension of the sutures can
lead to recurrence.
The techniques in group 1 are all well suited to the use
of local anesthesia."
Reference: Schwartz Chapter 39: Pediatric Srugery
page 1744;
Source: Schwartz’s 11th edition. Ch 39, p. 1743
5. A male infant with prune-belly syndrome will
display all of the following abnormalities except
a. Dilatation of the urinary bladder
b. Dilatation of the ureters
c. Malformed renal parenchyma
d. Bilateral intraabdominal testes
Answer: C. Malformed renal parenchyma
Ratio: Despite the marked dilatation of the urinary
tract, most children with prune-belly syndrome have
adequate renal parenchyma for growth and
development.
Source: schwartz 10th ed page 1634
6. Surgical closure for gastroschisis can usually be
done within approximately how many weeks?
A. 1-2 weeks B. 2-3 weeks
C. 4-5 weeks D. 3-4 weeks
Answer: A. 1-2 weeks
Rationale: “Gastroschisis Treatment: (...) Surgical
closure can usually be accomplished within
approximately 1 to 2 weeks.”
Reference: Schwartz 11th ed, page 1742
7. Early sign of patent urachus is
A. Inflammatory mass inferior to the umbilicus
B. Tenderness around the umbilicus
C. Recurrent UTI
D. Persistent draining umbilicus
Answer: D. Persistent draining umbilicus
Rationale: The first sign of a patent urachus is
moisture or urine flow from the umbilicus. In the
child with a persistently draining umbilicus, a
diagnosis of patent urachus should be considered
Source: Schwartz’s Principles of Surgery 10th Ed.,
Chapter 39: Pediatric Surgery, page 1740
8. Type of hernia common children is
a. Indirect inguinal
b. Umbilical
H
c. Femoral
d. Direct inguinal
Answer: A. Indirect Inguinal Hernia
TC
Ratio: Using the classification system that is
typically applied to adult hernias, all congenital
hernias in children are by definition indirect inguinal
hernias. Children also present with direct inguinal
and femoral hernias, although these are much less
common.
BA
Source: Schwartz 10th ed., page 1634
9. Newborn with gastroschisis is at increased risk of
a. Exstrophy of the cloaca
b. Macroglossia
c. Hepatomegaly
d. Intestinal atresia
Answer: D. Intestinal atresia
Rationale: Associated anomalies not usually seen
except 10% intestinal atresia
Source: Dr. MAS’ ppt on Gastroschisis, slide 15
10. Prune-belly syndrome occurs almost
exclusively in males
A. False B. True
Answer: B. True
Rationale: Prune-belly syndrome is also known as
Eagle-Barrett syndrome and the triad syndrome,
because of the three major manifestations. The
incidence is significantly higher in males.
Source: Schwartz’s Principles of Surgery. 10th ed.
Chapter 39: Pediatric Surgery; Deformities of the
Abdominal Wall; Prune-Belly Syndrome page 1634
11. Recurrence rate of hernia repair in children
a. A 2% b. A 1%
c. A <1% d. A 3%
23
Answer: c. A <1%
Rationale: Inguinal hernias in children recur in less
than 1% of patients, and recurrences usually result
from missed hernia sacs at the first procedure, a
direct hernia, or a missed femoral hernia.
20
Source: Schwartz Principles of Surgery, Chapter 39
Pediatric Surgery, Inguinal Hernia, Surgical Repair,
p.1635
12. The treatment of umbilical hernia for
asymptomatic child is governed by the following,
EXCEPT:
a. Cosmetic appearance
b. Size of the defect
c. Duration of the condition
d. Age of the patient
answer: Duration
rationale:Treatment for child that is asymptomatic
governed by:
a. Size of the defect
b. Age of the patient
c. The concerns regarding the cosmetic
appearance of the abdomen
Delay surgical correction until 5 years of age
Repair of umcomplicated umbilical hernia is
performed under general anesthesia as an
outpatient procedure
Source: Dr. Singco. [ppt] Gastroschisis.slide 6
13. PROOFREADER
The abdominal wall is formed by four separate
embryologic folds, EXCEPT
A. Caudal
B. Right lateral folds
C. Left lateral folds
D. Cephalic
Answer: No answer, since all choices are the four
embryologic folds of the abdominal wall.
Rationale:
The abdominal wall is formed by four separate
embryologic folds: cephalic, caudal, right, and left
lateral folds.
Source: Schwartz’s Principles of Surgery 11th ed.,
Chapter 39 (Pediatric Surgery), page 1740.
14. Which of the following is not typically
associated with prune belly syndrome?
A. Dilated ureters
B. Lax abdominal wall
C. Bilateral undescended testes
D. Respiratory insufficiency
Answer: D. Respiratory insufficiency
Rationale: Prune-belly syndrome refers to a
disorder that is characterized by extremely lax
lower abdominal musculature, dilated urinary tract
including the bladder, and bilateral undescended
testes. The major genitourinary manifestation in
prune-belly syndrome is ureteral dilation.
Source: Schwartz’s 11th edition. Ch 39, p. 1743
2017. The following are the major manifestation of
15. Which of the following is NOT part of
Beckwith-Wiedemann constellation of anomalies?
a. Hyperglycemia
H
b. Macrosomia
c. Macroglossia
d. Omphalocele
TC
Answer: A. hyperglycemia
Ratio: Omphalocele occurs in association with
special syndromes such as exstrophy of the cloaca
(vesicointestinal fissure), the
Beckwith-Wiedemann constellation of anomalies
(macroglossia, macrosomia, hypoglycemia, and
BA
visceromegaly and omphalocele), and Cantrell’s
pentalogy (lower thoracic wall malformations [cleft
sternum], ectopia cordis, epigastric omphalocele,
anterior midline diaphragmatic hernia, and cardiac
anomalies).
Source: Omphalocele occurs in association with
special syndromes such as exstrophy of the cloaca
(vesicointestinal fissure), the Beckwith-Wiedemann
constellation of anomalies (macroglossia,
macrosomia, hypoglycemia, and visceromegaly
and omphalocele), and Cantrell’s pentalogy (lower
thoracic wall malformations [cleft sternum], ectopia
cordis, epigastric omphalocele, anterior midline
diaphragmatic hernia, and cardiac anomalies).
Source: schwartz 10th ed page 1632
16. Interruption of the central migration of the
lateral fold results abdominal wall defect is:
A. Omphalocele
B. Gastroschisis
C. Exstrophy of the cloaca
D. Internal atresia
Answer: A. Omphalocele
Rationale: “Failure of the cephalic fold to close
results in sternal defects such as congenital
absence of the sternum. Failure of the caudal fold
to close results in exstrophy of the bladder and, in
more extreme cases, exstrophy of the cloaca.
Interruption of central migration of the lateral folds
23
results in omphalocele. Gastroschisis, originally
thought to be a variant of omphalocele, possibly
results from a fetal accident in the form of
intrauterine rupture of a hernia of the umbilical cord,
although other hypotheses have been advanced.”
Reference: Schwartz’s 10th ed., 1631.
Eagle-Barrett syndrome, except
a. Dysplasia of the hip
b. Pulmonary hypoplasia
c. Intestinal atresia
d. Pectus excavatum
Answer: c. Intestinal atresia
Rationale: Prune-belly syndrome (Eagle-Barrett
syndrom) refers to a dis- order that is characterized
by extremely lax lower abdominal musculature,
dilated urinary tract including the bladder, and
bilateral undescended testes.
● Incidence more higher in males
● MOst significant: Pulmonary hypoplasia
● Skeletal abnormalities: Skeletal abnormalities
include dislocation or dysplasia of the hip and
pectus excavatum.
● Major genitourinary manifestation: ureteral
dilation. The ureters are typically long and
tortuous and become more dilated distally.
Source: Schwartz’s 10th Ed., Ch 39:page 1634
18. Chromosomal anomalies are more common in
children with bigger defects in omphalocele
Answer: False
Rationale: Chromosomal anomalies seen more in
children with smaller defects
Source: Gastroschisis wrap up, Slide 12
19. In children, hernias are most common
a. In boys, on the right side
b. In girls, on the right side
c. In girls, on the left side
d. In boys, on the left side

Answer: A. In boys, on the right side
Rationale: Inguinal hernias occur more commonly
in males than females (10:1) and are more
common on the right side than the left.
Source: Schwartz 11th Ed Chap 39 p. 1743
20. The abdominal wall defect results the failure of
the caudal fold to close is called
A. Exstrophy of the cloaca
B. Omphalocele
ans: Umbilical hernia
Ratio: "Umbilical hernias are generally asymtomatic
protrusions of the abdominal wall. They are
generally noted by parents or physicians shortly
after birth." (pg. 1740)
Source: Schwartz 10th ed. Chapter 39 Pediatric
Surgery. Subhead: Deformities of the Abdominal
Wall. page 1740
24. Which of the following is not part of
Beckwith-Weidemann constellation of anomalies?

23
C. Gastroschisis A. Hyperglycemia
D. Absence of the sternum B. Macrosomia
C. Macroglossia
Answer: A. Exstrophy of the cloaca D. Omphalocele
Rationale: Failure of the caudal fold to close results
in exstrophy of the bladder and, in more extreme Answer: A. Hyperglycemia
cases, exstrophy of the cloaca.
Source: Schwartz’s Principles of Surgery. 11th ed.
Chapter 39 Pediatric Surgery. Page 1740

21. ​Which of the following is NOT part of Cantrell’s

20
Rationale: Beckwith-Wiedemann constellation of
anomalies
hypoglycemia,
omphalocele)
(macroglossia,
and
macrosomia,
visceromegaly and

Source: Schwartz’s 11th edition. Chapter 39, p.

pentalogy? 1741
A. Omphalocele
B. Cardiac abnormalities 25. The defect that results the failure of the
H
C. Posterolateral diaphragmatic hernia cephalic fold to close is
D. Ectopia cordis a. Sternal defect
b. Omphalocele
Answer: C. Posterolateral diaphragmatic hernia c. Exstrophy of the cloaca
TC

Rationale: Cantrell’s Pentalogy (lower thoracic wall d. Gastroschisis

malformations [cleft sternum], ectopia cordis,
epigastric omphalocele, anterior midline Answer: A. sternal defect
diaphragmatic hernia and cardiac anomalies). Ratio: Failure of the cephalic fold to close results
Source: Schwartz 11th ed. Page 1741 in sternal defects such as congenital absence of
the sternum. Failure of the caudal fold to close
BA

22. The defect in Gastroschisis is usually
A Through the umbilicus
B To the right of the umbilicus
C Superior to the umbilicus
D To the left of the umbilicus
Ans: B To the right of the umbilicus
Ratio: The abdominal wall defect is located at the
junction of the umbilicus and normal skin and is
almost always to the right of the umbilicus
Ref: Schwartz 10th, page 1633. Gastroschisis
results in exstrophy of the bladder and, in more
extreme cases, exstrophy of the cloaca.
Interruption of central migration of the lateral folds
results in omphalocele. Gastroschisis, originally
thought to be a variant of omphalocele, possibly
results from a fetal accident in the form of
intrauterine rupture of a hernia of the umbilical cord,
although other hypotheses have been advanced.
Source: schwartz 10th ed page 1631

23. Generally asymptomatic protrusions of the

abdominal wall called
a. Omphalocele
b. Umbilical hernia
c. Inguinal hernia
d. Patent urachus