COMMON NON-TRAUMATIC SURGICAL DISEASES PART 2

Question 1

What are the four embryologic folds involved in abdominal wall formation?

Answer 1

Cephalic, Caudal, Right lateral fold, Left lateral fold

Question 2

What structure surrounds the 2 umbilical arteries, 1 umbilical vein, and yolk sac during embryologic development?

Answer 2

Umbilical ring

Question 3

At what weeks of fetal development does rapid intestinal growth outside the abdominal cavity occur?

Answer 3

Between the 5th and 10th weeks

Question 4

When does the midgut return to the abdominal cavity after temporary herniation?

Answer 4

12th week of gestation

Question 5

What completes the process of abdominal wall formation?

Answer 5

Contraction of the umbilical ring

Question 6

What results from failure of the caudal fold to close?

Answer 6

Exstrophy of the bladder or cloaca

Question 7

What defect results from failure of cephalic fold closure?

Answer 7

Sternal defects such as congenital absence of the sternum

Question 8

What results from interruption of central migration of lateral folds?

Answer 8

Omphalocele

Question 9

What condition results from intrauterine rupture or hernia of the umbilical cord?

Answer 9

Gastroschisis

Question 10

How can umbilical cord hernia be distinguished from omphalocele?

Answer 10

Umbilical cord hernia is <4 cm and looks like omphalocele with a sac

Question 11

When is an umbilical hernia usually diagnosed?

Answer 11

After desiccation of the umbilical cord

Question 12

What covers an umbilical hernia?

Answer 12

Normal skin covering the defect

Question 13

What is the primary cause of umbilical hernia?

Answer 13

Failure of the umbilical ring to close

Question 14

At what size do umbilical hernias usually close spontaneously?

Answer 14

<1 cm

Question 15

By what age do small umbilical hernias typically close spontaneously?

Answer 15

4 to 5 years

Question 16

What are signs of umbilical hernia incarceration that require immediate exploration?

Answer 16

Abdominal pain, bilious emesis, pseudo-obstruction, tender hard mass protruding from the umbilicus

Question 17

When is surgical correction for an umbilical hernia delayed until?

Answer 17

5 years if small and likely to close spontaneously

Question 18

What is the procedure for umbilical hernia repair?

Answer 18

Small curving incision at umbilical crease, sac dissected free, fascial defect closed

Question 19

What condition can increase risk of umbilical hernia recurrence?

Answer 19

Elevated intra-abdominal pressure (e.g., ventriculoperitoneal shunt)

Question 20

What is the embryologic origin of a patent urachus?

Answer 20

Failure of urachus obliteration, maintaining connection between bladder and umbilicus

Question 21

What is the first sign of patent urachus?

Answer 21

Moisture or urine flow from the umbilicus

Question 22

What diagnosis presents with a fleshy mass in the umbilicus resolving with silver nitrate?

Answer 22

Umbilical granuloma

Question 23

What diagnostic imaging can help confirm patent urachus?

Answer 23

KUB ultrasound

Question 24

What is the definitive treatment for patent urachus?

Answer 24

Excision of urachal tract and closure of bladder with absorbable suture

Question 25

What is the risk of leaving a patent urachus untreated?

Answer 25

Development of transitional cell carcinoma

Question 26

What is the difference between patent urachus and patent omphalomesenteric duct?

Answer 26

Patent urachus connects to bladder (urine drainage), omphalomesenteric duct connects to small intestine (stool drainage)

Question 27

What covers the abdominal contents in omphalocele?

Answer 27

Peritoneum and amniotic membrane

Question 28

What is the size cutoff for omphalocele?

Answer 28

4 cm or more

Question 29

Omphalocele is associated with what syndromes?

Answer 29

Exstrophy of the cloaca, Beckwith-Wiedemann, Cantrell's Pentalogy

Question 30

What is the prognosis for small to medium omphaloceles?

Answer 30

Significantly better than giant omphaloceles

Question 31

What organ's presence in the omphalocele sac is a poor prognostic factor?

Answer 31

Liver

Question 32

What is the treatment for small to medium omphalocele?

Answer 32

Primary repair with membrane resection and fascial closure

Question 33

What treatment approach is used for giant omphaloceles with small abdominal domains?

Answer 33

Non-operative with topical treatment for sac hardening, followed by staged repair after re-epithelialization

Question 34

What abdominal wall defect features uncovered intestinal contents protruding to the right of the umbilicus?

Answer 34

Gastroschisis

Question 35

What is the usual size of the gastroschisis defect?

Answer 35

<4 cm

Question 36

What is the first-line treatment for gastroschisis?

Answer 36

Urgent surgical treatment with fluid resuscitation and primary closure if feasible

Question 37

What is the purpose of a plastic spring-loaded silo in gastroschisis?

Answer 37

Covers bowel, allows for gradual reduction into abdominal cavity

Question 38

What embryologic structure fails to close in congenital inguinal hernia?

Answer 38

Processus vaginalis

Question 39

What is the female counterpart to the processus vaginalis?

Answer 39

Canal of Nuck

Question 40

What is a communicating hydrocele?

Answer 40

Fluid accumulation in the scrotum with persistent communication to peritoneal cavity

Question 41

How are all congenital hernias classified?

Answer 41

Indirect inguinal hernias

Question 42

What side is more commonly affected in congenital inguinal hernia and why?

Answer 42

Right side; right testicle descends later than left

Question 43

What is the silk glove sign in inguinal hernia?

Answer 43

Thickened spermatic cord on affected side

Question 44

What is the difference between incarcerated and strangulated hernia?

Answer 44

Incarcerated: firm, tender bulge; Strangulated: ischemic, skin changes, edematous

Question 45

What is the treatment for all congenital inguinal hernias?

Answer 45

Surgical repair once diagnosed

Question 46

What is the recommended management for non-communicating hydrocele in infants?

Answer 46

Observe until 12 months, surgical correction if persists

Question 47

What is the surgery for inguinal hernia repair?

Answer 47

Herniotomy with high ligation of hernial sac

Question 48

What is the difference between umbilical hernia and umbilical cord hernia?

Answer 48

Umbilical hernia covered by skin, umbilical cord hernia found at birth with sac

Question 49

What causes cryptorchidism?

Answer 49

Failure of testis descent into scrotum

Question 50

What are common locations for undescended testis?

Answer 50

Retroperitoneum, internal ring, inguinal canal, external ring

Question 51

What is the incidence of undescended testes in preterm and term infants?

Answer 51

30% preterm, 1-3% term

Question 52

What exam finding may suggest undescended testis?

Answer 52

Poorly rugated or hypoplastic scrotum

Question 53

Why are undescended testes at higher risk for infertility?

Answer 53

Higher temperature impairs spermatogenesis

Question 54

At what age should undescended testes be surgically repositioned?

Answer 54

By 1 year of age

Question 55

What is the risk if undescended testes are not corrected?

Answer 55

Infertility, malignancy, torsion

Question 56

What is an ectopic testis?

Answer 56

Testis located outside scrotum after passing inguinal canal

Question 57

What hormone therapies can be used in undescended testis?

Answer 57

Chorionic gonadotropin, testosterone replacement

Question 58

What is the most common primary malignant tumor of the kidney in children?

Answer 58

Wilms' tumor

Question 59

At what age is Wilms' tumor most commonly diagnosed?

Answer 59

Between 1 and 5 years old (peak at age 3)

Question 60

What is the most common presenting sign of Wilms' tumor?

Answer 60

Asymptomatic abdominal or flank mass

Question 61

What symptom helps differentiate Wilms' tumor from neuroblastoma?

Answer 61

Hematuria

Question 62

What syndrome is associated with Wilms' tumor

Answer 62

aniridia

Question 63

What is the chromosomal abnormality associated with Wilms' tumor?

Answer 63

Deletion of WT1 and PAX6 on chromosome 11p13

Question 64

What imaging is used to characterize Wilms' tumor and check for metastases?

Answer 64

Abdominal and chest CT

Question 65

What imaging is used to check for renal vein or vena caval extension in Wilms' tumor?

Answer 65

Abdominal ultrasound

Question 66

What is the preferred initial treatment approach for Wilms' tumor in the United States?

Answer 66

Surgery followed by chemotherapy

Question 67

What is the preferred initial treatment approach for Wilms' tumor in Europe (SIOP)?

Answer 67

Preoperative chemotherapy followed by surgery

Question 68

What surgical procedure is performed for Wilms' tumor?

Answer 68

Radical nephroureterectomy

Question 69

What is the hallmark of Stage I Wilms' tumor?

Answer 69

Tumor limited to the kidney and completely excised

Question 70

What defines Stage III Wilms' tumor?

Answer 70

Residual tumor confined to the abdomen (e.g.

Question 71

What defines Stage IV Wilms' tumor?

Answer 71

Hematogenous metastases or distant lymph node involvement

Question 72

What defines Stage V Wilms' tumor?

Answer 72

Bilateral renal involvement

Question 73

What is the third most common pediatric malignancy?

Answer 73

Neuroblastoma

Question 74

What is the most common extracranial solid tumor in children?

Answer 74

Neuroblastoma

Question 75

What embryonic origin do neuroblastomas arise from?

Answer 75

Neural crest cells

Question 76

What is the most common site of origin for neuroblastomas?

Answer 76

Adrenal glands

Question 77

What is a common presenting sign of neuroblastoma?

Answer 77

Asymptomatic abdominal mass crossing the midline

Question 78

What metastatic sign is associated with neuroblastoma and causes proptosis and periorbital ecchymosis?

Answer 78

Retrobulbar metastasis

Question 79

What paraneoplastic syndrome can occur in neuroblastoma causing severe watery diarrhea?

Answer 79

Vasoactive Intestinal Peptide (VIP) secretion

Question 80

What paraneoplastic syndrome in neuroblastoma causes opsoclonus-myoclonus?

Answer 80

Cerebellar involvement

Question 81

What diagnostic test is used to detect catecholamine metabolites in neuroblastoma?

Answer 81

Urine VMA and HVA

Question 82

What is the minimum diagnostic criterion for neuroblastoma?

Answer 82

Biopsy or elevated catecholamines

Question 83

What is the goal of surgery for neuroblastoma?

Answer 83

Complete surgical resection (≥95%)

Question 84

What is Stage 4S neuroblastoma?

Answer 84

Localized tumor with metastases limited to skin

Question 85

What type of teratoma contains all 3 germ layers?

Answer 85

Mature teratoma

Question 86

What is the most common teratoma in neonates?

Answer 86

Sacroccocygeal teratoma

Question 87

At what age does sacrococcygeal teratoma risk malignant transformation?

Answer 87

After 2 months of age

Question 88

What is the most common malignant liver tumor in children?

Answer 88

Hepatoblastoma

Question 89

At what age is hepatoblastoma usually diagnosed?

Answer 89

Before age 4

Question 90

What liver tumor is associated with elevated AFP?

Answer 90

Hepatoblastoma

Question 91

What is the most common benign liver lesion in children?

Answer 91

Hemangioma

Question 92

What is the peak age range for hepatocellular carcinoma in children?

Answer 92

10-15 years

Question 93

What imaging determines resectability of pediatric liver tumors?

Answer 93

Abdominal CT scan

Question 94

What is the treatment goal for pediatric liver tumors?

Answer 94

Complete surgical resection

Question 95

When is liver transplantation indicated for pediatric liver tumors?

Answer 95

When tumors are massive or multicentric

Question 96

What defines Stage I pediatric liver cancer?

Answer 96

Completely resected tumor with no metastasis

Question 97

What defines Stage IV pediatric liver cancer?

Answer 97

Distant metastases present