Q.1 What is the most common cause of intestinal obstruction in neonates?
Duodenal atresia
Meconium ileus
Hirschsprung’s disease
Malrotation with volvulus
Explanation - Duodenal atresia is the most frequent cause of neonatal intestinal obstruction and is classically associated with the 'double bubble' sign on X-ray.
Correct answer is: Duodenal atresia
Q.2 A 2-day-old baby presents with bilious vomiting and abdominal distension. What is the most likely diagnosis?
Pyloric stenosis
Malrotation with volvulus
Duodenal ulcer
Meconium plug syndrome
Explanation - Bilious vomiting in a neonate is a surgical emergency, most commonly due to malrotation with midgut volvulus.
Correct answer is: Malrotation with volvulus
Q.3 Which congenital anomaly is most commonly associated with esophageal atresia?
Congenital diaphragmatic hernia
VACTERL association
Omphalocele
Pyloric stenosis
Explanation - Esophageal atresia is commonly part of VACTERL association (Vertebral, Anal, Cardiac, Tracheo-esophageal, Renal, Limb anomalies).
Correct answer is: VACTERL association
Q.4 What is the initial investigation of choice for suspected Hirschsprung’s disease?
CT scan
Contrast enema
Anorectal manometry
Rectal biopsy
Explanation - A contrast enema is often the first investigation, showing a transition zone; definitive diagnosis requires rectal biopsy.
Correct answer is: Contrast enema
Q.5 Which of the following is a feature of hypertrophic pyloric stenosis?
Bilious vomiting
Olive-shaped mass in the epigastrium
Abdominal distension
Bloody stools
Explanation - Hypertrophic pyloric stenosis presents with projectile non-bilious vomiting and a palpable 'olive-shaped' mass.
Correct answer is: Olive-shaped mass in the epigastrium
Q.6 What is the most common site of intussusception in children?
Jejunum
Ileocolic junction
Sigmoid colon
Rectum
Explanation - Most pediatric intussusceptions occur at the ileocolic junction, often idiopathic or secondary to lymphoid hyperplasia.
Correct answer is: Ileocolic junction
Q.7 In gastroschisis, the defect is typically located:
Left of the umbilicus
Right of the umbilicus
At the umbilical ring
In the lower abdomen
Explanation - Gastroschisis is an abdominal wall defect to the right of the umbilicus with exposed bowel loops.
Correct answer is: Right of the umbilicus
Q.8 Which neonatal condition is characterized by a 'scaphoid abdomen'?
Congenital diaphragmatic hernia
Omphalocele
Duodenal atresia
Necrotizing enterocolitis
Explanation - A scaphoid (sunken) abdomen is a classic sign of congenital diaphragmatic hernia due to bowel herniating into the chest.
Correct answer is: Congenital diaphragmatic hernia
Q.9 What is the gold standard investigation for Hirschsprung’s disease?
Ultrasound
Rectal biopsy
Contrast enema
CT scan
Explanation - Rectal biopsy showing absence of ganglion cells confirms Hirschsprung’s disease.
Correct answer is: Rectal biopsy
Q.10 The classic 'double bubble sign' on X-ray is diagnostic of:
Pyloric stenosis
Duodenal atresia
Malrotation
Necrotizing enterocolitis
Explanation - The double bubble sign on abdominal X-ray is pathognomonic of duodenal atresia.
Correct answer is: Duodenal atresia
Q.11 Which condition is most often associated with Down syndrome?
Pyloric stenosis
Duodenal atresia
Malrotation
Necrotizing enterocolitis
Explanation - Duodenal atresia has a strong association with trisomy 21 (Down syndrome).
Correct answer is: Duodenal atresia
Q.12 In a neonate with bilious vomiting, the first step in management is:
Nasogastric decompression
Immediate laparotomy
Start oral feeds
CT abdomen
Explanation - Initial management includes stabilization, NG decompression, and IV fluids before definitive surgery.
Correct answer is: Nasogastric decompression
Q.13 Necrotizing enterocolitis is most common in:
Full-term infants
Preterm infants
Adolescents
Toddlers
Explanation - NEC primarily affects premature infants due to immaturity of the gut and immune defenses.
Correct answer is: Preterm infants
Q.14 The most common solid tumor in infants is:
Neuroblastoma
Wilms tumor
Hepatoblastoma
Rhabdomyosarcoma
Explanation - Neuroblastoma is the most common solid tumor in infants and can arise from the adrenal medulla.
Correct answer is: Neuroblastoma
Q.15 Which pediatric abdominal wall defect is covered by a sac?
Gastroschisis
Omphalocele
Congenital diaphragmatic hernia
Urachal cyst
Explanation - Omphalocele is a midline defect with abdominal contents herniated into a sac covered by peritoneum and amnion.
Correct answer is: Omphalocele
Q.16 What is the most common cause of acquired intestinal obstruction in children?
Volvulus
Intussusception
Adhesions
Hernia
Explanation - Intussusception is the leading cause of acquired intestinal obstruction in children under 2 years.
Correct answer is: Intussusception
Q.17 Which imaging modality is most useful for diagnosing intussusception?
Plain X-ray
Ultrasound
CT scan
MRI
Explanation - Ultrasound shows the classic 'target sign' and is the investigation of choice.
Correct answer is: Ultrasound
Q.18 Which congenital anomaly is associated with polyhydramnios in utero?
Duodenal atresia
Pyloric stenosis
Hirschsprung’s disease
Meconium ileus
Explanation - Duodenal atresia causes impaired swallowing leading to polyhydramnios in pregnancy.
Correct answer is: Duodenal atresia
Q.19 The first-line treatment for intussusception in children is:
Surgical reduction
Air or contrast enema
IV antibiotics
Observation
Explanation - Non-surgical reduction with air or contrast enema is the initial management of intussusception.
Correct answer is: Air or contrast enema
Q.20 Congenital diaphragmatic hernia most commonly occurs through:
Foramen of Bochdalek
Foramen of Morgagni
Umbilical ring
Esophageal hiatus
Explanation - The Bochdalek hernia (posterolateral defect) is the most common type of congenital diaphragmatic hernia.
Correct answer is: Foramen of Bochdalek
Q.21 The most common cause of lower GI bleeding in infants is:
Meckel’s diverticulum
Polyps
Necrotizing enterocolitis
Anal fissure
Explanation - Meckel’s diverticulum is the most common cause of painless rectal bleeding in infants.
Correct answer is: Meckel’s diverticulum
Q.22 Which test is diagnostic for Meckel’s diverticulum?
Ultrasound
CT scan
Technetium-99m pertechnetate scan
MRI
Explanation - The Meckel’s scan detects ectopic gastric mucosa in the diverticulum.
Correct answer is: Technetium-99m pertechnetate scan
Q.23 What is the most common renal tumor in children?
Wilms tumor
Neuroblastoma
Renal cell carcinoma
Mesoblastic nephroma
Explanation - Wilms tumor (nephroblastoma) is the most common renal malignancy in children.
Correct answer is: Wilms tumor
Q.24 Which genetic condition is strongly associated with Wilms tumor?
Beckwith-Wiedemann syndrome
Down syndrome
Turner syndrome
Klinefelter syndrome
Explanation - Wilms tumor is associated with syndromes like Beckwith-Wiedemann and WAGR.
Correct answer is: Beckwith-Wiedemann syndrome
Q.25 In pyloric stenosis, electrolyte abnormality typically seen is:
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Hyperkalemia
Explanation - Prolonged vomiting leads to loss of hydrogen and chloride ions, causing hypochloremic metabolic alkalosis.
Correct answer is: Metabolic alkalosis