A full-term newborn is 30 hours old and has not yet passed urine or meconium. Which is most accurate regarding normal timing?
Anonymous Quiz
2%
Timing is irrelevant in healthy newborns
5%
Both urine and meconium must occur within 12 hours
13%
Meconium within 72 hours, urine within 48 hours
18%
Urine within 48 hours, meconium within 24 hours
63%
Urine within 24 hours, meconium within 48 hours
A 4-day-old newborn has not passed meconium, feeds poorly, and appears hypotonic. Exam shows a large anterior fontanelle and constipation. Most likely cause?
Anonymous Quiz
16%
Hirschsprung disease
13%
Meconium ileus (cystic fibrosis)
65%
Congenital hypothyroidism
3%
Small left colon syndrome
3%
Normal variant
❤3
A 3-week-old infant presents with sudden bilious vomiting, abdominal distension, and lethargy. Vital signs show tachycardia and hypotension. What is the most likely diagnosis?
Anonymous Quiz
39%
Midgut Volvulus
12%
Hirschsprung disease
20%
Pyloric stenosis
10%
Meconium ileus
19%
Necrotizing enterocolitis
A 2-year-old swallows a metallic pin. X-ray shows it lodged in the proximal duodenum. The child is asymptomatic. What is the next best step?
Anonymous Quiz
33%
Observe and repeat X-ray in 24 hours
8%
Give laxatives and monitor stools
40%
Immediate endoscopic removal
4%
Attempt removal with magnet or external manipulation
15%
Wait for spontaneous passage
6-month-old infant with hard, infrequent stools, otherwise healthy.
Initial management?
Initial management?
Anonymous Quiz
31%
Fruit juice/puree
7%
Mineral oil
26%
Lactulose solution
25%
Rectal stimulation
11%
Anorectal testing
A 3-year-old child presents with recurrent febrile urinary tract infections. Ultrasound shows normal kidneys. Which of the following diagnostic tests is indicated to evaluate for vesicoureteral reflux?
Anonymous Quiz
3%
MRI of the kidneys
86%
Contrast voiding cystourethrogram (VCUG)
6%
Cystoscopy
3%
Plain abdominal X-ray
2%
Nuclear medicine renal scan
A 2-year-old child presents with dehydration: dry mucous membranes, tachycardia, and lethargy. Labs reveal hypernatremia. What is the most appropriate initial management?
Anonymous Quiz
50%
Emergency fluid resuscitation with isotonic saline
36%
Rapid correction with hypotonic solution (0.45% NaCl)
10%
Oral rehydration solution
2%
Hypertonic saline infusion
2%
Diuretic therapy
❤1
A newborn presents with respiratory distress, flattened facies, and limb deformities. Prenatal history reveals severely decreased amniotic fluid in the third trimester. What is the primary underlying abnormality?
Anonymous Quiz
26%
Pulmonary hypoplasia
32%
Oligohydramnios
3%
Flattened facies
2%
Limb deformities
37%
Renal agenesis
A 7-year-old child presents with dark urine and mild edema. Laboratory studies show low serum C3 with normal C4. Which of the following is the most likely diagnosis?
Anonymous Quiz
63%
Poststreptococcal glomerulonephritis
9%
Alport syndrome
9%
Lupus nephritis
14%
IgA nephropathy
5%
Membranous nephropathy
❤3
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A 60-year-old man presents with progressive abdominal distension. Paracentesis reveals: Ascitic albumin: 1.0 g/dL, Serum albumin: 3.5 g/dL, Total protein (ascites): 3.8 g/dL, WBC: 180/mm³ (lymphocyte predominant). Most likely cause of this ascites is?
Anonymous Quiz
44%
Cirrhosis
21%
Peritoneal carcinomatosis
13%
Nephrotic syndrome
16%
Heart failure
6%
Pancreatic ascites
❤2
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A 72-year-old man with a history of recurrent diverticulitis presents with pneumaturia and recurrent UTIs. He denies abdominal pain. Which of the following statements is most accurate regarding colovesical fistula?
Anonymous Quiz
19%
Fecaluria is present in almost all patients.
29%
CT scan is more sensitive than cystoscopy for diagnosis.
11%
Antibiotic therapy is usually curative.
38%
Colorectal cancer is the most common cause in Western countries.
2%
Surgery is contraindicated in elderly patients.
❤1
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A 65-year-old man has a right groin bulge lateral to the inferior epigastric vessels, reducible and worse with coughing. Which of the following is the most accurate?
Anonymous Quiz
32%
This is most likely a direct inguinal hernia passing through Hesselbach’s triangle.
10%
Indirect inguinal hernias are more common in older men than in young men.
7%
Femoral hernias are more common than inguinal hernias in men.
49%
Indirect inguinal hernias enter the deep inguinal ring lateral to inferior epigastric vessels.
2%
Direct inguinal hernias are usually congenital due to a patent processus vaginalis.
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A 45-year-old man presents with painless bright red rectal bleeding on defecation. On anoscopy, you see a hemorrhoid that prolapses with straining and spontaneously reduces. Which of the following statements is most accurate?
Anonymous Quiz
10%
This is a Grade I internal hemorrhoid
69%
This is a Grade II internal hemorrhoid
15%
This is a Grade III internal hemorrhoid
3%
This is a Grade IV internal hemorrhoid
2%
Hemorrhoidectomy is immediately indicated
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A 52-year-old man has painless rectal bleeding but no prolapse. He is found to have internal hemorrhoids visible only on anoscopy. Which is the most accurate description and initial management?
Anonymous Quiz
78%
Grade I, manage with high-fiber diet and hydration
13%
Grade II, proceed to rubber band ligation immediately
6%
Grade III, manual reduction required
2%
Grade IV, urgent surgery indicated
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A 68-year-old woman with prior abdominal surgeries has vomiting, distension, constipation, and high-pitched bowel sounds. X-ray shows dilated small bowel with air-fluid levels; colon is collapsed. Which is most accurate?
Anonymous Quiz
19%
Paralytic ileus is likely; bowel sounds are typically high-pitched
10%
SBO causes uniform dilation including colon
61%
High-pitched, tinkling sounds suggest mechanical SBO
8%
X-ray cannot differentiate SBO from ileus; CT is required
1%
SBO and ileus are managed the same way
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A 65-year-old man presents with progressive epigastric pain, early satiety, & unintentional weight loss. On endoscopy, a ulcerated lesion with raised edges is noted in the antrum, and biopsy confirms adenocarcinoma. The most accurate statement is?
Anonymous Quiz
11%
Early-stage gastric adenocarcinoma is usually symptomatic with bleeding
56%
Intestinal-type adenocarcinoma is associated with H. pylori infection and chronic gastritis
15%
Linitis plastica ommonly presents as a well-circumscribed mass in the distal stomach.
10%
Surgical resection is rarely indicated because most tumors respond to chemotherapy alone
8%
Virchow’s node (left supraclavicular) metastasis is specific for intestinal-type only
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A 72-year-old man presents with sudden-onset abdominal distension, constipation & vomiting. On examination, his abdomen is tympanic and diffusely tender, with high-pitched bowel sounds. AXR shows a “coffee bean” sign pointing to the RUQ. Most accurate?
Anonymous Quiz
17%
Sigmoid volvulus usually occurs in young adults
13%
The cecum is involved in the majority of sigmoid volvulus cases
49%
Initial management is endoscopic decompression if there are no signs of peritonitis
10%
Emergent surgery is always required first-line, regardless of stability
11%
A barium enema is the safest first-line diagnostic tool in acute obstruction
❤1👍1