10 Best Choice Questions (BCQs) on Pediatric Surgery Topics for Postgraduate Trainees
BCQ 1: Omphalocele Management
A 1-day-old newborn is diagnosed with an omphalocele measuring 6 cm in diameter with the liver partially protruding through the defect. Vital signs are stable. What is the initial management for this newborn?
A) Immediate primary surgical closure B) Staged reduction with a nonsurgical silo C) Topical application of silver sulfadiazine D) Watchful waiting for spontaneous closure E) Immediate laparotomy with mesh placement
Key: B) Staged reduction with a nonsurgical silo
BCQ 2: Tympanostomy Tubes and Otorrhea
A 3-year-old child with tympanostomy tubes presents with purulent otorrhea for 24 hours. The child is afebrile and otherwise well. What is the most appropriate initial treatment?
A) Oral amoxicillin-clavulanate for 10 days B) Topical antibiotic ear drops C) Oral ciprofloxacin for 7 days D) Systemic corticosteroids E) Watchful waiting with saline irrigation
Key: B) Topical antibiotic ear drops
BCQ 3: Recurrent Acute Otitis Media
A 2-year-old child has experienced 4 episodes of acute otitis media in the past 6 months, with the most recent episode 4 weeks ago. Current examination shows no middle ear effusion. What is the most appropriate management?
A) Prophylactic antibiotics for 6 months B) Immediate tympanostomy tube insertion C) Adenoidectomy alone D) Watchful waiting with follow-up E) Antihistamine therapy
Key: D) Watchful waiting with follow-up
BCQ 4: Otitis Media with Effusion
A 3-year-old child has bilateral otitis media with effusion for 4 months. Hearing test shows mild conductive hearing loss (25 dB). The child has no developmental delays. What is the most appropriate next step?
A) Oral antibiotics for 14 days B) Intranasal corticosteroids C) Bilateral tympanostomy tube insertion D) Antihistamine-decongestant combination E) Adenoidectomy alone
Key: C) Bilateral tympanostomy tube insertion
BCQ 5: Surgical Management of Chronic OME
A 5-year-old child requires surgery for bilateral chronic otitis media with effusion resistant to medical management. What is the most appropriate surgical approach?
A) Tympanostomy tubes alone B) Adenoidectomy alone C) Tympanostomy tubes with adenoidectomy D) Myringotomy without tube placement E) Tonsillectomy with adenoidectomy
Key: C) Tympanostomy tubes with adenoidectomy
BCQ 6: Giant Omphalocele Management
A newborn presents with a giant omphalocele (8 cm diameter) containing more than 50% of the liver. The infant is hemodynamically stable. What is the most appropriate initial management strategy?
A) Immediate primary closure B) Staged reduction with a nonsurgical silo using hydrocolloid dressing C) Immediate mesh placement D) Topical application of povidone-iodine E) Emergency laparotomy
Key: B) Staged reduction with a nonsurgical silo using hydrocolloid dressing
BCQ 7: Prenatal Omphalocele Diagnosis
A 16-week prenatal ultrasound reveals a fetus with an omphalocele. What is the most appropriate next step in management?
A) Immediate termination of pregnancy B) Amniocentesis for karyotyping and detailed anatomic survey C) Maternal bed rest for remainder of pregnancy D) Cesarean delivery at 34 weeks E) Intrauterine surgical repair
Key: B) Amniocentesis for karyotyping and detailed anatomic survey
BCQ 8: Failed Newborn Hearing Screen
A 2-week-old infant who failed the newborn hearing screen is found to have bilateral otitis media with effusion. What is the most appropriate management?
A) Immediate tympanostomy tube placement B) Oral antibiotics for 10 days C) Counseling parents about follow-up and documentation in medical record D) Hearing aids fitting E) Watchful waiting for 6 months
Key: C) Counseling parents about follow-up and documentation in medical record
BCQ 9: Chronic OME in At-Risk Child
A 2-year-old child with Down syndrome has persistent bilateral otitis media with effusion for 2 months. What is the most appropriate management?
A) Continue observation for another 4 months B) Oral antibiotics for 14 days C) Obtain age-appropriate hearing test D) Intranasal corticosteroids E) Antihistamine therapy
Key: C) Obtain age-appropriate hearing test
BCQ 10: Delivery Planning for Omphalocele
A 36-week pregnant woman carries a fetus diagnosed with a 6 cm omphalocele containing part of the liver. What is the most appropriate delivery plan?
A) Spontaneous vaginal delivery at 40 weeks at a community hospital B) Elective cesarean delivery at 38 weeks at a tertiary care center C) Induction of labor at 37 weeks at a tertiary care center D) Emergency cesarean delivery immediately E) Spontaneous vaginal delivery at a tertiary care center with pediatric surgery available
Key: B) Elective cesarean delivery at 38 weeks at a tertiary care center