Multiple-Choice Questions on Small Bowel Atresia for Postgraduate Trainees
Below are 10 multiple-choice questions with clinical scenarios on small bowel atresia, each with five homogeneous options and keys.
Question 1
A 1-day-old term neonate presents with bilious vomiting and abdominal distension. Prenatal ultrasound had shown dilated bowel loops. Plain abdominal X-ray shows multiple air-fluid levels. What is the most likely etiology of small bowel atresia in this patient?
A) Chromosomal abnormality B) Vascular accident in utero C) Congenital infection D) Maternal medication exposure E) Radiation exposure
Key: B) Vascular accident in utero 1, 2
Question 2
A neonate with jejunal atresia undergoes surgical exploration. Multiple atretic segments are identified in the small bowel. Which surgical approach is most appropriate for managing multiple small bowel atresia?
A) Creation of multiple stomas B) Resection of all atretic segments with single anastomosis C) One-stage restoration of bowel continuity with preservation of maximal intestinal length D) Temporary bypass with staged reconstruction E) Complete bowel rest with parenteral nutrition only
Key: C) One-stage restoration of bowel continuity with preservation of maximal intestinal length 1, 3
Question 3
A newborn with suspected small bowel atresia is being prepared for surgery. Which of the following preoperative management steps is most important?
A) Administration of prophylactic antibiotics B) Fluid resuscitation and correction of electrolyte abnormalities C) Placement of central venous access D) Bowel decompression with nasogastric tube E) Administration of parenteral nutrition
Key: B) Fluid resuscitation and correction of electrolyte abnormalities 4
Question 4
During surgery for small bowel atresia, a type III atresia (disconnected bowel segments with V-shaped mesenteric defect) is identified. What is the most significant concern with this type of atresia?
A) Risk of anastomotic leak B) Potential for short bowel syndrome C) Need for multiple anastomoses D) Higher risk of malrotation E) Increased incidence of reoperation
Key: B) Potential for short bowel syndrome 1, 3
Question 5
A 2-day-old neonate with ileal atresia undergoes resection and primary anastomosis. On postoperative day 5, the patient develops abdominal distension, bilious vomiting, and increased gastric residuals. What is the most likely complication?
A) Anastomotic leak B) Adhesive small bowel obstruction C) Functional ileus D) Necrotizing enterocolitis E) Bacterial overgrowth
Question 6
A 3-day-old infant with jejunal atresia has undergone surgical repair. The surgical team is planning nutritional support. Which of the following statements regarding postoperative nutrition is most accurate?
A) Parenteral nutrition should be continued indefinitely B) Enteral feeds should be started immediately after surgery C) Duration of parenteral nutrition depends on the length of residual bowel and clinical recovery D) Enteral nutrition is contraindicated in the first week E) Breast milk is contraindicated in the early postoperative period
Key: C) Duration of parenteral nutrition depends on the length of residual bowel and clinical recovery 1, 3
Question 7
A neonate with suspected small bowel atresia undergoes laparoscopic exploration. Which of the following best describes the current role of minimally invasive surgery in small bowel atresia?
A) Contraindicated due to high risk of complications B) Limited to diagnostic purposes only C) Safe and feasible with reduced postoperative adhesions compared to open surgery D) Only appropriate for duodenal atresia, not jejunoileal atresia E) Associated with higher mortality rates than open surgery
Key: C) Safe and feasible with reduced postoperative adhesions compared to open surgery 5, 6
Question 8
A neonate with multiple small bowel atresias undergoes surgical repair with preservation of all bowel segments. Postoperatively, the patient develops abdominal distension, high gastric output, and failure to tolerate feeds after 2 weeks. Which of the following is the most likely diagnosis?
A) Missed atretic segment B) Anastomotic stricture C) Small bowel bacterial overgrowth D) Short bowel syndrome E) Adhesive small bowel obstruction
Key: C) Small bowel bacterial overgrowth 4
Question 9
A 1-month-old infant who underwent repair of multiple jejunal atresias presents with poor weight gain despite adequate caloric intake. Laboratory studies show low albumin and fat-soluble vitamin deficiencies. What is the most likely cause of these findings?
A) Anastomotic stricture B) Intestinal dysmotility C) Malabsorption due to reduced mucosal surface area D) Pancreatic insufficiency E) Biliary atresia
Key: C) Malabsorption due to reduced mucosal surface area 4, 3
Question 10
A 6-month-old infant with a history of surgically repaired ileal atresia presents with intermittent abdominal pain, distension, and vomiting that resolves spontaneously. The most appropriate next step in management is:
A) Immediate surgical exploration B) Upper GI contrast study C) Trial of low-fiber diet D) CT scan of abdomen with contrast E) Colonoscopy
Key: B) Upper GI contrast study 4
[Note: These questions cover various aspects of small bowel atresia including etiology, surgical management, complications, and long-term follow-up, appropriate for postgraduate trainees.]