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Supplemental Digital Content 4

This is a list of multiple choice questions (MCQs) that was created to test important knowledge about
the management of gastroschisis that could not be included in the simulation scenario itself. The
maximum score is 15.

1. Which of the following abnormalities are associated with gastroschisis? (1)
a. Cleft palate
b. Spina bifida
c. Undescended testes
d. Talipes equinovarus
e. Omphalocele
f. Patent ductus arteriosus

2. After the resuscitation of a neonate with gastroschisis, what radiological investigation should
this patient have? (Please choose the single most appropriate answer) (1)
a. Abdominal ultrasound
b. Abdominal x-ray
c. Abdominal MRI
d. Cranial ultrasound
e. Barium enema
f. Head CT

3. During the resuscitation of a neonate with gastroschisis, which three of these variables
should help guide the amount of fluid they require? (2)
a. Blood lactate
b. Core temperature
c. Core-toe temperature gap
d. Bowel oedema
e. Blood pressure
f. Blood urea and creatinine

4. Which of the following are least likely to be options for the initial management of
gastroschisis after resuscitation? (Please tick all that apply) (2)
a. Primary closure of defect
b. Silo insertion
c. Distal stoma formation
d. Patch insertion
e. Bowel resection
f. Defunctioning stoma formation

5. After application of a silo, which antacid is likely to give the best protective effect? (1)
a. Gaviscon
b. Domperidone
c. Ranitidine
d. Loperamide
e. Pepto-bismol
f. Alka-Seltzer

6. A patient with a silo develops a temperature; blood gases show a pH 7.31 and BE -5.8, which
of the following investigations might you request? (Please tick all that apply) (1)
a. CXR
b. Wound swab
c. Urine culture
d. CRP
e. Abdominal MRI
f. Bowel biopsy

7. Which of the following patches could you use to close the defect if it is too large for primary
closure? (Please tick all that apply) (2)
a. Dacron
b. Goretex
c. Surgisis gold
d. Permacol
e. Prolene

8. One month after closure of the defect the patient returns with bilious vomiting and
abdominal distension, what is the most likely underlying cause? (1)
a. Atresia
b. Bowel cancer
c. Stricture
d. Small bowel volvulus
e. Adhesions

9. Your options for the following questions are:

a. Short gut syndrome
b. Adhesions and obstruction
c. Neoplastic changes
d. Food intolerance
e. Bowel perforation
f. Motility disorders

The parent of a child with gastroschisis asks you what is most likely to impact their child’s life
in the long-term.
Please choose which of the following pairs is most likely if the child required bowel resection:
i. A+C
ii. B+E
iii. D+F
iv. A+B
v. B+F
vi. C+D

Please choose which of the following pairs is most likely if the child did not require bowel
resection: (1)
i. A+C
ii. B+E
iii. D+F
iv. A+B
v. B+F
vi. C+D

10. Which of the following has not been found as being associated with gastroschisis? (1)
a. Maternal smoking
b. Autosomal recessive inheritance
c. Maternal opioid use
d. Maternal illness during first trimester of pregnancy
e. Change in paternity with a multiparous mother
f. High maternal caffeine intake during pregnancy

11. What, approximately, is the recent UK incidence of gastroschisis per live births? (1)
a. 1 in 1,000
b. 1 in 10,000
c. 1 in 100,000
d. 4 in 1,000
e. 4 in 10,000
f. 4 in 100,000