{"id":5251,"date":"2022-10-05T22:01:42","date_gmt":"2022-10-05T22:01:42","guid":{"rendered":"https:\/\/staycurrentmd.wpengine.com\/pediatricsurgery\/?p=5251"},"modified":"2022-10-05T22:02:44","modified_gmt":"2022-10-05T22:02:44","slug":"anorectal-malformation","status":"publish","type":"post","link":"https:\/\/staycurrent.md\/pediatricsurgery\/anorectal-malformation\/","title":{"rendered":"Anorectal Malformation"},"content":{"rendered":"<script>\n                            if (window.qmn_quiz_data === undefined) {\n                                    window.qmn_quiz_data = new Object();\n                            }\n                    <\/script><script>window.qmn_quiz_data[\"3\"] = {\"quiz_id\":\"3\",\"quiz_name\":\"Anorectal Malformation (ARM)\",\"disable_answer\":\"0\",\"ajax_show_correct\":\"0\",\"progress_bar\":0,\"contact_info_location\":\"0\",\"qpages\":[],\"skip_validation_time_expire\":0,\"timer_limit_val\":\"0\",\"disable_scroll_next_previous_click\":0,\"disable_first_page\":0,\"enable_result_after_timer_end\":0,\"enable_quick_result_mc\":1,\"end_quiz_if_wrong\":0,\"form_disable_autofill\":0,\"disable_mathjax\":0,\"enable_quick_correct_answer_info\":0,\"quick_result_correct_answer_text\":\"Correct! You have selected correct answer.\",\"quick_result_wrong_answer_text\":\"Wrong! You have selected wrong answer.\",\"quiz_processing_message\":\"\",\"quiz_limit_choice\":\"Limit of choice is reached.\",\"not_allow_after_expired_time\":0,\"scheduled_time_end\":false,\"error_messages\":{\"email_error_text\":\"Not a valid e-mail address!\",\"number_error_text\":\"This field must be a number!\",\"incorrect_error_text\":\"The entered text is not correct!\",\"empty_error_text\":\"Please complete all required fields!\",\"url_error_text\":\"The entered URL is not valid!\",\"minlength_error_text\":\"Required atleast %minlength% characters.\",\"maxlength_error_text\":\"Maximum %maxlength% characters allowed.\",\"recaptcha_error_text\":\"ReCaptcha is missing\"},\"question_list\":{\"20\":{\"question_id\":\"20\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:134:\\\"Wait 24 hours (as in all anorectal malformation patients) to perform a cross table radiograph to establish the position on the rectum.\\\";i:1;d:0;i:2;i:0;}i:1;a:3:{i:0;s:45:\\\"Perform a colostomy within the first 24 hours\\\";i:1;d:0;i:2;i:0;}i:2;a:3:{i:0;s:97:\\\"Wait for 24 hours and perform the cross table radiograph and then perform a colostomy in 72 hours\\\";i:1;d:1;i:2;i:1;}i:3;a:3:{i:0;s:37:\\\"Perform an ileostomy within 24 hours.\\\";i:1;d:0;i:2;i:0;}i:4;a:3:{i:0;s:40:\\\"Wait 5 days and then perform a colostomy\\\";i:1;d:0;i:2;i:0;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p><u>Explanation:<\\\/u> Because it is still possible that a perineal fistula will come visible after pressure of the meconium, it is advised to wait 24 hours, according to ERN guidelines. When you perform a cross-table X-ray and there is no passage of meconium, you can decide to perform a colostomy. If the abdomen becomes very distended within the 24 hours, you can always decide to perform a colostomy sooner.<\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:138:\\\"You are called to see a newborn male infant (2 hours old) with an anorectal malformation and there is no apparent opening on the perineum.\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"Wait 24 hours (as in all anorectal malformation patients) to perform a cross table radiograph to establish the position on the rectum.\",0,0],[\"Perform a colostomy within the first 24 hours\",0,0],[\"Wait for 24 hours and perform the cross table radiograph and then perform a colostomy in 72 hours\",1,1],[\"Perform an ileostomy within 24 hours.\",0,0],[\"Wait 5 days and then perform a colostomy\",0,0]]},\"21\":{\"question_id\":\"21\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:5:\\\"5,000\\\";i:1;d:1;i:2;i:1;}i:1;a:3:{i:0;s:6:\\\"10,000\\\";i:1;d:0;i:2;i:0;}i:2;a:3:{i:0;s:5:\\\"1,000\\\";i:1;d:0;i:2;i:0;}i:3;a:3:{i:0;s:5:\\\"3,000\\\";i:1;d:0;i:2;i:0;}i:4;a:3:{i:0;s:6:\\\"20,000\\\";i:1;d:0;i:2;i:0;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p><u>Explanation: <\\\/u>No Explantation \\u2013 there is the <a href=\\\"http:\\\/\\\/www.onein5000foundation.org\\\/\\\">http:\\\/\\\/www.onein5000foundation.org\\\/<\\\/a><\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:58:\\\"What is the incidence of ARM per live births \\u2013 1 in\\u2026.?\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"5,000\",1,1],[\"10,000\",0,0],[\"1,000\",0,0],[\"3,000\",0,0],[\"20,000\",0,0]]},\"22\":{\"question_id\":\"22\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:104:\\\"Into low, intermediate, or high, depending on the termination of the rectum relative to the puborectalis\\\";i:1;d:0;i:2;i:0;}i:1;a:3:{i:0;s:25:\\\"Wingspread classification\\\";i:1;d:0;i:2;i:0;}i:2;a:3:{i:0;s:26:\\\"Krickenbeck classification\\\";i:1;d:1;i:2;i:1;}i:3;a:3:{i:0;s:23:\\\"Montreal classification\\\";i:1;d:0;i:2;i:0;}i:4;a:3:{i:0;s:19:\\\"Pena classification\\\";i:1;d:0;i:2;i:0;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p><u>Explanation (source: Pearls and Tricks in Pediatric Surgery, Chapter 34 \\u201c Anorectal Malformations\\u201d by Hira Ahmad and Marc A. Levitt Springer; 1st ed. 2021 Edition (30. Oktober 2020)): <\\\/u>In the past, ARMs were classified according to gender and as low, intermediate, or high, depending on the termination of the rectum relative to the puborectalis muscle complex based on Wingspread classification. Currently, ARMs are classified by the precise anatomical abnormality of the distal rectum and the location of the fistula in relationship to the perineum and urogenital system. The Krickenbeck classification is utilized as it helps predict the type of surgery required<\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:218:\\\"According to which classification are anorectal malformations classified by the precise anatomical abnormality of the distal rectum and the location of the fistula in relationship to the perineum and urogenital system?\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"Into low, intermediate, or high, depending on the termination of the rectum relative to the puborectalis\",0,0],[\"Wingspread classification\",0,0],[\"Krickenbeck classification\",1,1],[\"Montreal classification\",0,0],[\"Pena classification\",0,0]]},\"23\":{\"question_id\":\"23\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:10:\\\"Trisomy 21\\\";i:1;d:1;i:2;i:1;}i:1;a:3:{i:0;s:10:\\\"Trisomy 18\\\";i:1;d:0;i:2;i:0;}i:2;a:3:{i:0;s:10:\\\"Trisomy 13\\\";i:1;d:0;i:2;i:0;}i:3;a:3:{i:0;s:29:\\\"Beckwith\\u2013Wiedemann syndrome\\\";i:1;d:0;i:2;i:0;}i:4;a:3:{i:0;s:18:\\\"Currarino-Syndrome\\\";i:1;d:0;i:2;i:0;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p>Explanation: Trisomy 21 is associated with ARM and no fistula<\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:173:\\\"A patient with an anorectal malformation without a fistula defect (blind ending rectum) on high pressure distal colostogram, is most commonly associated with which syndrome?\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"Trisomy 21\",1,1],[\"Trisomy 18\",0,0],[\"Trisomy 13\",0,0],[\"Beckwith\\u2013Wiedemann syndrome\",0,0],[\"Currarino-Syndrome\",0,0]]},\"24\":{\"question_id\":\"24\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:10:\\\"Trisomy 21\\\";i:1;d:0;i:2;i:0;}i:1;a:3:{i:0;s:10:\\\"Trisomy 18\\\";i:1;d:0;i:2;i:0;}i:2;a:3:{i:0;s:13:\\\"Frey syndrome\\\";i:1;d:0;i:2;i:0;}i:3;a:3:{i:0;s:29:\\\"Beckwith\\u2013Wiedemann syndrome\\\";i:1;d:0;i:2;i:0;}i:4;a:3:{i:0;s:18:\\\"Currarino-Syndrome\\\";i:1;d:1;i:2;i:1;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p><u>Explanation (source: Pearls and Tricks in Pediatric Surgery, Chapter 34 \\u201c Anorectal Malformations\\u201d by Hira Ahmad and Marc A. Levitt Springer; 1st ed. 2021 Edition (30. Oktober 2020)): <\\\/u>With a normal appearance of the anal canal and dentate line, the typical appearance of this rare type of malformation, a workup should specifically evaluate for Currarino syndrome and an associated presacral mass. Currarino syndrome is characterized by partial agenesis of the sacrum, pre-sacral mass, and anal atresia.<\\\/p>\\n<p>&nbsp;<\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:69:\\\"A child with a rectal atresia and anal stenosis requires which workup\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"Trisomy 21\",0,0],[\"Trisomy 18\",0,0],[\"Frey syndrome\",0,0],[\"Beckwith\\u2013Wiedemann syndrome\",0,0],[\"Currarino-Syndrome\",1,1]]},\"25\":{\"question_id\":\"25\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:28:\\\"Vesico-ureteral-reflux (VUR)\\\";i:1;d:0;i:2;i:0;}i:1;a:3:{i:0;s:14:\\\"Rectal atresia\\\";i:1;d:0;i:2;i:0;}i:2;a:3:{i:0;s:14:\\\"Vaginal septum\\\";i:1;d:1;i:2;i:1;}i:3;a:3:{i:0;s:16:\\\"Urethral atresia\\\";i:1;d:0;i:2;i:0;}i:4;a:3:{i:0;s:16:\\\"Absent os sacrum\\\";i:1;d:0;i:2;i:0;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p><u>Explanation (source: Pearls and Tricks in Pediatric Surgery, Chapter 34 \\u201c Anorectal Malformations\\u201d by Hira Ahmad and Marc A. Levitt Springer; 1st ed. 2021 Edition (30. Oktober 2020)): <\\\/u>Vaginal septum. Vaginal anomalies such as vaginal septum (longitudinal or transverse) occur in 5% of females with ARM. Usually a vaginal septum can be resected at the same time as the PSARP. The clinician must have a high index of suspicion for other gynecological anomalies, albeit rare, such as distal vaginal atresia. Thus, careful examination under anesthesia of the vagina at the same time as PSARP is prudent.<\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:121:\\\"What is the most common gynecologic associated issue in a female with an anorectal malformation- rectovestibular fistula?\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"Vesico-ureteral-reflux (VUR)\",0,0],[\"Rectal atresia\",0,0],[\"Vaginal septum\",1,1],[\"Urethral atresia\",0,0],[\"Absent os sacrum\",0,0]]},\"26\":{\"question_id\":\"26\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:36:\\\"Congenital adrenal hyperplasia (CAH)\\\";i:1;d:1;i:2;i:1;}i:1;a:3:{i:0;s:31:\\\"Congenital hyperinsulinism (HI)\\\";i:1;d:0;i:2;i:0;}i:2;a:3:{i:0;s:6:\\\"Cloaca\\\";i:1;d:0;i:2;i:0;}i:3;a:3:{i:0;s:33:\\\"ARM with recto-vestibular fistula\\\";i:1;d:0;i:2;i:0;}i:4;a:3:{i:0;s:20:\\\"Klinefelter-Syndrome\\\";i:1;d:0;i:2;i:0;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p><u>Explanation<\\\/u>: Congenital adrenal hyperplasia (CAH) is an inborn condition in which a person\\u2019s adrenal glands don\\u2019t work normally. People with CAH are missing an enzyme that is needed for the adrenals to do their job. Some forms of CAH are very serious and require intense medical management. Some are less severe but still require monitoring. Most states now require newborn screening for CAH because CAH can be a very dangerous disease.<\\\/p>\\n<p>The adrenal glands make androgens, which are sometimes called \\u201cmasculinizing hormones.\\u201d The adrenal glands are not the only organs that make androgens; for example, the testes also make testosterone, which is a type of androgen. High levels of androgens usually lead to male-typical development in the womb, while low levels usually lead to female-typical development.<\\\/p>\\n<p>If a female (46,XX) fetus has a certain form of CAH, the CAH may cause her to develop along a more male-typical pathway. She may be born with genitals that are a little bit \\u2013 or very much \\u2013 \\u201cmasculinized.\\u201d Her clitoris may be large, her labia may be joined more like a scrotum, and her vagina may not be fully formed, or may be joined with her urethra. The sex development of (46,XY) fetuses is not affected by CAH.<\\\/p>\\n<p>This question (not the explanation) <u>derives from: \\u201cPearls and Tricks in Pediatric Surgery, Chapter 34 \\u201c Anorectal Malformations\\u201d by Hira Ahmad and Marc A. Levitt Springer; 1st ed. 2021 Edition (30. Oktober 2020)\\u201d<\\\/u><\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:110:\\\"A female patient with a normal anus, urogenital sinus and hypertrophy of the clitoris requires evaluation for:\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"Congenital adrenal hyperplasia (CAH)\",1,1],[\"Congenital hyperinsulinism (HI)\",0,0],[\"Cloaca\",0,0],[\"ARM with recto-vestibular fistula\",0,0],[\"Klinefelter-Syndrome\",0,0]]},\"27\":{\"question_id\":\"27\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:11:\\\"Bladderneck\\\";i:1;d:0;i:2;i:0;}i:1;a:3:{i:0;s:14:\\\"Bulbar urethra\\\";i:1;d:1;i:2;i:1;}i:2;a:3:{i:0;s:17:\\\"Prostatic urethra\\\";i:1;d:0;i:2;i:0;}i:3;a:3:{i:0;s:6:\\\"Vagina\\\";i:1;d:0;i:2;i:0;}i:4;a:3:{i:0;s:9:\\\"Symphysis\\\";i:1;d:0;i:2;i:0;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p>Explanation: The \\u201cno fstula\\u201d defect in ARM patients is a LOW defect. The distal end of the rectum typically ends at the level of the bulbar urethra (An ARM with recto-bulbar fistula is also a LOW defect)<\\\/p>\\n<p>This question (not the explanation) <u>derives from: \\u201cPearls and Tricks in Pediatric Surgery, Chapter 34 \\u201c Anorectal Malformations\\u201d by Hira Ahmad and Marc A. Levitt Springer; 1st ed. 2021 Edition (30. Oktober 2020)\\u201d<\\\/u><\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:91:\\\"In a male ARM patient, the \\u201cno fstula\\u201d defect is almost always located at the level of:\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"Bladderneck\",0,0],[\"Bulbar urethra\",1,1],[\"Prostatic urethra\",0,0],[\"Vagina\",0,0],[\"Symphysis\",0,0]]},\"28\":{\"question_id\":\"28\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:15:\\\"Rectal prolapse\\\";i:1;d:0;i:2;i:0;}i:1;a:3:{i:0;s:9:\\\"Rectocele\\\";i:1;d:0;i:2;i:0;}i:2;a:3:{i:0;s:36:\\\"R.O.O.F. Remnant Of Original Fistula\\\";i:1;d:1;i:2;i:1;}i:3;a:3:{i:0;s:15:\\\"Rectal prolapse\\\";i:1;d:0;i:2;i:0;}i:4;a:3:{i:0;s:21:\\\"Urethral diverticulum\\\";i:1;d:0;i:2;i:0;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p><strong><u>Explanation:<\\\/u><\\\/strong> A complication of the surgical management of anorectal malformations (ARMs) is a retained remnant of the original fistula (ROOF) formerly called a posterior urethral diverticulum (PUD). A ROOF may have multiple presentations or may be incidentally discovered during the work-up of ARM after previous surgery. There are several unique complications which may result after laparoscopic-assisted ARM repair, although the rates of these complications remain unknown. Laparoscopic ligation of the fistula may result in a retained remnant of the original fistula (ROOF). Issues with the ROOF include urinary tract infections, difficulty with catheterization, stone formation in the ROOF, mucous from the urethra, postvoid dribbling and incontinence, and also potential oncologic risk from mucosal irritation. Investigating for a ROOF requires both VCUG and MRI as the ROOF can be decompressed or sealed off and be missed by either imaging modality, respectively (Rentea RM et al. J Pediatr Surg. 2019 Oct;54(10):1988-1992).<\\\/p>\\n<p>A \\u201cROOF\\u201d was previously called a \\u201cUrethral diverticulum\\u201d. However, as it is the remnant of the rectum it is not a diverticulum. Therefore the term \\u201cUrethral diverticulum\\u201d should no longer be used.<\\\/p>\\n<p>This question (not the explanation) <u>derives from: \\u201cPearls and Tricks in Pediatric Surgery, Chapter 34 \\u201c Anorectal Malformations\\u201d by Hira Ahmad and Marc A. Levitt Springer; 1st ed. 2021 Edition (30. Oktober 2020)\\u201d<\\\/u><\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:220:\\\"A previously repaired ARM patient is found to have mislocated anus with rectal prolapse. MRI of the pelvis reveals a mass behind the urethra. Reoperation is considered. The posterior urethral mass most likely represents:\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"Rectal prolapse\",0,0],[\"Rectocele\",0,0],[\"R.O.O.F. Remnant Of Original Fistula\",1,1],[\"Rectal prolapse\",0,0],[\"Urethral diverticulum\",0,0]]},\"29\":{\"question_id\":\"29\",\"quiz_id\":\"3\",\"question_name\":\"\",\"answer_array\":\"a:5:{i:0;a:3:{i:0;s:11:\\\"Ureterocele\\\";i:1;d:0;i:2;i:0;}i:1;a:3:{i:0;s:9:\\\"Rectocele\\\";i:1;d:0;i:2;i:0;}i:2;a:3:{i:0;s:40:\\\"Ureteropelvic junction (UPJ) obstruction\\\";i:1;d:0;i:2;i:0;}i:3;a:3:{i:0;s:67:\\\"Hematometrocolpos associated with an obstructed Mullerian structure\\\";i:1;d:1;i:2;i:1;}i:4;a:3:{i:0;s:16:\\\"Cloacal extrophy\\\";i:1;d:0;i:2;i:0;}}\",\"answer_one\":\"\",\"answer_one_points\":\"0\",\"answer_two\":\"\",\"answer_two_points\":\"0\",\"answer_three\":\"\",\"answer_three_points\":\"0\",\"answer_four\":\"\",\"answer_four_points\":\"0\",\"answer_five\":\"\",\"answer_five_points\":\"0\",\"answer_six\":\"\",\"answer_six_points\":\"0\",\"correct_answer\":\"0\",\"question_answer_info\":\"<p><strong><u>Explanation:<\\\/u><\\\/strong> Hematometrocolpos is a rare condition which occurs when the uterus fills with menstrual blood. The common denominator of this is an obstruction of one or more Mullerian structure that interfere with the drainage of menstrual blood. Asymmetric gynecologic anatomy or a vaginal atresia in the neonatal period seem to correlate with future obstruction to menstrual flow (Levitt MA et al. J Pediatr Surg. 1998 Feb;33(2):188-93)<\\\/p>\\n<p>This question (not the explanation) <u>derives from: \\u201cPearls and Tricks in Pediatric Surgery, Chapter 34 \\u201c Anorectal Malformations\\u201d by Hira Ahmad and Marc A. Levitt Springer; 1st ed. 2021 Edition (30. Oktober 2020)\\u201d<\\\/u><\\\/p>\",\"comments\":\"1\",\"hints\":\"\",\"question_order\":\"1\",\"question_type\":\"0\",\"question_type_new\":\"0\",\"question_settings\":\"a:14:{s:8:\\\"required\\\";i:0;s:12:\\\"answerEditor\\\";s:4:\\\"text\\\";s:14:\\\"question_title\\\";s:154:\\\"A 13 years old previously repaired cloacal patient, presents with cyclical, monthly left lower quadrant abdominal pain. What is the most likely diagnosis?\\\";s:14:\\\"featureImageID\\\";s:0:\\\"\\\";s:15:\\\"featureImageSrc\\\";s:0:\\\"\\\";s:11:\\\"matchAnswer\\\";s:6:\\\"random\\\";s:14:\\\"case_sensitive\\\";s:0:\\\"\\\";s:16:\\\"image_size-width\\\";s:0:\\\"\\\";s:17:\\\"image_size-height\\\";s:0:\\\"\\\";s:8:\\\"autofill\\\";s:0:\\\"\\\";s:10:\\\"limit_text\\\";s:1:\\\"0\\\";s:23:\\\"limit_multiple_response\\\";s:1:\\\"0\\\";s:17:\\\"file_upload_limit\\\";s:1:\\\"0\\\";s:16:\\\"file_upload_type\\\";s:0:\\\"\\\";}\",\"category\":\"\",\"deleted\":\"0\",\"deleted_question_bank\":\"0\",\"answers\":[[\"Ureterocele\",0,0],[\"Rectocele\",0,0],[\"Ureteropelvic junction (UPJ) obstruction\",0,0],[\"Hematometrocolpos associated with an obstructed Mullerian structure\",1,1],[\"Cloacal extrophy\",0,0]]}},\"first_page\":true}\n                    <\/script><script src=https:\/\/staycurrent.md\/pediatricsurgery\/wp-content\/plugins\/qsm-analysis\/js\/plotly.min.js><\/script><div class='qsm-quiz-container qsm-quiz-container-3 qmn_quiz_container mlw_qmn_quiz  quiz_theme_default  '>\n\t\t\t\t\t<form name=\"quizForm3\" id=\"quizForm3\" action=\"\/pediatricsurgery\/wp-json\/wp\/v2\/posts\/5251\" method=\"POST\" class=\"qsm-quiz-form qmn_quiz_form mlw_quiz_form\" novalidate enctype=\"multipart\/form-data\">\n\t\t\t\t<input type=\"hidden\" name=\"qsm_hidden_questions\" id=\"qsm_hidden_questions\" value=\"\">\n\t\t\t\t<input type=\"hidden\" name=\"qsm_nonce\" id=\"qsm_nonce_3\" value=\"fb36cd938b\">\n\t\t\t\t<input type=\"hidden\" name=\"qsm_unique_key\" id=\"qsm_unique_key_3\" value=\"6ac9784443f95\">\n\t\t\t\t<div id=\"mlw_error_message\" class=\"qsm-error-message qmn_error_message_section\"><\/div>\n\t\t\t\t<span id=\"mlw_top_of_quiz\"><\/span>\n\t\t\t\t\t\t\t<div class=\"qsm-auto-page-row quiz_section quiz_begin \">\n\t\t\t\t\t\t\t\t<div class='mlw_qmn_message_before'>\n\t\t\t\t\t<p>Welcome to your Anorectal Malformation (ARM)<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-20 slide1  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>You are called to see a newborn male infant (2 hours old) with an anorectal malformation and there is no apparent opening on the perineum. <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question20-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question20\" id=\"question20_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question20_1\">\n\t\t\t\t\tWait 24 hours (as in all anorectal malformation patients) to perform a cross table radiograph to establish the position on the rectum.\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question20-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question20\" id=\"question20_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question20_2\">\n\t\t\t\t\tPerform a colostomy within the first 24 hours\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question20-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question20\" id=\"question20_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question20_3\">\n\t\t\t\t\tWait for 24 hours and perform the cross table radiograph and then perform a colostomy in 72 hours\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question20-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question20\" id=\"question20_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question20_4\">\n\t\t\t\t\tPerform an ileostomy within 24 hours.\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question20-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question20\" id=\"question20_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question20_5\">\n\t\t\t\t\tWait 5 days and then perform a colostomy\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question20_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question20\" id=\"question20_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-21 slide2  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>What is the incidence of ARM per live births \u2013 1 in\u2026.? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question21-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question21\" id=\"question21_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question21_1\">\n\t\t\t\t\t5,000\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question21-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question21\" id=\"question21_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question21_2\">\n\t\t\t\t\t10,000\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question21-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question21\" id=\"question21_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question21_3\">\n\t\t\t\t\t1,000\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question21-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question21\" id=\"question21_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question21_4\">\n\t\t\t\t\t3,000\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question21-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question21\" id=\"question21_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question21_5\">\n\t\t\t\t\t20,000\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question21_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question21\" id=\"question21_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-22 slide3  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>According to which classification are anorectal malformations classified by the precise anatomical abnormality of the distal rectum and the location of the fistula in relationship to the perineum and urogenital system? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question22-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question22\" id=\"question22_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question22_1\">\n\t\t\t\t\tInto low, intermediate, or high, depending on the termination of the rectum relative to the puborectalis\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question22-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question22\" id=\"question22_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question22_2\">\n\t\t\t\t\tWingspread classification\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question22-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question22\" id=\"question22_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question22_3\">\n\t\t\t\t\tKrickenbeck classification\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question22-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question22\" id=\"question22_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question22_4\">\n\t\t\t\t\tMontreal classification\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question22-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question22\" id=\"question22_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question22_5\">\n\t\t\t\t\tPena classification\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question22_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question22\" id=\"question22_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-23 slide4  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>A patient with an anorectal malformation without a fistula defect (blind ending rectum) on high pressure distal colostogram, is most commonly associated with which syndrome? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question23-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question23\" id=\"question23_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_1\">\n\t\t\t\t\tTrisomy 21\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question23-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question23\" id=\"question23_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_2\">\n\t\t\t\t\tTrisomy 18\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question23-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question23\" id=\"question23_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_3\">\n\t\t\t\t\tTrisomy 13\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question23-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question23\" id=\"question23_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_4\">\n\t\t\t\t\tBeckwith\u2013Wiedemann syndrome\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question23-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question23\" id=\"question23_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question23_5\">\n\t\t\t\t\tCurrarino-Syndrome\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question23_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question23\" id=\"question23_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-24 slide5  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>A child with a rectal atresia and anal stenosis requires which workup <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question24-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question24\" id=\"question24_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question24_1\">\n\t\t\t\t\tTrisomy 21\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question24-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question24\" id=\"question24_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question24_2\">\n\t\t\t\t\tTrisomy 18\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question24-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question24\" id=\"question24_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question24_3\">\n\t\t\t\t\tFrey syndrome\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question24-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question24\" id=\"question24_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question24_4\">\n\t\t\t\t\tBeckwith\u2013Wiedemann syndrome\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question24-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question24\" id=\"question24_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question24_5\">\n\t\t\t\t\tCurrarino-Syndrome\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question24_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question24\" id=\"question24_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-25 slide6  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>What is the most common gynecologic associated issue in a female with an anorectal malformation- rectovestibular fistula? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question25-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question25\" id=\"question25_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_1\">\n\t\t\t\t\tVesico-ureteral-reflux (VUR)\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question25-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question25\" id=\"question25_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_2\">\n\t\t\t\t\tRectal atresia\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question25-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question25\" id=\"question25_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_3\">\n\t\t\t\t\tVaginal septum\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question25-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question25\" id=\"question25_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_4\">\n\t\t\t\t\tUrethral atresia\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question25-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question25\" id=\"question25_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question25_5\">\n\t\t\t\t\tAbsent os sacrum\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question25_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question25\" id=\"question25_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-26 slide7  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>A female patient with a normal anus, urogenital sinus and hypertrophy of the clitoris requires evaluation for: <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question26-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question26\" id=\"question26_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question26_1\">\n\t\t\t\t\tCongenital adrenal hyperplasia (CAH)\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question26-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question26\" id=\"question26_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question26_2\">\n\t\t\t\t\tCongenital hyperinsulinism (HI)\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question26-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question26\" id=\"question26_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question26_3\">\n\t\t\t\t\tCloaca\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question26-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question26\" id=\"question26_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question26_4\">\n\t\t\t\t\tARM with recto-vestibular fistula\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question26-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question26\" id=\"question26_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question26_5\">\n\t\t\t\t\tKlinefelter-Syndrome\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question26_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question26\" id=\"question26_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-27 slide8  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>In a male ARM patient, the \u201cno fstula\u201d defect is almost always located at the level of: <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question27-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question27\" id=\"question27_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question27_1\">\n\t\t\t\t\tBladderneck\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question27-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question27\" id=\"question27_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question27_2\">\n\t\t\t\t\tBulbar urethra\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question27-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question27\" id=\"question27_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question27_3\">\n\t\t\t\t\tProstatic urethra\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question27-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question27\" id=\"question27_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question27_4\">\n\t\t\t\t\tVagina\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question27-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question27\" id=\"question27_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question27_5\">\n\t\t\t\t\tSymphysis\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question27_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question27\" id=\"question27_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-28 slide9  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>A previously repaired ARM patient is found to have mislocated anus with rectal prolapse. MRI of the pelvis reveals a mass behind the urethra. Reoperation is considered. The posterior urethral mass most likely represents: <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question28-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question28\" id=\"question28_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question28_1\">\n\t\t\t\t\tRectal prolapse\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question28-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question28\" id=\"question28_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question28_2\">\n\t\t\t\t\tRectocele\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question28-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question28\" id=\"question28_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question28_3\">\n\t\t\t\t\tR.O.O.F. Remnant Of Original Fistula\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question28-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question28\" id=\"question28_4\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question28_4\">\n\t\t\t\t\tUrethral diverticulum\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question28_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question28\" id=\"question28_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t\t<div class=\"quiz_section qsm-question-wrapper question-type-0  question-section-id-29 slide10  category-section-id-c95\">\n\t\t\t\t\t\t<div class='mlw_qmn_new_question'>A 13 years old previously repaired cloacal patient, presents with cyclical, monthly left lower quadrant abdominal pain. What is the most likely diagnosis? <\/div>\n\t\t\t<div class='mlw_qmn_question  qsm_remove_bold' >\n\t\t<p><\/p>\n\t<\/div>\n\t\t<fieldset>\n\t\t<legend><\/legend>\n\t<div class='qmn_radio_answers mlwRequiredRadio'>\n\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question29-1 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question29\" id=\"question29_1\" value=\"0\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question29_1\">\n\t\t\t\t\tUreterocele\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question29-2 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question29\" id=\"question29_2\" value=\"1\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question29_2\">\n\t\t\t\t\tRectocele\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question29-3 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question29\" id=\"question29_3\" value=\"2\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question29_3\">\n\t\t\t\t\tUreteropelvic junction (UPJ) obstruction\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question29-4 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question29\" id=\"question29_4\" value=\"3\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question29_4\">\n\t\t\t\t\tHematometrocolpos associated with an obstructed Mullerian structure\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t<div class=\"qmn_mc_answer_wrap  mrq_checkbox_class\" id=\"question29-5 \">\n\t\t\t\t\t\t\t\t\t\t\t<input type='radio' class='qmn_quiz_radio qmn-multiple-choice-input ' name=\"question29\" id=\"question29_5\" value=\"4\" \/>\n\t\t\t\t\t<label class=\"qsm-input-label\" for=\"question29_5\">\n\t\t\t\t\tCloacal extrophy\t\t\t\t\t<\/label>\n\t\t\t\t\t \t\t\t\t<\/div>\n\t\t\t\t\t \t\t\t<label style=\"display: none !important;\" for=\"question29_none\">None<\/label>\n\t\t\t<input type=\"radio\" style=\"display: none;\" name=\"question29\" id=\"question29_none\" checked=\"checked\" value=\"\" \/>\n\t\t\t\t<\/div>\n\t<\/fieldset>\n\t\t\t\t<\/div><!-- .quiz_section -->\n\t\t\t\t\t<input type=\"hidden\" name=\"qmn_question_list\" value=\"20Q21Q22Q23Q24Q25Q26Q27Q28Q29Q\" \/>\n\t\t\t\t\t<div class=\"qsm-auto-page-row quiz_section quiz_end empty_quiz_end \" >\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div id=\"mlw_error_message_bottom\" class=\"qsm-error-message qmn_error_message_section\"><\/div>\n\t\t\t\t\t<input type=\"hidden\" name=\"qmn_all_questions_count\" id=\"qmn_all_questions_count\" value=\"10\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"total_questions\" id=\"total_questions\" value=\"10\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"timer\" id=\"timer\" value=\"0\" \/>\n\t\t\t\t\t<input type=\"hidden\" name=\"timer_ms\" id=\"timer_ms\" value=\"0\"\/>\n\t\t\t\t\t<input type=\"hidden\" class=\"qmn_quiz_id\" name=\"qmn_quiz_id\" id=\"qmn_quiz_id\" value=\"3\" \/>\n\t\t\t\t\t<input type='hidden' name='complete_quiz' value='confirmation' \/>\n\t\t\t\t\t\t\t\t\t<\/form>\n\t\t<\/div>\n\t\t<div style=\"display: none;\" class=\"qsm-popup qsm-popup-slide\" id=\"modal-4\" aria-hidden=\"false\"><div class=\"qsm-popup__overlay\" tabindex=\"-1\" data-micromodal-close=\"\"><div class=\"qsm-popup__container qmn_quiz_container\" role=\"dialog\" aria-modal=\"true\"><div class=\"qsm-popup__content\"><img decoding=\"async\" src=\"https:\/\/staycurrent.md\/pediatricsurgery\/wp-content\/plugins\/quiz-master-next\/assets\/clock.png\" alt=\"clock.png\"\/><p 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