DHA Pediatric Surgery exam questions

6 worked Pediatric Surgery practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Abdominal and gastrointestinal surgery

   A 3-month-old ex-preterm boy has an incarcerated right inguinal hernia that reduces with sedation and gentle taxis. There is no sign of strangulation. When should repair be performed?

   1. AElective repair at 1 year of age
   2. BWithin 24 to 72 hours once oedema settles
   3. CImmediately, before the child wakes
   4. DOnly if it incarcerates a second time
   Show answer and explanation

   Correct answer: B. Within 24 to 72 hours once oedema settles

   After successful reduction, repair is advised during the same admission once tissue oedema has settled, as re-incarceration risk is high in infants. Delaying until 1 year or a second episode exposes the child to bowel and testicular ischaemia.

   Reference: Holcomb and Ashcraft's Pediatric Surgery, 7th ed.

2. Question 2 · Ethics, consent, safeguarding and patient safety

   According to the WHO Surgical Safety Checklist, which check is done at the sign-in stage before induction of anaesthesia?

   1. ACounting instruments, sponges and needles
   2. BTeam members introducing themselves by name and role
   3. CLabelling of specimens and equipment problems
   4. DConfirming patient identity, site, procedure and consent
   Show answer and explanation

   Correct answer: D. Confirming patient identity, site, procedure and consent

   Sign-in occurs before induction and confirms identity, site, procedure and consent, along with allergy, airway and blood loss risk. Team introductions occur at time-out, and counts and specimen labelling occur at sign-out.

   Reference: WHO Surgical Safety Checklist 2009

3. Question 3 · Neonatal surgery and congenital anomalies

   A newborn has excessive drooling, and a nasogastric tube coils in the upper chest on X-ray. There is gas in the stomach and bowel. What is the most likely anomaly?

   1. AOesophageal atresia with distal tracheo-oesophageal fistula
   2. BPure oesophageal atresia without fistula
   3. CH-type tracheo-oesophageal fistula
   4. DOesophageal atresia with proximal fistula only
   Show answer and explanation

   Correct answer: A. Oesophageal atresia with distal tracheo-oesophageal fistula

   A blind upper pouch with gas below the diaphragm indicates a distal fistula, the most common type (about 85%). Pure atresia gives a gasless abdomen, and an H-type fistula does not prevent tube passage.

   Reference: Holcomb and Ashcraft's Pediatric Surgery, 7th ed.

4. Question 4 · Paediatric surgical oncology

   During upfront nephrectomy for a unilateral Wilms tumour, there is intraoperative tumour spillage into the peritoneal cavity. Lymph nodes are negative. How does this affect staging under the COG system?

   1. ARemains stage I
   2. BBecomes stage II
   3. CUpstaged to stage III
   4. DBecomes stage IV
   Show answer and explanation

   Correct answer: C. Upstaged to stage III

   In COG staging, intraoperative tumour spillage makes the tumour local stage III, requiring more intensive therapy including radiotherapy. This is why careful handling and avoiding rupture are key surgical principles.

   Reference: Children's Oncology Group Wilms Tumour Staging

5. Question 5 · Paediatric surgical oncology

   A newborn has a large external sacrococcygeal teratoma. What technical step most reduces the risk of recurrence?

   1. ADebulking and later radiotherapy
   2. BExcision of the external component only
   3. CEn bloc resection including the coccyx
   4. DPreoperative chemotherapy in all cases
   Show answer and explanation

   Correct answer: C. En bloc resection including the coccyx

   Failure to remove the coccyx is associated with a high recurrence rate, so complete en bloc excision with coccygectomy is standard. Most neonatal lesions are benign and do not need chemotherapy.

   Reference: Holcomb and Ashcraft's Pediatric Surgery, 7th ed.

6. Question 6 · Paediatric trauma

   A 7-year-old has bilious vomiting 2 days after a handlebar injury to the upper abdomen. CT shows an intramural duodenal haematoma with no free air. What is the most appropriate treatment?

   1. ALaparotomy and evacuation of the haematoma
   2. BNasogastric decompression and parenteral nutrition
   3. CGastrojejunostomy bypass
   4. DEndoscopic incision of the haematoma
   Show answer and explanation

   Correct answer: B. Nasogastric decompression and parenteral nutrition

   Isolated duodenal haematoma usually resolves with gastric decompression and nutritional support over 1 to 3 weeks. Surgery is reserved for perforation or failure to resolve.

   Reference: Holcomb and Ashcraft's Pediatric Surgery, 7th ed.