Pediatric Surgery Prometric exam questions with answers

1. Question 1Abdominal and gastrointestinal surgerymedium

   A 9-year-old has 6 days of abdominal pain and fever. CT shows perforated appendicitis with a 5 cm well-defined pelvic abscess. She is stable. What is the most appropriate initial management?

   1. AIntravenous antibiotics and percutaneous drainage
   2. BImmediate open appendicectomy
   3. COral antibiotics and discharge home
   4. DDiagnostic laparoscopy within the hour
   Show answer and explanation▾

   Answer: A. Intravenous antibiotics and percutaneous drainage

   A well-formed abscess in a stable child is commonly managed with antibiotics and image-guided drainage, avoiding a difficult early operation in inflamed tissue. Oral antibiotics alone at home are inadequate for a large abscess.

2. Question 2Abdominal and gastrointestinal surgeryhard

   A 4-year-old has intermittent abdominal pain and jaundice. Imaging shows fusiform dilatation of the common bile duct (Todani type I). What is the recommended operation?

   1. ACystoduodenostomy with cholecystectomy
   2. BEndoscopic sphincterotomy and stenting alone
   3. CCyst excision with Roux-en-Y hepaticojejunostomy
   4. DCholecystectomy with intraoperative cholangiogram
   Show answer and explanation▾

   Answer: C. Cyst excision with Roux-en-Y hepaticojejunostomy

   Complete excision of the cyst with biliary reconstruction is standard because the cyst wall carries a long-term risk of cholangiocarcinoma. Internal drainage procedures such as cystoduodenostomy leave the cyst behind and cause cholangitis.

3. Question 3Neonatal surgery and congenital anomaliesmedium

   A 4-day-old term baby has new bilious vomiting. He is haemodynamically stable with a soft abdomen, and plain radiograph shows a non-specific gas pattern. What is the most appropriate next investigation?

   1. AAbdominal ultrasound for pyloric stenosis
   2. BUrgent upper gastrointestinal contrast study
   3. CContrast enema for Hirschsprung disease
   4. DRepeat plain radiograph in 12 hours
   Show answer and explanation▾

   Answer: B. Urgent upper gastrointestinal contrast study

   Bilious vomiting in a neonate is malrotation with volvulus until proven otherwise, and an urgent upper GI contrast study showing an abnormal duodenojejunal flexure position is the standard test. Delay risks loss of the midgut, and pyloric stenosis causes non-bilious vomiting.

4. Question 4Neonatal surgery and congenital anomaliesmedium

   A newborn has a midline abdominal wall defect with bowel and liver contained in a membranous sac at the umbilical cord insertion. Which investigation is most important before planning repair?

   1. AUpper gastrointestinal contrast study
   2. BAbdominal CT scan
   3. CEchocardiography and karyotype
   4. DRectal suction biopsy
   Show answer and explanation▾

   Answer: C. Echocardiography and karyotype

   Exomphalos is commonly associated with cardiac and chromosomal anomalies (such as trisomies 13, 18 and 21) and Beckwith-Wiedemann syndrome, which affect prognosis and timing. Gastroschisis has no sac and fewer associated anomalies.

5. Question 5Paediatric urology and genital surgeryeasy

   A 13-year-old has 3 hours of sudden severe left testicular pain, a high-riding testis and absent cremasteric reflex. What is the most appropriate next step?

   1. AImmediate scrotal exploration
   2. BDoppler ultrasound the next morning
   3. COral antibiotics for epididymitis
   4. DAnalgesia and review in 6 hours
   Show answer and explanation▾

   Answer: A. Immediate scrotal exploration

   Clinical findings strongly suggest torsion, and exploration should not be delayed for imaging because testicular salvage falls sharply after about 6 hours. Bilateral fixation is performed at operation.

6. Question 6Paediatric surgical oncologymedium

   A 2-year-old has an abdominal mass crossing the midline with calcification on CT and encasement of the aorta. Which test best supports the likely diagnosis?

   1. ASerum alpha-fetoprotein level
   2. BSerum beta-hCG level
   3. CUrine microscopy for blood
   4. DUrinary VMA and HVA levels
   Show answer and explanation▾

   Answer: D. Urinary VMA and HVA levels

   Calcification, crossing the midline and vessel encasement suggest neuroblastoma, which raises urinary vanillylmandelic and homovanillic acid. Alpha-fetoprotein is the marker for hepatoblastoma and germ cell tumours.

7. Question 7Perioperative care, fluids and nutritionhard

   A 6-year-old is admitted after appendicectomy and needs intravenous maintenance fluid. Which choice best reduces the risk of hospital-acquired hyponatraemia?

   1. AIsotonic crystalloid such as 0.9% saline with 5% glucose
   2. B0.18% saline with 4% glucose at full rate
   3. C0.45% saline at twice the maintenance rate
   4. D5% glucose in water without added sodium
   Show answer and explanation▾

   Answer: A. Isotonic crystalloid such as 0.9% saline with 5% glucose

   Postoperative children have non-osmotic ADH release, and hypotonic fluids have caused fatal hyponatraemia. Isotonic maintenance fluid with added glucose is recommended, with daily electrolyte monitoring.

8. Question 8Thoracic, head and neck surgeryeasy

   A 5-year-old has a midline neck swelling that moves upward on tongue protrusion. Thyroid tissue is normal on ultrasound. What operation is recommended?

   1. ASimple excision of the cyst and its wall
   2. BIncision and drainage then antibiotics
   3. CSistrunk procedure including the central hyoid
   4. DHemithyroidectomy with cyst excision
   Show answer and explanation▾

   Answer: C. Sistrunk procedure including the central hyoid

   Thyroglossal duct cysts are excised with the central portion of the hyoid bone and the tract towards the foramen caecum. Simple excision has a much higher recurrence rate.

9. Question 9Paediatric traumamedium

   A 10-year-old restrained back-seat passenger has abdominal wall bruising across the lower abdomen and a lumbar flexion-distraction (Chance) fracture. Which injury must be specifically sought?

   1. ADelayed rupture of the spleen
   2. BBlunt thoracic aortic transection
   3. CRupture of the left hemidiaphragm
   4. DBowel or mesenteric injury
   Show answer and explanation▾

   Answer: D. Bowel or mesenteric injury

   A lap-belt bruise with a Chance fracture is strongly associated with intestinal and mesenteric injury, which may be missed on early CT. Serial examination and a low threshold for laparoscopy are needed.

10. Question 10Paediatric traumamedium

    A 3-year-old in hypovolaemic shock after trauma has had two failed peripheral cannulation attempts. What is the next best route for access?

    1. AFemoral venous cut-down
    2. BIntraosseous needle in the proximal tibia
    3. CSubclavian central line
    4. DFurther peripheral attempts until successful
    Show answer and explanation▾

    Answer: B. Intraosseous needle in the proximal tibia

    If peripheral access fails after two attempts in a shocked child, intraosseous access is fast and reliable. Central lines and cut-downs take longer and need more expertise.

11. Question 11Paediatric urology and genital surgerymedium

    A newborn boy with antenatal bilateral hydronephrosis and a thick-walled bladder has a poor urinary stream. Which test confirms the likely diagnosis?

    1. ADMSA scan
    2. BVoiding cystourethrogram
    3. CIntravenous urogram
    4. DRenal biopsy
    Show answer and explanation▾

    Answer: B. Voiding cystourethrogram

    Posterior urethral valves are confirmed by voiding cystourethrography showing a dilated posterior urethra. Initial management is bladder drainage followed by endoscopic valve ablation.

12. Question 12Paediatric urology and genital surgerymedium

    Parents of a newborn with distal hypospadias ask for neonatal circumcision. What is the appropriate advice?

    1. AAvoid circumcision; the foreskin may be needed for repair
    2. BProceed with circumcision before discharge home
    3. CCircumcise now and plan the repair at 5 years
    4. DCircumcision now will correct the hypospadias
    Show answer and explanation▾

    Answer: A. Avoid circumcision; the foreskin may be needed for repair

    The foreskin is often used in hypospadias repair, so circumcision should be avoided until a urologist has assessed the child. Circumcision does not correct the abnormal meatal position.

13. Question 13Perioperative care, fluids and nutritionmedium

    A 6-month-old exclusively breastfed infant is booked for elective hernia repair. What is the minimum fasting time for breast milk?

    1. A2 hours
    2. B6 hours
    3. C4 hours
    4. D8 hours
    Show answer and explanation▾

    Answer: C. 4 hours

    Breast milk requires a minimum 4-hour fast in infants, compared with 6 hours for formula and solids. Clear fluids may be given up to 1 hour before induction under current paediatric guidance.

14. Question 14Thoracic, head and neck surgerymedium

    A 7-year-old has a recurrent discharging sinus at the anterior border of the lower third of the sternocleidomastoid. What is the most likely origin?

    1. AFirst branchial cleft
    2. BThyroglossal duct
    3. CThird pharyngeal pouch
    4. DSecond branchial cleft
    Show answer and explanation▾

    Answer: D. Second branchial cleft

    Second branchial cleft anomalies are the most common and open along the anterior border of the lower sternocleidomastoid, with a tract passing to the tonsillar fossa. First cleft anomalies relate to the ear and parotid region.

15. Question 15Thoracic, head and neck surgerymedium

    A 4-year-old with pneumonia has a large loculated pleural effusion on ultrasound and persistent fever despite 48 hours of antibiotics. What is an appropriate first intervention?

    1. AChest drain with intrapleural fibrinolytics
    2. BRepeated needle aspirations daily
    3. COpen thoracotomy and decortication
    4. DContinue antibiotics alone for 2 more weeks
    Show answer and explanation▾

    Answer: A. Chest drain with intrapleural fibrinolytics

    A small-bore drain with intrapleural fibrinolytics such as urokinase has outcomes similar to video-assisted thoracoscopic surgery in children. Open decortication is reserved for failed initial treatment.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.