Free Paediatric Surgery Section 1 (JCIE) Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Paediatric Surgery Section 1 (JCIE) practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 7-month-old boy has a persistently palpable inguinal testis that has never reached the scrotum. Surgery is being scheduled. According to the EAU recommendation, what is the latest age by which orchidopexy should be completed?

   1. A.12 months
   2. B.18 monthsCorrect answer: B
   3. C.24 months
   4. D.36 months

   Explanation: The EAU recommends: "Perform surgical orchidofunicolysis and orchidopexy before the age of 12 months, and by 18 months at the latest." The preferred timing is earlier, but the question asks for the latest recommended age: 18 months. Later dates exceed that boundary; 12 months is the preferred target rather than the latest limit.

   Reference: EAU Paediatric Urology: Undescended Testes — 4.7, Summary of evidence and recommendations for the management of undescended testes

2. 2A 6-week-old infant has persistent non-bilious projectile vomiting from confirmed pyloric stenosis. Which biochemical pattern is most consistent with prolonged gastric losses?

   1. A.Hyperchloraemic hypokalaemic metabolic acidosis
   2. B.Hypochloraemic hypokalaemic metabolic alkalosisCorrect answer: B
   3. C.Hypochloraemic hyperkalaemic metabolic acidosis
   4. D.Hyperchloraemic hyperkalaemic metabolic alkalosis

   Explanation: The source states: "Hypochloraemic hypokalaemic metabolic alkalosis" Loss of gastric acid and chloride produces the characteristic alkalosis, often with potassium depletion. The other combinations do not match prolonged vomiting in pyloric stenosis.

   Reference: RCH Clinical Practice Guideline: Pyloric Stenosis — Investigations

3. 3A 6-year-old has symptomatic phimosis without suspected balanitis xerotica obliterans and has not yet received medical treatment. Which topical drug class is recommended first-line?

   1. A.Topical antibiotics
   2. B.Topical corticosteroidsCorrect answer: B
   3. C.Topical antifungals
   4. D.Topical local anaesthetics

   Explanation: The guideline states: "Offer topical corticosteroids (ointment or cream) as first-line treatment in symptomatic phimosis." Corticosteroid treatment targets the narrowed preputial ring. The other classes are used for infection or analgesia, rather than first-line treatment of symptomatic phimosis.

   Reference: EAU Paediatric Urology: phimosis and other abnormalities of the penile skin — 3.6, Summary of evidence and recommendations for the management of phimosis

4. 4A neonate with oesophageal atresia is awaiting repair. Saliva must be drained from the upper oesophageal pouch. Which tube is used for this purpose?

   1. A.Foley catheter
   2. B.Replogle tubeCorrect answer: B
   3. C.Nasojejunal tube
   4. D.Gastrostomy tube

   Explanation: The source states: "a Replogle tube passed through his or her nose into the oesophagus." The Replogle tube drains pooled saliva before repair. The other named tubes serve different drainage or feeding routes.

   Reference: GOSH: Oesophageal Atresia with Tracheo-oesophageal Fistula — What happens before the operation?

5. 5A child with a renal mass has congenital aniridia, genitourinary anomalies and developmental delay. Which predisposition syndrome best fits this combination?

   1. A.Beckwith–Wiedemann syndrome
   2. B.WAGR syndromeCorrect answer: B
   3. C.Li–Fraumeni syndrome
   4. D.DICER1 syndrome

   Explanation: The source states: "WAGR = Wilms tumor, aniridia, genitourinary abnormalities, and range of developmental delays." This combination is the WAGR phenotype. Other cancer-predisposition syndromes have different defining clinical features.

   Reference: NCI PDQ: Wilms Tumor and Other Childhood Kidney Tumors Treatment — Table 1, abbreviation key, WAGR

6. 6An adolescent with pheochromocytoma needs treatment for persistent tachycardia before tumour resection. Which drug class must be established before a beta-blocker is added?

   1. A.Calcium-channel blocker
   2. B.Alpha-adrenergic receptor blockerCorrect answer: B
   3. C.Angiotensin-converting-enzyme inhibitor
   4. D.Thiazide diuretic

   Explanation: The PDQ states: "Beta-adrenergic blockade must never be initiated before alpha-adrenergic blockade". Alpha-blockade must precede adding the beta-blocker, avoiding unopposed alpha-mediated vasoconstriction. The other antihypertensive classes do not replace this prerequisite.

   Reference: NCI PDQ: Pheochromocytoma and Paraganglioma Treatment — Preoperative management

7. 7A teenager undergoes minimally invasive repair of pectus excavatum using a curved bar placed behind the sternum and rotated to elevate it, without cartilage resection. Which procedure is this?

   1. A.Modified Ravitch procedure
   2. B.Nuss procedureCorrect answer: B
   3. C.PectusUP procedure
   4. D.Abramson procedure

   Explanation: The source states: "The bar is put in under the skin and behind the breastbone." A retrosternal bar elevating the sternum without cartilage resection describes Nuss repair. Ravitch, PectusUP and Abramson are different chest-wall corrective procedures.

   Reference: SCTS: Pectus Conditions — The Nuss Procedure

8. 8A healthy child is preparing for elective anaesthesia under a paediatric fasting policy that permits clear fluids until one hour before surgery. If induction is scheduled for 10:00, what is the latest permitted time for clear water?

   1. A.06:00
   2. B.07:00
   3. C.08:00
   4. D.09:00Correct answer: D

   Explanation: The source states: "drinking clear fluids until 1 hour before surgery does not increase the risk of aspiration" 10:00 minus one hour is 09:00. 08:00 applies a two-hour interval; 07:00 applies three hours; 06:00 applies four hours. This question explicitly applies the stated clear-fluid policy rather than extending it to milk or solids.

   Reference: NHS GGC: Preoperative fasting of patients for theatre — Audience, fasting physiology and fluid intervals

9. 9After resuscitation of a child with severe head injury, shock has been corrected and spinal precautions are maintained. Which head position supports cerebral venous drainage?

   1. A.Head elevated 30° with the neck midlineCorrect answer: A
   2. B.Head elevated 30° with the neck rotated
   3. C.Head lowered 30° with the neck midline
   4. D.Head flat with the neck flexed forward

   Explanation: The source states: "30 degrees head up (after correction of shock) with head in midline position to help venous drainage" After correction of shock, 30° elevation with the head midline promotes venous drainage. Rotation, flexion and head-down positioning do not meet this neuroprotective recommendation.

   Reference: RCH Clinical Practice Guideline: Head injury — Standard neuroprotective measures

10. 10A paediatric surgical service in England is preparing for inspection of its quality and safety as a healthcare provider. Which body is the independent regulator of health and social care in England?

    1. A.General Medical Council
    2. B.Care Quality CommissionCorrect answer: B
    3. C.Health Research Authority
    4. D.Medicines and Healthcare products Regulatory Agency

    Explanation: The source states: "the independent regulator of health and social care in England" CQC regulates provider-level health and social care in England. The GMC regulates professionals; HRA concerns health research; MHRA regulates medicines and medical devices.

    Reference: Care Quality Commission — Homepage, regulatory role