Candidate I.D.

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Pediatric Surgery
The following are examples of items that you
would find in a short-answer question (SAQ)
exam. Model answers are included for your
information.

[Date]

Confidential – all rights reserved – unauthorized reproduction or use prohibited.

The images in this sample exam are for illustrative purposes only.

Booklet 1 of 1
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Pediatric Surgery

Instructions – Please Read Carefully

1. The time allowed for this examination is THREE hours.

2. Please use a ball-point or fountain pen only. Do not use a felt-tip pen.
It produces a script that spreads or is too thick and, therefore, is difficult or
impossible to read.

3. Please write or print as legibly as possible. The examiners cannot assign

marks for answers they cannot read.

4. Be as brief and as direct as possible, making use of the space provided after
each question.

5. Examination booklets must be returned intact to the invigilator. You may

not copy and/or remove the questions in any way.

6. If a specific number of answers is requested (e.g. list FOUR), do not list

more than requested as they will not be marked (e.g. if four are requested,
only the first four will be marked).

7. Certain questions might contain more than one page. Please make sure that
you have completed all pages of each booklet.

8. Please affix your candidate number sticker in the space provided on the
COVER PAGE of each examination booklet.

NOTE:
After test administration, statistical analyses are conducted and a small number of
questions may be deleted if they do not meet standards for psychometric validity.
Question weighting may vary because of the importance of the question or the number
of answers required. Deleted questions are not included when calculating candidates'
final scores and unanswered questions are scored as incorrect; therefore, you should
answer every question.

There is a standard process for evaluating changes in medicine that occur too late in the
test administration schedule to replace or modify any affected examination questions.
We advise candidates to answer all questions according to their understanding of
current clinical principles and practice. If it is determined that any question has been
compromised by new information (newly published findings), that question will be
reviewed to ensure that test-taker results are not adversely affected.
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Pediatric Surgery

Marks
1. A 12-year-old boy presents to the emergency department with an acutely
painful and tender right testicle. He received a knee to the genitalia
90 minutes ago while playing hockey. Two images from his ultrasound are
shown below. Physical examination shows an acutely tender, mildly bruised
and mildly swollen testicle.
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Pediatric Surgery
Marks

a) What is your presumptive diagnosis? 3

b) List the MAJOR ultrasound criteria that can lead to this diagnosis. 3

c) How will you treat the patient if your presumptive diagnosis is correct? 4
Justify your answer.
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Pediatric Surgery

Model Answer
Total 10 marks

a) This is a fractured testicle until proven otherwise. (3 marks)

b) The ultrasonic criteria for a ruptured or fractured testicle include;

i) Irregular outline of the testicle
ii) Inhomogeneous texture to the testicle
iii) Discrete fracture line can be seen in 17%
(3 marks, 1 for each item)
The candidate may note that there is blood supply, which is important but doesn’t rate a
mark as it doesn't answer the exact question.

c) Surgical exploration, debridement, irrigation and suture of the capsule. Justification is

optimization of maintenance of testicular function (4 marks)
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Pediatric Surgery

Marks
2.

a) Briefly describe the findings shown in the above illustration. State how 2
the test is performed.

b) List TWO other investigations that would be diagnostic. 1

c) List THREE clinical manifestations of this anomaly. 3

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Pediatric Surgery
Marks

d) What is the treatment for this anomaly? 1

e) List SIX possible postoperative complications. 3

Model Answer
Total 10 marks

a) H-type tracheoesophageal fistula (TEF), pull-back tube esophagography in prone

position (2 marks)

b) Bronchoscopy and esophagoscopy (1 mark)

c) Coughing, chocking and cyanosis with feeds. (1 mark)

Abdominal distension when crying or coughing. (1 mark)
Aspiration pneumonia. (1 mark)

d) Division and ligation of the fistula via a right cervical incision or thoracoscopy
(1 mark)

e)
Respiratory distress secondary to edema of trachea (0.5 mark)
Esophageal leak (0.5 mark)
Recurrent laryngeal nerve injury (0.5 mark)
Esophageal stricture (0.5 mark)
Recurrence (0.5 mark)
Infection (0.5 mark)
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Pediatric Surgery

Marks
3. a) What is the natural history of pectus carinatum? 1

b) Why is bracing effective in correcting pectus carinatum? 1

c) How long should a 14-year-old adolescent girl with pectus carinatum 3

wear the brace during the day? What is the total period of time that this
patient should wear the brace before it is discontinued?

d) What is the MOST common cause of inadequate correction of pectus 1

carinatum with bracing?

e) How is the brace tolerated by most patients? List THREE common 4

patient complaints associated with wearing a brace.
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Pediatric Surgery

Model Answer
Total 10 marks

a) 1 mark
The natural history of pectus carinatum is of a mild defect seen in infancy, which is
stable during childhood, but then with the growth spurt of puberty, the deformity often
worsens dramatically (1), drawing medical attention.

b) 1 mark
The chest wall is typically malleable and plastic during puberty.

c) 3 marks
Initially, patients are instructed to wear the brace for 23 hours daily (1) (correction
phase, CP). They are evaluated every 2-3 months during this phase. After the defect is
corrected to the satisfaction of the surgeon and the patient, bracing is reduced to 8-12
hours daily (1) (typically overnight) until cessation of axial skeletal growth (maintenance
phase, MP). Once the patient's height is stable for 6 months, the bracing is discontinued
(1).

d) 1 mark
Non-compliance

e) 4 marks
Overall, it is well tolerated (1), some reporting mild erythema at the bracing site (1),
minimal pain (1), and rarely skin breakdown (1).
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Pediatric Surgery

Marks
4. a) How is Peutz-Jeghers syndrome characterized clinically? 1

b) A diagnosis of Peutz-Jeghers syndrome is made in a 5-year-old boy. 1

What is this boy’s risk of dying from Peutz-Jegher associated cancer by
the age of 60?

c) What are eight elements of long-term surveillance in patients with 8

Peutz-Jeghers syndrome related to age that you would advise your
patients they should receive in the future when they leave your
practice?
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Pediatric Surgery

Model Answer
Total 10 marks

a) the association of intestinal polyps with mucocutaneous pigmentations (mouth, hands

and feet) (1 mark)

b) 50% (1 mark)

c) Annual evaluations of the following (8 marks):

1. Symptoms related to polyps
2. CBC to detect anemia
3. Breast and pelvic exam with cervical smears and pelvic ultrasound in girls
4. Testicular examination and ultrasound in boys
5. Biannual pancreatic ultrasound
6. Esophagogastroduodenoscopy and colonoscopy biannually
7. MRI of small intestine/pancreas
8. Mammography at age 25, 30, 35, and 38; then biannually until the age of 50, then
annually
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Pediatric Surgery

Marks
5. a) List TWO mechanisms of gas exchange in high-frequency oscillatory 2
ventilation (HFOV).

b) List FOUR parameters or settings that can be manipulated in HFOV. 2

c) Indicate the HFOV setting(s) or parameter(s) that can be manipulated

in order to achieve the desired effect listed below. A specific setting
may be used more than once, and more than one setting may be
required to achieve the desired effect.
i) increase in pO 2 2

ii) decrease in pCO 2 2

d) How do you determine that ideal lung volumes have been attained in 2
HFOV?
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Pediatric Surgery

Model Answer
Total 10 marks

a) 2 marks total; 1 mark each for any of the following

- Bulk ventilation
- Taylor dispersion
- Convective dispersion
- Molecular diffusion
- Cardiogenic mixing
- Pendelluft
- Collateral ventilation

b) 2 marks; 0.5 marks per correct answer

- Mean airway pressure (MAP)
- Amplitude
- Hertz
- FiO 2
- Bias flow

c) 4 marks total; 1 mark each

- Increase in pO 2 - increase mean airway pressure or increase FiO 2
- Decrease in pCO 2 - increase amplitude/ΔP or decrease Hertz

d) 2 marks
- Get a chest radiograph to assess lung distension - ideally should be 7-10 ribs

Before you leave the room, please return your examination

End booklet(s) to the invigilator.