100+ Free ABS Pediatric Surgery Practice Questions

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A term newborn with prenatally diagnosed left congenital diaphragmatic hernia (CDH) is intubated in the delivery room. Which ventilation strategy is recommended per CDH Study Group (CDHSG) consensus?

Aggressive hyperventilation to PaCO2 < 30 mmHg

Gentle ventilation with permissive hypercapnia (PaCO2 up to 60-65 mmHg) and preductal SpO2 85-95%

High-frequency jet ventilation with tidal volumes of 10 mL/kg

Immediate surfactant and delivery-room thoracotomy

to track

2026 Statistics

Key Facts: ABS Pediatric Surgery Exam

~200

Total MCQ Items

ABS Pediatric Surgery Certifying Examination

~6-7 hr

Total Exam Time

1-day computer-based test including breaks

~31%

Neonatal Weight

Largest single domain on 2026 ABS pediatric surgery content outline

~$1,950

2026 Certifying Exam Fee

ABS (verify current schedule)

2 yr

Fellowship Duration

ACGME-accredited pediatric surgery fellowship after ABS General Surgery certification

~80-90%

First-Time Pass Rate

ABS annual statistics

The ABS Pediatric Surgery Certifying Examination is a 1-day computer-based test from the American Board of Surgery comprising ~200 single-best-answer MCQs over ~6-7 hours at Pearson VUE. Content spans neonatal (~31%), pediatric oncology (~17%), GI/abdominal wall (~15%), thoracic (~11%), trauma/burns (~7%), urology (~6%), endocrine/bariatric (~4%), airway (~3%), MIS (~2%), ECMO (~2%), fluids/nutrition (~2%), and ethics (~2%). Certifying Examination fee is ~$1,950; requires ABS General Surgery certification plus a 2-year ACGME pediatric surgery fellowship.

Sample ABS Pediatric Surgery Practice Questions

Try these sample questions to test your ABS Pediatric Surgery exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A term newborn with prenatally diagnosed left congenital diaphragmatic hernia (CDH) is intubated in the delivery room. Which ventilation strategy is recommended per CDH Study Group (CDHSG) consensus?

A.Aggressive hyperventilation to PaCO2 < 30 mmHg

B.Gentle ventilation with permissive hypercapnia (PaCO2 up to 60-65 mmHg) and preductal SpO2 85-95%

C.High-frequency jet ventilation with tidal volumes of 10 mL/kg

D.Immediate surfactant and delivery-room thoracotomy

Explanation: The CDHSG and APSA consensus advocate gentle ventilation: peak inspiratory pressures ≤25 cmH2O, permissive hypercapnia (PaCO2 up to 60-65 mmHg), preductal SpO2 85-95%, and avoidance of barotrauma. Hyperventilation worsens pulmonary hypertension and outcomes. Surgery is delayed until physiologic stabilization.

2In neonates with CDH, which threshold supports consideration of ECMO per current CDHSG criteria?

A.Oxygenation index (OI) > 40 despite maximal medical therapy

B.OI > 10 for 30 minutes

C.Any preductal SpO2 < 95%

D.Bilirubin > 5 mg/dL

Explanation: Persistent OI > 40, inability to maintain preductal SpO2 > 85%, severe refractory hypotension, or rising lactate despite optimization are ECMO criteria. Venoarterial ECMO is preferred in most centers for severe cardiac compromise; venovenous when cardiac function adequate.

3What is the most common anatomic variant of esophageal atresia with tracheoesophageal fistula?

A.Type A — pure esophageal atresia without fistula

B.Type B — proximal fistula with distal atresia

C.Type C — proximal atresia with distal TEF

D.Type E (H-type) — isolated fistula without atresia

Explanation: Gross Type C (proximal esophageal atresia with distal tracheoesophageal fistula) accounts for approximately 85% of cases. Type A (pure atresia) ~8%, Type E (H-type) ~4%, Type D (both fistulae) and Type B are rare.

4The VACTERL association includes which constellation of anomalies that should be screened for in an infant with esophageal atresia?

A.Vertebral, anorectal, cardiac, tracheoesophageal, renal, limb

B.Vitreoretinal, auditory, cranial, thymic, endocrine, lingual

C.Vascular, adrenal, colonic, thoracic, retinal, lumbar

D.Ventricular, abdominal, cerebellar, thyroid, rectal, laryngeal

Explanation: VACTERL = Vertebral, Anorectal, Cardiac, TracheoEsophageal, Renal, Limb. Diagnosis requires ≥3 components. Any infant with EA/TEF should receive echocardiography (identifies aortic arch side for thoracotomy planning), renal US, spine imaging, and limb/anal exam.

5A neonate presents with bilious emesis on day 3 of life. Upper GI contrast shows the duodenojejunal junction to the right of the spine and a corkscrew appearance of the proximal jejunum. What is the next step?

A.Observation with nasogastric decompression

B.Barium enema

C.Emergent laparotomy and Ladd procedure

D.Outpatient follow-up in 2 weeks

Explanation: Bilious emesis in a neonate is malrotation with midgut volvulus until proven otherwise. Corkscrew/Z appearance on UGI confirms volvulus. Emergent Ladd procedure: counterclockwise detorsion, division of Ladd bands, broadening of mesentery, appendectomy, bowel placed with small bowel on right and colon on left.

6Which radiographic sign is pathognomonic for duodenal atresia?

A.Ground-glass appearance

B.Double-bubble sign with no distal gas

C.Triple-bubble sign

D.Pneumatosis intestinalis

Explanation: The double-bubble sign (dilated stomach and proximal duodenum) with absence of distal bowel gas is classic for duodenal atresia. ~30% of patients have trisomy 21. Repair is duodenoduodenostomy (diamond-shaped anastomosis). Presence of distal gas suggests duodenal stenosis, web with fenestration, or malrotation.

7A neonate is born with bowel eviscerated through a defect to the right of an intact umbilicus with no covering sac. What is the diagnosis?

A.Omphalocele

B.Gastroschisis

C.Umbilical hernia

D.Patent urachus

Explanation: Gastroschisis: full-thickness paraumbilical abdominal wall defect, almost always to the RIGHT of the umbilicus, NO sac. Associated intestinal atresia in ~10%. Management: bowel-bag at birth, NG decompression, IV fluids, assess perfusion, then primary closure vs silo reduction.

8Omphalocele is distinguished from gastroschisis by which feature?

A.Always to the right of the umbilicus

B.Defect is covered by a sac (peritoneum + amnion) with the umbilical cord inserting on the sac

C.Never associated with chromosomal anomalies

D.Intestinal atresia is the most common association

Explanation: Omphalocele is a central abdominal wall defect with a covering sac and umbilical cord inserting on the sac. High association with chromosomal anomalies (trisomy 13, 18, 21), cardiac anomalies, and syndromes (Beckwith-Wiedemann, pentalogy of Cantrell). Gastroschisis lacks a sac and has lower rate of chromosomal anomalies but higher bowel injury.

9A premature infant at day 10 develops abdominal distension, bloody stools, and pneumatosis intestinalis on abdominal radiograph. Which Bell stage does this represent?

A.Bell stage IA — suspected NEC

B.Bell stage IIA — definite NEC, mildly ill

C.Bell stage IIIA — advanced NEC with perforation

D.Bell stage 0 — normal

Explanation: Bell staging: I (suspected — systemic/intestinal signs, nonspecific imaging), IIA (definite NEC with pneumatosis intestinalis, mildly ill), IIB (with portal venous gas or ascites), IIIA (critically ill, impending perforation), IIIB (perforation, pneumoperitoneum — surgical).

10Which radiographic finding in necrotizing enterocolitis mandates surgical intervention?

A.Pneumatosis intestinalis alone

B.Fixed dilated loop on serial films

C.Pneumoperitoneum (free air)

D.Portal venous gas

Explanation: Pneumoperitoneum (free air) is the ONLY absolute surgical indication in NEC, indicating perforation. Other findings such as fixed loop, portal venous gas, or clinical deterioration (worsening acidosis, thrombocytopenia, abdominal wall erythema, palpable mass) are relative indications. Options: laparotomy with resection vs primary peritoneal drainage (NEST trial — equivalent mortality for ELBW).

About the ABS Pediatric Surgery Exam

The ABS Pediatric Surgery Certifying Examination validates core knowledge for independent practice in pediatric surgery. Content spans neonatal surgery (CDH, EA/TEF, gastroschisis/omphalocele, intestinal atresias, Hirschsprung, imperforate anus, malrotation, NEC), pediatric oncology (Wilms, neuroblastoma, rhabdomyosarcoma, hepatoblastoma, sacrococcygeal teratoma), GI and abdominal wall (pyloric stenosis, intussusception, Meckel, biliary atresia, choledochal cyst, inguinal hernia), thoracic (CPAM, sequestration, pectus, empyema), pediatric trauma and burns, pediatric urology (orchiopexy, PUV, VUR, hypospadias), endocrine and adolescent metabolic/bariatric surgery, airway and head/neck, minimally invasive surgery, neonatal ECMO, fluids/nutrition, and ethics. Requires ABS General Surgery certification plus completion of an ACGME-accredited 2-year pediatric surgery fellowship.

Questions

200 scored questions

Time Limit

1-day CBT (~6-7 hours including breaks)

Passing Score

Criterion-referenced scaled score set by ABS (modified Angoff standard)

Exam Fee

~$1,950 Certifying Examination fee (ABS 2026 — verify current schedule) (American Board of Surgery (ABS) / Pearson VUE)

ABS Pediatric Surgery Exam Content Outline

~31%

Neonatal Surgery

CDH (Bochdalek vs Morgagni; CDHSG ECMO criteria; TOTAL trial FETO for severe left CDH; gentle ventilation, permissive hypercapnia, iNO for PPHN), EA/TEF (Gross classification — type C most common, primary repair with azygos ligation), gastroschisis vs omphalocele (silo, staged closure; Beckwith-Wiedemann, pentalogy of Cantrell), intestinal atresias (Apple-peel jejunal type IIIb), Hirschsprung (rectal suction biopsy, transanal pull-through — Soave/Swenson/Duhamel), imperforate anus (Peña PSARP, Krickenbeck), malrotation/volvulus (Ladd procedure), NEC (Bell staging, pneumatosis, portal venous gas, perforation → surgery).

~17%

Pediatric Oncology

Wilms/nephroblastoma (COG AREN, favorable vs unfavorable histology, 1p/16q LOH, transabdominal nephrectomy without preop biopsy unless bilateral), neuroblastoma (MYCN amplification, 11q, INRG staging, age <18 months favorable, urine VMA/HVA, MIBG), rhabdomyosarcoma (embryonal vs alveolar — PAX3/7-FOXO1 fusion risk stratification, IRS grouping, parameningeal and GU primaries), hepatoblastoma (PRETEXT, AFP, cisplatin-based chemo, resection or transplant), sacrococcygeal teratoma (Altman classification, AFP surveillance, mandatory coccygectomy), thyroid cancer (MEN2 RET prophylactic thyroidectomy).

~15%

GI & Abdominal Wall

Hypertrophic pyloric stenosis (Ramstedt, hypochloremic hypokalemic metabolic alkalosis — correct before OR), intussusception (ileocolic, air/contrast enema reduction, Meckel lead point), Meckel (rule of 2s, 99mTc pertechnetate scan), appendicitis, IBD surgical indications, short bowel syndrome (STEP), biliary atresia (Kasai hepatoportoenterostomy ideally <60 days), choledochal cyst (Todani type I most common, Roux-en-Y hepaticojejunostomy), inguinal hernia and hydrocele (high ligation).

~11%

Thoracic

CPAM (Stocker types 1-4, resection for symptomatic or oncologic risk — pleuropulmonary blastoma DICER1), congenital lobar emphysema, bronchogenic cyst, pulmonary sequestration (intralobar vs extralobar, aberrant systemic feeder from aorta), pectus excavatum (Haller index >3.25, Nuss procedure), pectus carinatum (Ravitch, bracing), empyema (VATS decortication, fibrinolytics), spontaneous pneumothorax, mediastinal masses (anterior — thymoma, teratoma, thyroid, terrible lymphoma).

~7%

Trauma & Burns

Pediatric primary survey (age-based tube size, pediatric vital sign ranges), non-accidental trauma (posterior rib, classic metaphyseal lesion, mandatory reporting), nonoperative management of hemodynamically stable spleen/liver/kidney, pediatric TBI, cervical spine clearance (SCIWORA), tranexamic acid in pediatric trauma (within 3 hours per CRASH-3-derived extrapolation), burns (modified Parkland 3-4 mL/kg/%TBSA, maintenance D5 separately <30 kg, avoid succinylcholine subacute burn — hyperkalemia).

~6%

Pediatric Urology

Undescended testis (orchiopexy 6-18 months to preserve fertility and reduce malignancy risk), testicular torsion (bell-clapper deformity — contralateral fixation), hypospadias (MAGPI, TIP/Snodgrass), posterior urethral valves (VCUG, cystoscopic ablation), UPJ obstruction (pyeloplasty), vesicoureteral reflux (grading, ureteral reimplantation), cloacal and bladder exstrophy-epispadias complex, varicocele.

~4%

Endocrine & Bariatric

Congenital hyperinsulinism (diffuse vs focal, 18F-DOPA PET, near-total pancreatectomy for diffuse), thyroid nodules (Bethesda), MEN syndromes (MEN2A/2B — RET — prophylactic thyroidectomy), pheochromocytoma, adolescent metabolic/bariatric surgery (sleeve gastrectomy is most common pediatric MBS; ASMBS pediatric BMI thresholds; lifelong vitamin/mineral supplementation).

~3%

Airway & Head/Neck

Foreign body aspiration (rigid bronchoscopy), laryngotracheal stenosis and reconstruction, tracheomalacia and aortopexy, branchial cleft anomalies (second most common), thyroglossal duct cyst (Sistrunk procedure with hyoid body), cystic hygroma/lymphatic malformation (sirolimus for complex microcystic or extensive disease, sclerotherapy), cervical lymphadenitis, congenital muscular torticollis.

~2%

Minimally Invasive Surgery (MIS)

Laparoscopic pyloromyotomy, thoracoscopic CDH and EA/TEF repair, laparoscopic Ladd procedure, laparoscopic appendectomy, CO2 insufflation pressures and pediatric ventilatory/hemodynamic considerations, single-incision approaches, pediatric robotics, retained foreign body risk.

~2%

ECMO

Neonatal and pediatric ECMO indications (CDH with severe PPHN, meconium aspiration, sepsis, refractory cardiogenic shock), VA vs VV cannulation, CDHSG ECMO selection criteria, anticoagulation (bivalirudin increasingly preferred over heparin for neonatal ECMO — reduced circuit thrombosis and bleeding), complications (intracranial hemorrhage — HUS surveillance), decannulation criteria.

~2%

Fluids, Nutrition & Perioperative

AAP 2018 isotonic maintenance fluids (D5 NS or D5 LR) in children to prevent hospital-acquired hyponatremia, 4-2-1 rate rule, Holliday-Segar daily volumes, neonatal glucose requirements (GIR 4-8 mg/kg/min), parenteral nutrition and intestinal failure-associated liver disease (SMOFlipid/Omegaven), pediatric antibiotic and adolescent VTE prophylaxis.

~2%

Ethics, Safety & Scholarly

Pediatric informed consent and assent, parental surrogate decision making, limits of parental authority, fetal intervention ethics (MOMS trial, FETO), end-of-life care, WHO surgical safety checklist, never events, biostatistics (sensitivity/specificity, PPV/NPV, NNT), research design (RCT, cohort, case-control), evidence levels.

How to Pass the ABS Pediatric Surgery Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABS (modified Angoff standard)
Exam length: 200 questions
Time limit: 1-day CBT (~6-7 hours including breaks)
Exam fee: ~$1,950 Certifying Examination fee (ABS 2026 — verify current schedule)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABS Pediatric Surgery Study Tips from Top Performers

1CDH management pearls — Bochdalek (posterolateral, 90%, more often left) vs Morgagni (anterior retrosternal, rare). Initial care is gentle ventilation with permissive hypercapnia, avoid high PIP, iNO for PPHN, and surfactant is NOT routinely beneficial. CDHSG ECMO criteria guide selection (OI, PaCO2, preductal SpO2). The TOTAL trial (2021) showed fetal endoluminal tracheal occlusion (FETO) improves survival in severe left-sided CDH (O/E LHR <25%). Repair after physiologic stabilization, not emergently.

2NEC Bell staging and surgical indications: Stage I suspected (nonspecific), Stage II definite (pneumatosis intestinalis), Stage III advanced (perforation, peritonitis, shock). Absolute surgical indications: pneumoperitoneum (free air) or clinical deterioration despite maximal medical therapy. Portal venous gas and fixed loop on serial films are relative indications. Surgery options: laparotomy with resection and enterostomy vs primary peritoneal drainage in extremely low birth weight (<1000 g) infants.

3Biliary atresia — Kasai hepatoportoenterostomy outcomes are strongly time-dependent. Best outcomes if performed BEFORE 60 days of life; results decline significantly after 90 days. Work-up: direct hyperbilirubinemia in neonate, HIDA scan (no excretion), intraoperative cholangiogram. Failed Kasai (persistent cholestasis or cirrhosis) → liver transplantation. Biliary atresia is the most common indication for pediatric liver transplant.

4Rhabdomyosarcoma risk stratification is driven by PAX-FOXO1 fusion status, NOT embryonal vs alveolar histology alone. PAX3-FOXO1 or PAX7-FOXO1 fusion positive = high risk (previously classified as alveolar). Fusion-negative tumors behave more like embryonal and have better prognosis. IRS grouping (I-IV) reflects completeness of resection and metastasis. Parameningeal primaries carry risk of CNS extension — MRI brain and CSF cytology required.

5AAP 2018 maintenance fluid guideline — use ISOTONIC fluids (D5 NS or D5 LR) at 4-2-1 rate for children >28 days to 18 years to reduce hospital-acquired hyponatremia from hypotonic fluids + ADH stress response. Neonates (<28 days) often need D10 or D12.5 given high glucose requirements (GIR 4-8 mg/kg/min). This represents a major departure from the historical hypotonic (0.45% NS or 0.2% NS) practice and is a favorite exam topic.

Frequently Asked Questions

What is the ABS Pediatric Surgery Certifying Examination?

The ABS Pediatric Surgery Certifying Examination is administered by the American Board of Surgery and is the written certifying examination for initial board certification in pediatric surgery. It validates breadth of knowledge across neonatal surgery, pediatric oncology, GI and abdominal wall, thoracic, trauma, urology, endocrine, airway and head/neck, minimally invasive surgery, neonatal ECMO, fluids and nutrition, and ethics/safety.

Who is eligible to take the ABS Pediatric Surgery Certifying Exam?

Candidates must hold current ABS General Surgery certification and have completed an ACGME-accredited 2-year pediatric surgery fellowship. A valid unrestricted medical license is required, and the fellowship program director must attest to satisfactory performance and ethics. Candidates must submit an application and operative case log per the ABS schedule.

What is the format of the ABS Pediatric Surgery Certifying Exam?

The ABS Pediatric Surgery Certifying Exam is a 1-day computer-based examination administered at Pearson VUE test centers, comprising approximately 200 single-best-answer multiple-choice questions over roughly 6-7 hours including breaks. Items commonly include clinical photographs, imaging, and intraoperative images. The exam is blueprinted to the ABS pediatric surgery content outline.

How much does the 2026 ABS Pediatric Surgery Certifying Exam cost?

The 2026 ABS Pediatric Surgery Certifying Examination fee is approximately $1,950 — always verify the current schedule on the ABS website. Cancellation and refund policies follow the ABS schedule with decreasing refunds as the exam date approaches. Retakes require re-registration and full fee payment within the allowed qualification window.

When is the 2026 exam administered?

The ABS Pediatric Surgery Certifying Examination is typically offered once annually. Applications generally open several months before the test with a strict submission deadline. Candidates schedule specific appointments with Pearson VUE after application approval. Exact 2026 dates should be confirmed on the ABS pediatric surgery certification page.

How is the exam scored?

ABS uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance relative to the fixed cut-score, not on other candidates. Score reports include domain-level feedback. Continuous Certification (CC) is required to maintain certification after initial passing.

What are the highest-yield topics?

Highest-yield topics include CDH management (CDHSG ECMO criteria, TOTAL trial FETO), EA/TEF Gross classification, gastroschisis vs omphalocele, Hirschsprung disease, malrotation and Ladd procedure, NEC Bell staging, biliary atresia Kasai <60 days, Wilms tumor COG AREN protocols, neuroblastoma MYCN/INRG, rhabdomyosarcoma PAX-FOXO1 risk stratification, sacrococcygeal teratoma Altman classification, CPAM Stocker types, pectus Nuss, orchiopexy timing, pediatric TXA in trauma, AAP 2018 isotonic maintenance fluids, sirolimus for lymphatic malformations, and bivalirudin neonatal ECMO.

How should I study for this exam?

Use a structured 18-24 month plan layered on fellowship. Map to the ABS content outline: begin with neonatal surgery and embryology, then pediatric oncology and thoracic, GI/abdominal wall, trauma/urology/endocrine, and finish with ECMO, airway, MIS, fluids/nutrition, and ethics. Integrate textbooks (Coran's Pediatric Surgery, Holcomb/Murphy), APSA review, In-Training Exam questions, and high-volume MCQ practice. Complete 2-3 full-length timed mock exams. Drill anatomy, operative steps, and clinical photograph recognition.