Free Practice Questions for Saudi Board Pediatric Surgery

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Sample Saudi Board Pediatric Surgery Practice Questions

Try these sample questions to review concepts for the Saudi Board Pediatric Surgery exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 6-month-old infant weighing 8 kg is admitted for elective repair of an inguinal hernia. According to the traditional Holliday-Segar method, what is the infant's baseline hourly maintenance fluid requirement, and which intravenous solution is currently recommended for routine perioperative maintenance to prevent hospital-acquired hyponatremia?

A.32 mL/hr using isotonic balanced crystalloid or 0.9% NaCl in 5% dextrose

B.32 mL/hr using hypotonic 0.2% NaCl in 5% dextrose (D5 0.2% NS)

C.24 mL/hr using hypotonic 0.45% NaCl in 5% dextrose (D5 0.45% NS)

D.40 mL/hr using isotonic balanced crystalloid without dextrose

Explanation: Based on the Holliday-Segar formula (100 mL/kg/day for the first 10 kg, equivalent to 4 mL/kg/hr), an 8 kg infant requires 32 mL/hr of maintenance fluid. Modern pediatric surgical and pediatric consensus guidelines (including AAP and international perioperative standards) recommend isotonic crystalloids (such as 0.9% normal saline or balanced electrolyte solutions like Plasmalyte or lactated Ringer with or without 5% dextrose) rather than hypotonic solutions, because surgical stress and pain stimulate non-osmotic antidiuretic hormone (ADH) secretion, placing children receiving hypotonic fluids at high risk for acute, life-threatening hyponatremic encephalopathy.

2A 4-month-old infant with short bowel syndrome secondary to neonatal volvulus has been receiving total parenteral nutrition (TPN) since birth. Over the past 3 weeks, total bilirubin rose to 7.8 mg/dL with a direct fraction of 5.6 mg/dL, and alkaline phosphatase and gamma-glutamyl transferase are markedly elevated. Which strategy is most effective in reversing or arresting the progression of intestinal failure-associated liver disease (IFALD) in this infant?

A.Increasing the soybean oil-based lipid emulsion dose to provide essential fatty acids

B.Immediate urgent surgical placement of a surgical biliary drainage stent

C.Initiating continuous prophylactic intravenous metronidazole while doubling the amino acid concentration

D.Replacing or reducing soybean oil-based lipid emulsion with a 100% fish oil-based lipid emulsion (Omegaven)

Explanation: Intestinal failure-associated liver disease (IFALD) is significantly driven by soybean oil-based lipid emulsions, which contain high concentrations of pro-inflammatory omega-6 fatty acids and plant phytosterols (such as stigmasterol) that impair biliary excretion and promote hepatic macrophage activation. Transitioning to a pure fish oil-based lipid emulsion (Omegaven) or a mixed composite lipid with fish oil provides omega-3 fatty acids (EPA and DHA), which possess potent anti-inflammatory properties, contain alpha-tocopherol (vitamin E), and lack phytosterols, consistently reversing direct hyperbilirubinemia in pediatric IFALD.

3A 3-year-old child weighing 14 kg is undergoing bilateral inguinal hernia repair. The surgeon plans a caudal epidural block using 0.25% bupivacaine (2.5 mg/mL) plain. What is the maximum safe recommended single-dose limit of plain bupivacaine for this child, and what is the first-line intravenous rescue agent if severe local anesthetic systemic toxicity (LAST) with cardiac arrest occurs?

A.14 mg (5.6 mL); intravenous calcium gluconate

B.28 mg (11.2 mL); 20% intravenous lipid emulsion

C.42 mg (16.8 mL); intravenous sodium bicarbonate

D.70 mg (28.0 mL); intravenous lidocaine bolus

Explanation: The maximum recommended safe single dose of plain bupivacaine in pediatric regional anesthesia is 2.0 to 2.5 mg/kg (for a 14 kg child, 2.0 mg/kg equals 28 mg, corresponding to 11.2 mL of 0.25% bupivacaine). If severe local anesthetic systemic toxicity (LAST) occurs—manifesting with refractory arrhythmias, severe myocardial depression, or cardiovascular collapse—the specific first-line antidote is 20% intravenous lipid emulsion (Intralipid), which creates a intravascular lipid sink that extracts the lipophilic local anesthetic and restores mitochondrial fatty acid oxidation.

4A full-term newborn undergoing laparotomy for intestinal obstruction experiences intraoperative hypothermia with a core body temperature dropping to 34.8°C. What is the primary physiological mechanism by which neonates attempt to generate heat, and what is the immediate pathophysiological consequence of cold stress in this population?

A.Shivering thermogenesis; peripheral vasodilation and respiratory alkalosis

B.Increased glycogenolysis in white adipose tissue; severe hyperthermic rebound and hypernatremia

C.Non-shivering thermogenesis in brown fat; pulmonary vasoconstriction and acidosis

D.Voluntary muscle activity and hyperventilation; hypokalemia and metabolic alkalosis

Explanation: Neonates cannot produce heat through shivering because their skeletal muscle mass is small and neurological thermoregulatory reflexes are immature. Instead, they rely on non-shivering thermogenesis in brown adipose tissue, mediated by norepinephrine-driven uncoupling protein-1 (UCP-1 / thermogenin) in mitochondrial membranes. Cold stress triggers intense sympathetic vasoconstriction, leading to pulmonary hypertension, right-to-left shunting through the ductus arteriosus or foramen ovale, hypoxemia, increased anaerobic metabolism, and severe refractory metabolic lactic acidosis.

5A 5-year-old child with severe blunt liver and splenic trauma is undergoing damage control laparotomy with massive ongoing hemorrhage. Which resuscitation strategy is considered best practice according to modern pediatric massive transfusion protocols (MTP)?

A.Aggressive crystalloid resuscitation with 60 mL/kg normal saline before giving any blood products

B.Initial administration of hydroxyethyl starch colloids followed by uncrossmatched whole blood without warming

C.Exclusive transfusion of packed red blood cells titrated to a hemoglobin of 14 g/dL without plasma or platelets

D.Balanced, weight-based fixed-ratio (1:1:1) transfusion of red cells, plasma and platelets

Explanation: Modern pediatric massive transfusion protocols prioritize balanced, damage-control hemostatic resuscitation using fixed ratios of packed red blood cells (pRBC), fresh frozen plasma (FFP), and platelets approximating 1:1:1 (or reconstituted whole blood) to prevent dilutional coagulopathy, acidosis, and hypothermia (the lethal triad). Ionized calcium must be monitored closely and aggressively repleted with calcium chloride or gluconate, because citrate in blood products binds free calcium, rapidly impairing coagulation factor assembly and myocardial contractility.

6Fetal skin wounds created early in gestation (before approximately 24 weeks) heal characteristically without scar formation. Which biomolecular feature is most characteristic of this unique scarless fetal wound healing environment?

A.High levels of transforming growth factor-beta 1 (TGF-beta 1) and marked neutrophil infiltration

B.Abundant hyaluronic acid, predominantly type III collagen and low TGF-beta 1

C.Predominant deposition of disorganized collagen type I with intense myofibroblast differentiation

D.High concentrations of platelet-derived growth factor (PDGF) and dense angiogenesis

Explanation: Scarless fetal cutaneous repair is characterized by a specialized extracellular matrix rich in hyaluronic acid (which remains elevated for prolonged periods), an organized network composed predominantly of type III collagen rather than dense type I collagen, and a remarkably diminished inflammatory response. Crucially, fetal wounds exhibit low levels of pro-fibrotic cytokines TGF-beta 1 and TGF-beta 2, along with high relative levels of anti-fibrotic TGF-beta 3, resulting in minimal fibroblast-to-myofibroblast differentiation and absent tissue contracture.

7An 8-year-old child with severe protein-calorie malnutrition secondary to neglected short bowel syndrome is started on full-dose aggressive parenteral nutrition with high dextrose content. On day 2, the child develops lethargy, generalized muscle weakness, and cardiac arrhythmias. Which biochemical hallmark is the primary driver of this refeeding syndrome?

A.Hyperphosphatemia and hyperkalemia

B.Isolated hypermagnesemia causing central nervous system depression

C.Severe hypercalcemia resulting from bone resorption

D.Hypophosphatemia from insulin-driven intracellular shift

Explanation: Refeeding syndrome occurs when carbohydrate or caloric intake is abruptly introduced to a chronically starved or malnourished patient. The sudden glucose load stimulates massive insulin secretion, which drives phosphate, potassium, and magnesium into the intracellular compartment to facilitate glycolysis and ATP synthesis. This precipitous drop in serum inorganic phosphate (severe hypophosphatemia) depletes 2,3-DPG and ATP, leading to impaired tissue oxygenation, diaphragmatic weakness, rhabdomyolysis, neuromuscular irritability, and fatal cardiac arrhythmias.

8A 4-year-old boy is brought to the pediatric trauma center following a severe motor vehicle crash with a Grade V liver laceration and profound hemorrhagic shock. Despite aggressive crystalloid resuscitation and application of pelvic binder, active hemorrhage continues and hemoglobin drops to 4.2 g/dL with impending cardiac arrest. The parents, who are devout Jehovah's Witnesses, adamantly refuse all blood product transfusions on religious grounds. What is the ethically and legally sound immediate action for the pediatric surgical team?

A.Respect parental refusal and administer only non-blood crystalloids and colloids even if death is imminent

B.Proceed immediately with emergent blood transfusion to preserve the child's life under the emergency treatment doctrine

C.Discharge the patient against medical advice or transfer the child immediately to a different facility

D.Delay blood transfusion until an emergency court order is formally granted by a judge several hours later

Explanation: In pediatric medical ethics and legal jurisprudence, parents have wide discretion in making medical decisions for their children, but parental autonomy does not extend to the right to refuse life-saving treatment or allow a child to die when an effective, life-saving therapy exists. In emergency situations with imminent peril to the child's life, the doctrine of parens patriae and the emergency medical exception obligate physicians to provide emergent life-saving blood products immediately; emergency court intervention can be obtained retrospectively or concurrently, but treatment must never be delayed.

9A 4-year-old girl weighing 16 kg is brought to the emergency department following an auto-pedestrian collision. She is pale, lethargic, tachycardic (heart rate 165 bpm), and has delayed capillary refill (4 seconds) with a blood pressure of 82/46 mmHg. According to pediatric ATLS guidelines, what is the initial recommended fluid bolus for her hemorrhagic shock?

A.5 mL/kg (80 mL) of 5% albumin solution

B.20 mL/kg (320 mL) of warmed isotonic crystalloid

C.40 mL/kg (640 mL) of cold 0.45% NaCl with 5% dextrose

D.100 mL/kg (1600 mL) rapid high-pressure infusion of crystalloid

Explanation: Pediatric Advanced Trauma Life Support (ATLS) guidelines recommend an initial bolus of 20 mL/kg of warmed isotonic crystalloid (such as lactated Ringer or normal saline) over 5-10 minutes for pediatric trauma patients presenting in hypovolemic shock. If the child shows no hemodynamic improvement or only transient response after one or two 20 mL/kg crystalloid boluses, immediate initiation of packed red blood cells (10-20 mL/kg) or balanced blood product resuscitation is indicated.

10An 8-year-old boy falls from a bicycle onto his handlebars and presents with left upper quadrant tenderness. Contrast-enhanced abdominal CT reveals a Grade III splenic laceration with perisplenic hemoperitoneum without contrast blush. The child remains hemodynamically stable with normal heart rate and serial hemoglobin measurements of 12.0 g/dL and 11.8 g/dL. According to updated American Pediatric Surgical Association (APSA) guidelines, what is the most appropriate management plan?

A.Immediate exploratory laparotomy and total splenectomy

B.Non-operative management guided by physiological stability

C.Angiographic embolization under general anesthesia within 2 hours of arrival

D.Mandatory 7-day bed rest in the intensive care unit regardless of clinical status

Explanation: Over 95% of blunt splenic injuries in children are successfully managed non-operatively. Updated APSA guidelines emphasize hemodynamic stability rather than CT injury grade in dictating the level of monitoring and hospital stay. Hemodynamically stable children do not require prolonged ICU stays; they can be monitored on a regular surgical floor, mobilized early (within 24-48 hours once stable), and restricted from contact sports/rough play for the injury grade plus 2 weeks (or approximately 4-6 weeks total for Grade III).

About the Saudi Board Pediatric Surgery Exam

Independent English-language MCQ study adaptation by OpenExamPrep. Independent practice resource by OpenExamPrep for the Saudi Board Residency Final Examination in Pediatric Surgery. Covers the ten blueprint areas: Basic Principles, Trauma, Oncology, Head and Neck, Thorax, Abdomen, Genitourinary, Special Areas, Gastrointestinal and Hepatobiliary, and Neonatal Surgery. Note: This question bank is an independent study aid for the final written examination and does not simulate the separate clinical OSCE and structured oral examination required for final board certification. This resource is distinct from the SCFHS subspecialty fellowship examination. OpenExamPrep is an independent learning platform and is not affiliated with or endorsed by the Saudi Commission for Health Specialties (SCFHS).

Exam sponsor: Saudi Commission for Health Specialties (SCFHS). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

Time Limit

Not published by SCFHS

Passing Score

70% (lowered to minimum 65% if pass rate under 70%)

Exam / Certification Fees

Not published by SCFHS

Exam sponsor website

Reported exam pass rate: Not published by SCFHS. SCFHS publishes no candidate pass rate. The blueprint instead sets the passing score at 70% and, if fewer than 70% of candidates pass before final approval, lowers that score one mark at a time until a 70% pass rate is reached or the score reaches 65%, whichever comes first; it is never lowered below 65%. Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

Basic Principles

Pediatric surgical physiology, fluid and electrolyte management, surgical nutrition, wound healing, and pharmacology.

10%

Trauma

Pediatric trauma resuscitation, blunt abdominal and thoracic trauma, non-accidental trauma, and organ injury management.

Oncology

Solid tumors of childhood including neuroblastoma, Wilms tumor, hepatoblastoma, rhabdomyosarcoma, and germ cell tumors.

Head and Neck

Congenital neck masses, branchial cleft anomalies, thyroglossal duct cysts, lymphatic malformations, and torticollis.

14%

Thorax

Congenital diaphragmatic hernia, lung lesions (CPAM, sequestration, CLE), esophageal atresia and tracheoesophageal fistula, and chest wall deformities.

11%

Abdomen

Pyloric stenosis, intussusception, pediatric inguinal and umbilical hernias, undescended testes, and appendicitis.

Genitourinary

Testicular and ovarian torsion, posterior urethral valves, vesicoureteral reflux, hypospadias, and differences of sex development.

Special Areas

Pediatric vascular access, burns, minimally invasive surgery, ECMO, fetal intervention, and adolescent bariatrics.

15%

Gastrointestinal and Hepatobiliary

Biliary atresia, choledochal cysts, portal hypertension, intestinal malrotation, Meckel diverticulum, Hirschsprung disease, and inflammatory bowel disease.

14%

Neonatal Surgery

Necrotizing enterocolitis, intestinal atresia, meconium ileus, abdominal wall defects (omphalocele, gastroschisis), and anorectal malformations.

Preparing for the Saudi Board Pediatric Surgery Exam

What You Need to Know

Passing score: 70% (lowered to minimum 65% if pass rate under 70%)
Assessment: Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.
Time limit: Not published by SCFHS
Exam / certification fees: Not published by SCFHS Official sources

Using Our Practice Resources

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Saudi Board Pediatric Surgery: Suggested Study Strategy

1Focus heavily on Neonatal Surgery (14%), Thorax (14%), and Gastrointestinal/Hepatobiliary (15%), which together represent nearly half of the written examination.

2Review the physiologic stabilization principles of congenital diaphragmatic hernia, emphasizing gentle ventilation, permissive hypercapnia, and targeted echocardiographic assessment of pulmonary hypertension.

3Master the diagnostic evaluation and surgical management timing of biliary atresia, including Kasai portoenterostomy principles and post-operative adjuvant therapies.

4Know the staging systems, genetic markers, and operative guidelines for pediatric solid tumors, including neuroblastoma (MYCN, INRGSS) and Wilms tumor (COG vs SIOP, nephron-sparing surgery indications).

5Understand the algorithmic management of pediatric blunt abdominal trauma according to APSA guidelines, identifying specific indications for surgical exploration versus angioembolization.

Frequently Asked Questions

What is the format of the Saudi Board Pediatric Surgery Final Written Examination?

Two papers, each with 100–125 single-best-answer MCQs. Up to 10% additional unscored items may be added. Duration is not stated in the written blueprint.

What is the passing score for the Saudi Board Pediatric Surgery Final Written Examination?

The passing standard is set at 70%. If the overall pass rate among candidates falls below 70%, the passing score is adjusted downward one mark at a time until reaching a 70% candidate pass rate, with an absolute floor of 65%.

Does this question bank simulate the clinical OSCE component?

This bank is an independent English-language MCQ study adaptation for the written examination. It does not simulate or replace the separate mandatory final clinical/practical assessment. Consult the specialty clinical blueprint for its station formats and any structured oral or OSCE components.

How does the residency board examination differ from the fellowship examination?

SCFHS conducts both the primary residency certification examination (Main Specialty in Pediatric Surgery) and a subspecialty fellowship examination. This question bank addresses the comprehensive residency final written examination syllabus.

Who administers the Saudi Board Pediatric Surgery certification?

The examination and specialty certification are administered by the Saudi Commission for Health Specialties (SCFHS). OpenExamPrep is an independent educational platform and is not affiliated with or endorsed by SCFHS.

Free Practice Questions for Saudi Board Pediatric Surgery

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