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Pediatric Board Questions – 3 Strategies to Skyrocket Your Score!


Doctor Examining ComputerNO! Pediatric board questions are NOT like mini-patients.

Don’t believe me? Well, by the end of this article you’re going to:

  1. Learn the difference between real life patients and test patients
  2. Learn 3 strategies towards correctly answering board-style questions that you can put into practice IMMEDIATELY to increase your board score
  3. Become familiar with free and paid resources at your disposal to help you work on your test-taking techniques
  4. Feel inspired to approach board-style questions as 75-second puzzles rather than stressful patient encounters


How would you proceed with the little girl below? It’s a short question, so please set your timer to 60 seconds, read the question below and commit to ONE answer choice. 

A 3-year-old female toddler presents for a routine well child visit. You note an abdominal mass on exam. You suspect the child may have a Wilms tumor. There have not been any urinary symptoms, but urine dipstick shows evidence of blood. There’s a history of breast cancer in the family. 

Which of the following is the most appropriate diagnostic test to determine the cause of the patient’s abdominal mass?

A. CT scan of the abdomen and pelvis

B. Complete urinalysis

C. Oncology referral

D. Biopsy of the mass

E. BRCA gene testing

Don’t worry. We’ll get to the answer!

Trust me, though… the lessons you’re about to learn from this article will forever change you. You will never approach your pediatric exam questions the same away again. I'm going to help you recognize that your TECHNIQUE towards answering board style questions can a MASSIVE impact on your score, and often has NOTHING to do with how you treat patients.

Click Here Now and Watch Your Free Video Training Session on Test-Taking Strategies!

Download the Pediatric Dermatology and Gastroenterology Chapters Now

To pass the boards, you need TECHNIQUE, the right CONTENT and COMMITMENT.


Click HERE & Learn 3 Test-Taking Techniques Right NOW to Increase Your Board Scores!



After failing the boards, I did hundreds of practice questions and soon realized that I had been answering board questions wrong my entire life. I’m now positive that my very average test-taking techniques contributed to my failing the pediatric board exam the first time I took it.

Here’s what I did back then. See if any of this sounds familiar.

STEP 1: I’d start by reading the entire clinical vignette.

STEP 2: Then I’d read the question being asked. This is sometimes referred to as the “question stem.”

STEP 3: Then I’d make a mental prediction about the answer.

STEP 4: Then I’d search the answer choices for my “predicted answer.”

After STEP 4, I’d usually go down one of two paths. If I saw my predicted answer, I’d choose it and then moved on to the next question. More commonly, it wasn’t that easy, and I did not see my predicted answer. That would lead me to STEP 5.

STEP 5: If I didn’t see my predicted answer, I’d then start reading the answer choices from A to E.

STEP 6: The next step varied for me a bit. I’d either read ALL of the answer choices and choose one immediately, or I’d find myself stuck with 2 or more answer choices that I liked. Then I’d have to re-read those possible choices to see which one I thought was most likely correct, or I would sometimes start working backwards by eliminating answer choices that were least likely to be correct.

STEP 7: I’d finally decide on one answer choice and then move on to the next question.

Oftentimes, the final decision is made by a guess because it came down to two answer choices.

Stressed Out DoctorWas it stressful to even read STEPS 1-7? Does a lot of this sound familiar?

If it does, you’re not alone. Pretty much everyone that I talk to about test-taking strategies mentions a very similar approach.

Sadly, we’ve all been doing it wrong!

We assume that board exams are meant to test our ability to evaluate patients. So, we approach each question as though it is representative of a patient under our care.

We listen to the chief complaint. We then listen to the History of Present Illness. We then perform a physical exam. We order labs. Finally, we come up with our most likely diagnosis.

The problem with taking this approach on an exam is that the patients on test can’t talk to us. We can’t ask them additional questions to help us narrow our differential diagnosis.

Also, we don’t have the luxury of being able to do any further research, a more detailed exam, or look up supporting data to help us come up with a conclusive diagnosis.

So if exam patients are not like our real life patients, shouldn’t we be taking a different approach to them?

Since all of their “lives” are worth the exact same to us in terms of equal examination points, wouldn’t it even make sense to simply abandon them after a challenging 75-second encounter?

Pediatric Board Questions Are Like A Game!THE “BOARD” GAME

Again, this is a board exam! It’s a TEST! The questions are MEANT to “test” you, but often with very limited information. This may seem like an obvious point, but this point of separating your duty to real life patients from a perceived duty to correctly answering every single test question correctly can be a HUGE realization for some people. It’s often a massive relief.

Getting back to this idea of the boards being a game, I think you’ll agree that all of us have said the words, “They tricked me!” at some point in our educational career.

Or, you may have said, “Ohhh…. I can’t believe I misread the question!

Or, “Are you serious? You mean I didn’t even have to read that entire page-long vignette in order to answer the question that was asked?

Or, “Next best step? C’mon!!! In real life practice I would do both ‘A' and ‘C' at the exact same time. How am I supposed to choose just one?

Whether they truly meant to “trick” you is actually not the point. The point is that pediatric board questions do not represent patients, and they DO represent a GAME! Each board question is essentially a game of strategy and wits… and trust me when I say that THERE ARE RULES AND ALGORITHMS THAT CAN BE APPLIED TO THE GAME!

Did you know that most board questions are reviewed by ENGLISH professors before they are used on an exam?

Why do you think that is?

The reason pediatric board questions are reviewed by English professors is because “the board” often uses the smallest nuisance to help them differentiate their correct answer from the next answer most likely to be chosen.



Remember the Wilms tumor question from the beginning of this article? What was your answer

Remember, it’s a game of information and a game of words! Here’s the question again.

A 3-year-old female toddler presents for a routine well child visit. You note an abdominal mass on exam. You suspect the child may have a Wilms tumor. There have not been any urinary symptoms, but urine dipstick shows evidence of blood. There’s a history of breast cancer in the family.

Which of the following is the most appropriate diagnostic test to determine the cause of the patient’s abdominal mass?

A. CT scan of the abdomen and pelvis

B. Complete urinalysis

C. Oncology referral

D. Biopsy of the mass

E. BRCA gene testing

Did you choose the same answer again?

Now that you know it’s a game, did you choose a different answer?


STOP! I don’t care if you got this question right or wrong. PLEASE read the rest of the article to LEARN some skills that are sure to help you on future exams.



Rule Book to Answering Pediatric Board QuestionsUntil I went through the PBR Coaching course myself, I would have NEVER believed that you could almost answer this question without any pediatric knowledge at all.

There is SO MUCH that goes into learning AWESOME strategies to answering board-style questions. It’s impossible for me to teach you everything in this one article, but I would like to share some strategies that you can immediately put into practice.


Start with the QUESTION!“The ask” refers to question stem, or the question/statement immediately preceding the answer choices.

There are a TON of reasons to do this, but one very simple reason to do this is so that you never have to say following phrase again:

“Are you serious?!? You mean I didn’t even have to read that entire page-long vignette in order to answer the question that was asked?”

When I failed the pediatric boards, I remember being unable to finish the first section of the exam. Early in the test section I remember having a TWO-PAGE clinical vignette that was associated with a growth chart. It took me forever to get through the information and digest the data.

When I finally got to “the ask,” I was asked something basic, like “Which of the following labs would you order to check for late onset congenital adrenal hyperplasia?”

Uhh… really? You mean I didn’t even have to read that entire thing? What was the purpose of the vignette?

For the last 7 questions of that section, I had to guess C because I ran out of time. The sad thing was that they were ALL 1-liner questions followed by 5 answer choices. I’m certain that I could have answered at least some of them correctly if I just had another 3 minutes on the exam. Sadly, I failed by about 7-9 questions.

I honestly have NO idea as to why the game is played this way, but it is. Knowing that question writers employ these kinds of tactics can be a huge timesaving advantage to you as you enter a 6-hour exam.


Focus on the detailsI see it OVER AND OVER again with the coaching students we work with. Poor test-taking technique is almost a disorder with some classic symptoms associated with it.

The most prevalent symptom is a LACK of attention to detail.

For PBR’s Coaching program, we provide detailed emails and PDFs with all of the information our coaching students will need, but we still get frantic emails asking where a particular resource is located. Oftentimes it’s at the bottom of the email string.

I was previously frustrated by these emails until I recognized this as a symptom of the “poor tester” disorder. I’m still not sure how to tell these docs that the info is right in front of them, and that they really need to practice focusing on the details of all written words. Any ideas?

Anyways, getting back to the “attention to detail”, once you have committed to reading something, please make sure you read every single word carefully. Don’t read to get “the gist.” That’s a HUGE mistake! Read with a clear intent to understand the meaning of all words in front of you.

This ties into another rule I’ll share with you about “reading the English.” So how can you work on this?


Having something under the word you are reading (finger or cursor) has been proven to increase comprehension AND speed.

Want to prove it to yourself? I suggest doing 25 questions the traditional way, and 25 questions as I’ve suggested. If you find yourself being slower the first time, don’t worry… just keep practicing until it becomes second nature.


I could write an entire article about this strategy alone, but I’ll try to summarize my thoughts in fewer than 300 words 🙂

Remember the Wilms tumor question? Let’s break down the ASK and the ANSWER CHOICES.


Which of the following is the most appropriate diagnostic test to determine the cause of the patient’s abdominal mass?

There’s so much information before the ASK, and there are so many great possible avenues that you could pursue with a real patient in your clinic, but at the end of the day, what is the question writer asking for?

Once you become familiar with our coaching techniques, you’ll be able to quickly summarize this ASK for just about any question into 1-2 words. For this question, the summary would be something along the lines of “diagnostic test.”

In real life, I’d probably want to do further imaging. For some clinicians, a referral to an oncologist might also seem appropriate as a next step, but that is NOT what the question is ASKing! This is not a “NEXT STEP in management” question. It’s a “DIAGNOSTIC test” question. Meaning, the answer MUST satisfy two conditions.

First, the answer choice MUST lead to a definitive diagnosis!

Second, as the question mentioned, it MUST be a TEST.

Now look at the answer choices below.


A. CT scan of the abdomen and pelvis

B. Complete urinalysis

C. Oncology referral

D. Biopsy of the mass

E. BRCA gene testing

A CT scan or a urinalysis can help to support the diagnosis of Wilms tumor, but will it give you a definitive diagnosis? NO!

Regardless of whether or not there is any connection between BRCA gene testing and Wilms tumor, will such testing give you a definitive diagnosis? NO!

Will a visit to an oncologist’s office give you a definitive diagnosis? NO! It may lead to the diagnosis, but it’s no different than ordering imaging. It’s only supportive.

What about the second condition that must be met? The ASK was for a diagnostic TEST. Is there an option shown above that can simply be eliminated because it’s not a TEST? YES! The oncology referral!

Board Exam Questions Are Like Puzzles!Are you starting to see how these test questions can be looked at as quick, 75-second PUZZLES?

Can you now see how starting with the ASK first, having attention to detail, and reading the ENGLISH words and their intent is so important? 

Is it possible that you could have answered that question without even reading the clinical vignette?


After this, hopefully you’ll NEVER have to say these words again!

Ohhh…. I can’t believe I misread the question!


There is SO MUCH MORE that you can learn about test-taking techniques. Even Googling the phrase “how to answer multiple choice questions” can give you free basic insights into how to work towards eliminating answer choices. Those techniques are great for ANY multiple-choice exam.

For medical exams there’s a bit to it, such as figuring out how to approach those “next best step in management” questions.

All of the techniques presented above and in PBR’s Test-Taking Strategies & Coaching course require practice in order to master them.


We now have a pure online program! The new PBR Test-Taking Strategies & Coaching Program starts with a 2-hour webinar titled, “The Core Concepts in Test-Taking Strategies.

After that, you can continue on with the FULL Test-Taking Strategies & Coaching Course in which you'll get:

  • 5 “Question Processing” webinars in which we process a ton of questions in a methodical and step-by-step manner
  • 1 “Group Chat” webinar (2 hours  long) in which 4 panelists discuss the following (and MUCH MORE)
    • The real reason it's important to take a full mock exam
    • How to focus on pacing during the exam
    • How to structure your breaks during the exam
    • How to manage stress and anxiety before and DURING the exam
    • Test-Day Diet
    • Experiment ABP questions
    • Specific strategies from the Test-Taking Strategies course
  • 16 BONUS “Question Processing” webinars
  • 1 BONUS “Group Chat” webinar

In total, that's 6 hours of core Test-Taking Strategies training plus and additional 20 hours of BONUS training.

Click the link below now and learn more about the”The Core Concepts in Test-Taking Strategies” webinar.

WIN at answering pediatric board questions!


Q&A Questions and AnswersThrough exclusive affiliate relationships with companies like BoardVitals and Exam Master, I've been able to secure great discount codes for you.

Just visit the TOOLS page to find the discount codes.

I would really LOVE to know how you answered the question above, and whether or not you found this article useful. PLEASE leave a comment below. Feel free to use an alias name as long as your email address (only visible to me) is real.

Ashish Goyal, M.D.

Click Here to Leave a Comment Below 8 comments
La Doc -

Very well written and informative article, Ashish.
Keep up the great work!

Dionne Cozier Ross -

I answered biopsy because I focused on diagnostic test in the question

Ashish Goyal, M.D. -

It’s the longest article I’ve ever written for PBR… and I felt like I continue writing for days given how much benefit there is around developing strong test-taking strategies. Thanks for the feedback!

Ashish Goyal, M.D. -

Excellent! Well done!

k -

Good emphasis on Reading the English as well as remebering this is not a child in your clinic ,it’s a test ,no luxury of ‘managing’ that child.

peggy -

perfect …as usual

jon -

I also immediately chose biopsy because like Dionne it focused on the diagnostic test. While you can skip the vignette and just answer the question, the vignettes while not real life, can help you down the road with actual patients since I tend to remember and absorb a lot of what I read.

Dr.suzan -

Thank you from all my heart , i feel great coz u open my eyes to these tricks
Iam from Saudi arabia i will get the exame next year


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