100+ Free ABEM Peds EM Practice Questions

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Question 1

Score: 0/0

A 4-year-old child (weight 16 kg) is in pulseless ventricular fibrillation. CPR is in progress. What is the initial defibrillation dose?

1 J/kg (16 J)

2 J/kg (32 J)

4 J/kg (64 J)

10 J/kg (160 J)

to track

2026 Statistics

Key Facts: ABEM Peds EM Exam

~200

Exam Questions

ABEM/ABP PEM blueprint

~4 hours

Testing Time

ABEM/ABP PEM

2-3 years

PEM Fellowship

ACGME (2 yr EM / 3 yr Peds)

$945 + $1,495

Exam + App Fees (ABEM)

ABEM 2026

~85-92%

First-Time Pass Rate

ABEM/ABP historical

Joint

ABEM + ABP Sponsorship

Co-sponsored subspecialty

The ABEM Pediatric Emergency Medicine exam is a joint ABEM/ABP subspecialty certification administered at Pearson VUE testing centers. It contains approximately 200 single-best-answer multiple-choice questions over about 4 hours and covers pediatric resuscitation (PALS, NRP), trauma (PECARN rules), fever and sepsis evaluation by age, respiratory emergencies (bronchiolitis, croup, asthma, epiglottitis), DKA, GI emergencies (intussusception, pyloric stenosis, volvulus), pediatric cardiology (SVT, ductal-dependent CHD, Tet spells), toxicology (one-pill-kills), non-accidental trauma, orthopedic emergencies, and pediatric airway management. Candidates must first be board certified in Emergency Medicine (ABEM) or Pediatrics (ABP) and must complete an ACGME-accredited PEM fellowship. First-time pass rates run approximately 85-92%. Certificates follow a 10-year MOC cycle through MyEMCert (ABEM) or MOCA-Peds (ABP) depending on the sponsoring board.

Sample ABEM Peds EM Practice Questions

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

1A 4-year-old child (weight 16 kg) is in pulseless ventricular fibrillation. CPR is in progress. What is the initial defibrillation dose?

A.1 J/kg (16 J)

B.2 J/kg (32 J)

C.4 J/kg (64 J)

D.10 J/kg (160 J)

Explanation: PALS guidelines recommend an initial defibrillation dose of 2 J/kg for pediatric VF/pulseless VT. Subsequent shocks are 4 J/kg, and additional shocks may be at higher energy levels up to 10 J/kg (not exceeding adult dose). For this 16 kg child, the first shock is 32 J.

2A 3-year-old (14 kg) in cardiac arrest has IV access established. What is the correct epinephrine dose?

A.0.14 mg (1.4 mL of 1:10,000)

B.1.4 mg (14 mL of 1:10,000)

C.0.014 mg IV

D.0.14 mg (0.14 mL of 1:1,000)

Explanation: PALS epinephrine dose for cardiac arrest is 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000 concentration). For 14 kg: 0.14 mg = 1.4 mL of 1:10,000. The 1:1,000 concentration is reserved for ETT administration (0.1 mg/kg = 0.1 mL/kg of 1:1,000).

3During neonatal resuscitation, after the initial 30 seconds of warming, drying, stimulating, and positioning, the infant has a heart rate of 80 bpm. What is the next step?

A.Begin chest compressions

B.Initiate positive pressure ventilation (PPV) at 40-60 breaths/min

C.Administer epinephrine

D.Continue routine care

Explanation: Per NRP, after 30 seconds of initial steps, if HR <100 bpm, begin positive pressure ventilation at 40-60 breaths/min. Chest compressions are started only when HR remains <60 bpm despite effective PPV for at least 30 seconds, with a 3:1 compression-to-ventilation ratio.

4A newborn has a heart rate of 50 bpm after 30 seconds of effective PPV. What is the correct compression-to-ventilation ratio for this neonate?

A.15:2

B.30:2

C.3:1

D.5:1

Explanation: NRP specifies a 3:1 compression-to-ventilation ratio for neonates (3 compressions followed by 1 breath, delivering 90 compressions and 30 breaths per minute). This differs from the PALS 15:2 ratio for 2-rescuer pediatric CPR. The goal is 120 events per minute.

5A 6-year-old requires intubation. Using the age-based formula, which is the most appropriate uncuffed endotracheal tube size?

A.4.0

B.5.0

C.5.5

D.6.5

Explanation: For uncuffed ETT sizing in children >2 years: (age/4) + 4 = (6/4) + 4 = 5.5. For cuffed tubes, use (age/4) + 3.5 = 5.0. Cuffed tubes are increasingly used in pediatrics and are safe when cuff pressure is monitored and kept <20-25 cm H2O.

6A 2-year-old has pulseless electrical activity after submersion injury. IV/IO access cannot be obtained. Epinephrine is given via the endotracheal tube. Which dose and concentration is correct?

A.0.01 mg/kg of 1:10,000

B.0.1 mg/kg of 1:1,000

C.1 mg/kg of 1:10,000

D.0.1 mg/kg of 1:10,000

Explanation: When epinephrine is administered via endotracheal tube in pediatric cardiac arrest, the dose is 10 times higher than IV/IO: 0.1 mg/kg of 1:1,000 (0.1 mL/kg). Standard IV/IO dose is 0.01 mg/kg of 1:10,000. IO access should be rapidly pursued if IV fails in arrest.

7A 3-month-old infant is brought in after a minor head injury. According to the PECARN head trauma decision rule for children <2 years, which finding requires CT imaging?

A.Occipital scalp hematoma

B.Parietal scalp hematoma

C.Frontal scalp hematoma

D.Non-frontal (parietal, temporal, or occipital) scalp hematoma

Explanation: The PECARN <2 yr rule identifies non-frontal scalp hematoma (parietal, temporal, or occipital) as a predictor of clinically important TBI. Other predictors include LOC ≥5 sec, severe mechanism, altered mental status, palpable skull fracture, and not acting normally per parent. Isolated frontal hematomas are considered low risk.

8A 5-year-old falls from a bicycle and has a brief loss of consciousness. He is now at GCS 15, interactive, and without vomiting, severe headache, or signs of basilar skull fracture. According to PECARN ≥2 years, what is the next step?

A.Immediate head CT

B.Observation (with option for CT based on clinical course)

C.Skull radiographs

D.Discharge with no further observation

Explanation: PECARN ≥2 yr stratifies risk. With isolated brief LOC or isolated severe mechanism, the ciTBI risk is intermediate (~0.9%) and PECARN endorses observation versus CT based on clinician judgment, parental preference, multiple predictors, worsening, or age <3 months. Immediate CT is not mandatory.

9A 10-year-old involved in a low-speed MVC has neck pain. She is alert, without midline cervical tenderness, focal neurologic deficit, painful distracting injury, or altered mental status. Which approach is most appropriate?

A.Obtain AP, lateral, and odontoid C-spine radiographs

B.Clinical clearance without imaging

C.CT of the cervical spine

D.MRI of the cervical spine

Explanation: NEXUS criteria (also supported by PECARN pediatric C-spine work) allow clinical clearance without imaging in children with no posterior midline tenderness, no focal neurologic deficit, normal alertness, no intoxication, and no distracting injury. Imaging is reserved for those failing criteria.

10A 7-year-old involved in a rollover MVC has hemodynamically stable abdominal pain. Which combination of findings would support obtaining an abdominal CT per the PECARN intra-abdominal injury rule?

A.Age <5 years alone

B.Isolated seat belt sign

C.Presence of any predictor: GCS <14, abdominal tenderness, seat belt sign, thoracic wall trauma, abdominal pain, decreased breath sounds, or vomiting

D.Normal physical exam with mechanism alone

Explanation: The PECARN IAI rule identifies children at very low risk for intra-abdominal injury requiring intervention when none of 7 predictors are present: evidence of abdominal wall trauma or seat belt sign, GCS <14, abdominal tenderness, thoracic wall trauma, complaints of abdominal pain, decreased breath sounds, or vomiting. Any predictor warrants further workup.

About the ABEM Peds EM Exam

The ABEM Pediatric Emergency Medicine (PEM) exam is the subspecialty board certification jointly sponsored by the American Board of Emergency Medicine (ABEM) and the American Board of Pediatrics (ABP). It certifies physicians who have completed an ACGME-accredited PEM fellowship (2 years for EM-trained, 3 years for pediatrics-trained) in the emergency care of infants, children, and adolescents.

Questions

200 scored questions

Time Limit

~4 hours, computer-based

Passing Score

Criterion-referenced scaled passing score

Exam Fee

$945 exam fee + $1,495 application (ABEM pathway) (American Board of Emergency Medicine (co-sponsored with ABP))

ABEM Peds EM Exam Content Outline

18-20%

Resuscitation & Stabilization

PALS, NRP, pediatric airway, shock, defibrillation (2 then 4 J/kg), epinephrine 0.01 mg/kg IV/IO

14-16%

Trauma

PECARN head trauma rules, pediatric C-spine clearance, PECARN IAI rule, non-accidental trauma

10-12%

Respiratory Emergencies

Bronchiolitis (AAP 2014), croup (dex, racemic epi), asthma (continuous albuterol, Mg), epiglottitis

10-12%

Infectious Disease & Fever

Neonate full sepsis workup, PECARN IBI rule 29-60 d, fever >90 d, Kawasaki, pediatric sepsis bundles

8-10%

Gastrointestinal Emergencies

Intussusception, pyloric stenosis, malrotation/volvulus, NEC, button battery, caustic ingestions

6-8%

Endocrine & Metabolic

DKA fluid/insulin protocol, cerebral edema risk, hypoglycemia, IEM, electrolyte emergencies

6-8%

Cardiovascular Emergencies

SVT (adenosine 0.1 then 0.2 mg/kg), ductal-dependent CHD (PGE1), Tet spells, myocarditis

5-7%

Neurologic Emergencies

Status epilepticus, febrile and first-time afebrile seizures, altered mental status, shunt malfunction

5-7%

Toxicology

One-pill-kills (CCB, sulfonylurea, opioid), acetaminophen (Rumack-Matthew), iron, antidotes

5-7%

Orthopedic & Musculoskeletal

Supracondylar Gartland, nursemaid elbow, SCFE, Legg-Calve-Perthes, Salter-Harris, septic joint

4-6%

Behavioral, Psychosocial & Administrative

Child abuse reporting, consent, EMTALA, disaster, quality/safety in pediatric ED

How to Pass the ABEM Peds EM Exam

What You Need to Know

Passing score: Criterion-referenced scaled passing score
Exam length: 200 questions
Time limit: ~4 hours, computer-based
Exam fee: $945 exam fee + $1,495 application (ABEM pathway)

Keys to Passing

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

ABEM Peds EM Study Tips from Top Performers

1Memorize PALS numbers cold — defibrillation 2 J/kg then 4 J/kg, epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO every 3-5 minutes, adenosine for SVT 0.1 then 0.2 mg/kg rapid push

2Know the fever workup by age — neonate <28 days gets full sepsis workup including LP; 29-60 days apply PECARN IBI rule (procalcitonin, ANC, urinalysis); >90 days is clinical-appearance driven

3Drill the PECARN head trauma decision rules separately for <2 years and ≥2 years — predictors of ciTBI and how to stratify to CT, observation, or discharge

4Lock in DKA pitfalls — use isotonic fluid (10-20 mL/kg boluses then 1.5-2x maintenance), insulin at 0.05-0.1 U/kg/hr without a bolus, avoid bicarbonate, calculate corrected sodium, and watch for cerebral edema (the leading cause of PEM mortality in DKA)

5Master bronchiolitis per AAP 2014 — supportive care only, no routine bronchodilators, steroids, chest X-ray, or viral testing in typical bronchiolitis; hypertonic saline only for hospitalized patients

Frequently Asked Questions

Who administers the ABEM Pediatric Emergency Medicine exam?

The Pediatric Emergency Medicine (PEM) subspecialty certification is jointly sponsored by the American Board of Emergency Medicine (ABEM) and the American Board of Pediatrics (ABP). Candidates take the exam through the board that issued their primary certification. EM-boarded physicians certify through ABEM (administered at Pearson VUE), and pediatrics-boarded physicians certify through ABP. The content blueprint and scope are harmonized between the two boards.

What are the eligibility requirements for the PEM exam?

Candidates must hold current primary board certification in Emergency Medicine (ABEM) or Pediatrics (ABP) and must have completed an ACGME-accredited Pediatric Emergency Medicine fellowship. The fellowship is 2 years for Emergency Medicine-trained physicians and 3 years for Pediatrics-trained physicians. Candidates also need an active, unrestricted medical license and a positive program director attestation regarding clinical competence and professionalism.

What is the format of the ABEM PEM exam?

The exam is a single-day, computer-based test delivered at Pearson VUE (ABEM pathway) or through the ABP's testing partner (ABP pathway). It consists of approximately 200 single-best-answer multiple-choice questions, including image-based items (rashes, X-rays, EKGs, ultrasound). The total testing time is approximately 4 hours, with scheduled breaks.

What score do I need to pass the PEM exam?

Both ABEM and ABP use a criterion-referenced scaled passing score determined through standard-setting methodology. The passing score is not expressed as a simple percentage correct. Historical first-time pass rates for the PEM subspecialty exam run approximately 85-92% depending on cohort and sponsoring board.

How much does the ABEM PEM exam cost?

On the ABEM pathway, the one-time PEM subspecialty application fee is approximately $1,495 and the exam fee is approximately $945. ABP fees are similar in total magnitude. Budget an additional $500-$1,500 for review courses (e.g., PEM Fellows Conference review, ACEP pediatric resources) and textbooks such as Fleisher & Ludwig's Textbook of Pediatric Emergency Medicine.

How should I prepare for the PEM subspecialty exam?

Most candidates study 150-300 hours over 4-8 months during or immediately after fellowship. High-yield resources include Fleisher & Ludwig, Tintinalli pediatric chapters, PEMCincinnati, PEM Playbook, Rogers' Textbook of Pediatric Intensive Care for critical care content, AAP clinical practice guidelines (bronchiolitis, febrile UTI, minor head trauma), and PECARN decision-rule papers. Targeted question banks and PEM board reviews significantly improve performance.

How do I maintain PEM certification?

ABEM diplomates use the MyEMCert continuous certification pathway for PEM (modules taken every 5 years with an 8-year MOC cycle). ABP diplomates use MOCA-Peds quarterly questions plus Part 4 improvement activities over a 10-year cycle. Neither board requires a decennial recertification examination as long as continuous certification requirements are met.

How is this different from the ABEM Electrodiagnostic exam?

These are two entirely different organizations that share the acronym ABEM. The American Board of Emergency Medicine (abem.org) sponsors Pediatric Emergency Medicine, Medical Toxicology, and other EM subspecialties. The American Board of Electrodiagnostic Medicine (operated under AANEM) is a separate organization that certifies physicians in nerve conduction studies and EMG. This page covers the American Board of Emergency Medicine's Pediatric EM subspecialty.