100+ Free ABP Neonatal-Perinatal Medicine Practice Questions

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Question 1

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A 27-week preterm infant develops progressive respiratory distress within the first hour of life with grunting, retractions, and a ground-glass chest radiograph. Surfactant replacement works primarily by which mechanism?

Lowering alveolar surface tension to prevent end-expiratory collapse

Increasing pulmonary vascular resistance to improve V/Q matching

Stimulating type I pneumocyte proliferation

Accelerating fetal lung liquid clearance via ENaC channels

to track

2026 Statistics

Key Facts: ABP Neonatal-Perinatal Medicine Exam

~200

MCQ Items

Approximately 200 single-best-answer questions

4h 30m

Total Exam Time

Two 2h 15m sessions

12%

Respiratory Weight

Largest domain on 2026 blueprint

$2,992

2026 Regular Fee

Includes $750 processing fee

3 yr

Required Fellowship

ACGME Neonatal-Perinatal Medicine

~89%

First-Time Pass Rate

ABP 2024 data

The ABP Neonatal-Perinatal Medicine exam is ~200 MCQs delivered in two 2h15m sessions at Prometric. The 2026 blueprint weights Respiratory 12%, Cardiovascular 9%, Nutrition 8%, Genetics/Dysmorphism 7%, Neurology 7%, Maternal-Fetal 6%, Infectious Diseases 6%, Water/Salt/Renal 5%, Endocrine/Metabolic/Thermal 5%, Hematology/Oncology 5%, Core Scholarly 5%, Asphyxia/Resuscitation 4%, Gastroenterology 4%, EENT 3%, Immunology 3%, Neurodevelopmental 3%, Bilirubin 2%, Skin 2%, Pharmacology 2%, Health Services/Ethics 2%. The 2026 fee is $2,992 regular ($750 processing) or $3,337 late. 2026 Spring exam date: April 14, 2026.

Sample ABP Neonatal-Perinatal Medicine Practice Questions

Try these sample questions to test your ABP Neonatal-Perinatal Medicine exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 27-week preterm infant develops progressive respiratory distress within the first hour of life with grunting, retractions, and a ground-glass chest radiograph. Surfactant replacement works primarily by which mechanism?

A.Lowering alveolar surface tension to prevent end-expiratory collapse

B.Increasing pulmonary vascular resistance to improve V/Q matching

C.Stimulating type I pneumocyte proliferation

D.Accelerating fetal lung liquid clearance via ENaC channels

Explanation: Pulmonary surfactant (primarily phosphatidylcholine with SP-A/B/C/D) reduces surface tension at the alveolar air-liquid interface, preventing atelectasis at end-expiration. In RDS, surfactant deficiency causes diffuse atelectasis. Exogenous surfactant (poractant alfa, beractant, calfactant) improves compliance and oxygenation and reduces mortality and air leak.

2A full-term infant of a diabetic mother presents at 6 hours with respiratory distress and a ground-glass radiograph indistinguishable from RDS. Homozygous loss-of-function mutation in which gene causes fatal surfactant deficiency in term infants?

A.SCN5A

B.CFTR

C.SFTPB (surfactant protein B)

D.DMD

Explanation: Hereditary SP-B deficiency (SFTPB mutations, autosomal recessive) causes lethal neonatal respiratory failure in term infants with RDS-like presentation unresponsive to surfactant; only lung transplantation is curative. ABCA3 and SFTPC mutations cause similar but variable interstitial lung disease. NKX2.1 (TTF-1) mutations cause brain-lung-thyroid syndrome.

3A term infant born through thick meconium-stained fluid develops respiratory distress, hypoxemia, and patchy infiltrates. Meconium aspiration syndrome causes hypoxemia primarily through which mechanism?

A.Direct viral injury to type II pneumocytes

B.Chemical pneumonitis, airway obstruction with air trapping, and surfactant inactivation leading to V/Q mismatch and PPHN

C.Alveolar hemorrhage from thrombocytopenia

D.Congenital pulmonary airway malformation

Explanation: MAS causes ball-valve airway obstruction (air trapping, pneumothorax), chemical pneumonitis, and inactivation of surfactant by meconium lipids/proteins. Hypoxemia and acidosis trigger pulmonary vasoconstriction producing PPHN. Management includes oxygen, gentle ventilation, surfactant lavage/bolus, and iNO for PPHN.

4A term infant has severe hypoxemia with a pre-ductal SpO2 of 95% and post-ductal of 75%, and echocardiogram shows right-to-left shunting at the PDA with suprasystemic pulmonary pressures. First-line pulmonary vasodilator therapy is:

A.Inhaled nitric oxide (iNO) 20 ppm

B.Oral sildenafil 1 mg/kg q6h

C.Intravenous milrinone

D.Nebulized epoprostenol

Explanation: In PPHN with hypoxemic respiratory failure (OI >15-25), iNO at 20 ppm is the standard first-line selective pulmonary vasodilator — it increases cGMP in pulmonary smooth muscle causing vasodilation without systemic hypotension. Sildenafil and milrinone are adjuncts. ECMO is reserved for iNO-refractory disease with OI >40.

5A 25-week infant at 36 weeks postmenstrual age still requires 30% FiO2 and nasal CPAP. Per the NICHD/Jensen 2019 definition, this is:

A.Grade 3 bronchopulmonary dysplasia

B.Grade 1 bronchopulmonary dysplasia

C.Grade 2 bronchopulmonary dysplasia

D.No BPD — resolved

Explanation: The 2019 Jensen/NICHD BPD grading uses respiratory support at 36 weeks PMA: Grade 1 = nasal cannula ≤2 L/min; Grade 2 = nasal cannula >2 L/min OR noninvasive positive pressure (CPAP/NIPPV); Grade 3 = invasive mechanical ventilation. This infant on CPAP has Grade 2 BPD, associated with intermediate risk of death/neurodevelopmental impairment.

6A term infant with severe respiratory failure and PPHN is refractory to iNO and maximal ventilation. Which FOXF1-associated disorder should be considered when biopsy shows misalignment of pulmonary veins with bronchial structures?

A.Alveolar capillary dysplasia with misalignment of pulmonary veins (ACDMPV)

B.Congenital pulmonary lymphangiectasia

C.Pulmonary interstitial glycogenosis

D.Neuroendocrine cell hyperplasia of infancy

Explanation: ACDMPV is caused by FOXF1 mutations/deletions at 16q24.1. Histology shows thickened alveolar septa, reduced capillaries not apposed to alveolar epithelium, and misalignment of pulmonary veins alongside bronchial arteries. It presents with severe, iNO- and ECMO-refractory PPHN and is uniformly fatal without lung transplant.

7A 26-week infant on conventional ventilation develops sudden desaturation, tachycardia, and a shift of heart sounds to the right. Transillumination of the left hemithorax is bright. The most appropriate immediate action is:

A.Order stat chest radiograph before intervention

B.Increase PEEP by 2 cm H2O

C.Needle decompression of the left hemithorax followed by chest tube placement

D.Bolus with 10 mL/kg normal saline

Explanation: A tension pneumothorax in a deteriorating ventilated infant with positive transillumination requires immediate needle decompression (2nd intercostal space, midclavicular line, or 4th-5th anterior axillary line) followed by chest tube. Waiting for radiographs risks cardiac arrest. Increasing PEEP will worsen the leak.

8High-frequency oscillatory ventilation (HFOV) provides gas exchange primarily through which physiologic principle distinct from conventional ventilation?

A.Spontaneous breathing with pressure support only

B.Passive expiration with tidal volumes 5-7 mL/kg

C.Active expiration with tidal volumes smaller than anatomic dead space using augmented diffusion (Taylor dispersion, pendelluft)

D.Synchronized intermittent mandatory ventilation with volume guarantee

Explanation: HFOV delivers very small tidal volumes (often < dead space) at 5-15 Hz with active expiration. Gas exchange occurs via bulk flow, Taylor dispersion, pendelluft, asymmetric velocity profiles, and molecular diffusion. Mean airway pressure sets oxygenation; amplitude and frequency govern CO2 removal (lower frequency = larger VT = better CO2 clearance).

9Which neonate is MOST appropriate for ECMO consideration per contemporary criteria?

A.A 24-week, 600 g infant with RDS and OI 30

B.A 36-week, 2.2 kg infant with MAS and OI 45 despite iNO and HFOV, no major intracranial hemorrhage

C.A term infant with lethal trisomy 13 and OI 50

D.A 2-day-old with Grade IV IVH and OI 40

Explanation: Standard neonatal ECMO criteria: GA ≥34 weeks, weight ≥2 kg, reversible lung disease, OI >40 despite maximal therapy, no major ICH or lethal anomaly, mechanical ventilation <10-14 days. Extreme prematurity increases IVH risk, and lethal chromosomal anomalies or Grade IV IVH are contraindications.

10A 26-week infant receives 2 doses of intratracheal poractant alfa for RDS. The most common immediate side effect is:

A.Transient bradycardia and desaturation during administration

B.Anaphylaxis

C.Severe hypertension

D.Hemolytic anemia

Explanation: Transient bradycardia, desaturation, and reflux of surfactant into the ETT are common during instillation and typically respond to pausing administration and bag ventilation. Pulmonary hemorrhage risk is slightly increased, particularly after rapid improvement in compliance that increases L-to-R PDA shunting.

About the ABP Neonatal-Perinatal Medicine Exam

The ABP Neonatal-Perinatal Medicine subspecialty certification validates expert-level knowledge of maternal-fetal medicine, neonatal resuscitation, respiratory disorders (RDS, BPD, MAS, PPHN), cardiovascular disease (PDA, ductal-dependent CHD), neurologic disorders (HIE, IVH, seizures), nutrition/TPN, genetics/dysmorphology, neonatal sepsis/TORCH, hyperbilirubinemia, NEC, endocrine/metabolic disorders, mechanical ventilation (HFOV, iNO, ECMO), and neurodevelopmental outcomes. Requires 3 years of ACGME-accredited Neonatal-Perinatal Medicine fellowship plus primary ABP Pediatrics certification.

Questions

200 scored questions

Time Limit

2 sessions of 2h 15m (~4h 30m)

Passing Score

Criterion-referenced (scaled 1-300; ~180 pass)

Exam Fee

$2,992 regular ($750 processing fee); $3,337 late registration (American Board of Pediatrics (ABP) / Prometric)

ABP Neonatal-Perinatal Medicine Exam Content Outline

12%

Respiratory (RDS, BPD, PPHN, MAS, Apnea)

Neonatal respiratory physiology, surfactant dysfunction, RDS, BPD (new 2018/2019 NICHD and 2019 Jensen definitions — oxygen/support at 36 weeks PMA), PPHN (iNO), MAS, air leak syndromes, CDH, CPAM, apnea of prematurity (caffeine), mechanical ventilation (conventional, HFOV, NAVA).

Cardiovascular

Fetal circulation and transition, PDA (hemodynamically significant — indomethacin, ibuprofen, acetaminophen), ductal-dependent CHD (PGE1), cyanotic CHD (TGA, TOF, HLHS, TAPVR, truncus), critical CHD pulse-ox screening, neonatal arrhythmias, cardiomyopathy, shock management.

Nutrition (TPN, Feeds, Growth)

Parenteral nutrition (AA/lipids/dextrose — GIR; SMOFlipid for PNALD prevention), human milk fortification, donor breast milk, enteral advancement, postnatal growth, metabolic bone disease of prematurity, cholestasis of TPN, refeeding syndrome, IUGR.

Neurology (HIE, IVH, Seizures)

HIE (Sarnat staging, therapeutic hypothermia 33.5°C x 72h within 6 hours, TOBY/NICHD/CoolCap/ICE trials), IVH (Papile grading I-IV), PVL, neonatal seizures (phenobarbital first-line; levetiracetam), aEEG, neonatal stroke, neural tube defects, hydrocephalus.

Genetics/Dysmorphism

Trisomies 21/18/13, Turner (45,X), Klinefelter (47,XXY), DiGeorge 22q11.2 deletion (CATCH-22), inheritance patterns, NIPT, amniocentesis, CVS, CMA, WES, RASopathies (Noonan — PTPN11), Beckwith-Wiedemann, VACTERL, CHARGE, dysmorphology assessment.

Maternal-Fetal Medicine

Maternal physiologic adaptation, preeclampsia/HELLP, gestational diabetes, preterm labor, PPROM, antenatal corticosteroids (betamethasone), MgSO4 for neuroprotection, TTTS, IUGR, fetal monitoring, teratogens, neonatal abstinence syndrome (NAS).

Infectious Diseases (Sepsis, TORCH)

Early-onset vs late-onset sepsis (GBS, E. coli, Listeria), TORCH (congenital CMV — most common; toxo; rubella; syphilis; HSV — SEM/CNS/disseminated; parvovirus B19; Zika), HIV PMTCT, hepatitis B, neonatal meningitis, Kaiser sepsis calculator, candida.

Water/Salt/Renal

Neonatal fluid physiology (insensible water loss, postnatal diuresis), electrolyte disturbances, AKI (KDIGO pediatric), RTA, ARPKD, MCDK, posterior urethral valves, hydronephrosis, nephrogenesis completes ~34 weeks, acid-base management.

Endocrine/Metabolic/Thermal

Neonatal hypoglycemia, congenital hyperinsulinism (diazoxide, octreotide), CAH (21-hydroxylase), congenital hypothyroidism, inborn errors of metabolism (urea cycle, MSUD, organic acidemias, FAOD — newborn screening), thermoregulation, IDM complications.

Hematology/Oncology

Neonatal anemia, Rh/ABO isoimmunization, exchange transfusion, polycythemia, NAIT (HPA-1a), DIC, VKDB, hemoglobinopathies, congenital leukemia/TAM in Trisomy 21, sacrococcygeal teratoma, transfusion thresholds (restrictive for most stable neonates).

Core Knowledge in Scholarly Activities

Biostatistics (sensitivity/specificity, PPV/NPV, NNT, RR, OR), study design, bias/confounding, systematic reviews/meta-analysis, research ethics (IRB, neonatal consent), QI (PDSA, run charts, SMART aims), patient safety.

Asphyxia & Resuscitation (NRP)

NRP 2025/8th edition algorithm — PPV, chest compressions 3:1, epinephrine 0.02 mg/kg IV/IO, volume 10 mL/kg NS, delayed cord clamping, intact cord resuscitation, term FiO2 21% vs preterm 21-30%, thermal bundle for preterm, ethics of non-initiation.

Gastroenterology (NEC, GI Anomalies)

NEC (Bell staging, pneumatosis, portal venous gas, medical vs surgical management, feeding protocols for prevention), SIP, TEF/EA, duodenal atresia (double bubble — T21), malrotation/volvulus, Hirschsprung, imperforate anus, biliary atresia.

EENT (ROP, Hearing Loss, Airway)

ROP (zones 1-3, stages 1-5, plus disease, screening <31 weeks GA or <1500g, anti-VEGF bevacizumab/laser), congenital cataracts, universal newborn hearing screening (OAE, ABR), choanal atresia (CHARGE), cleft lip/palate, Pierre Robin sequence.

Neurodevelopmental Outcomes

Long-term outcomes of prematurity (CP, learning/behavioral), Bayley Scales, high-risk follow-up, visual/hearing outcomes, ELBW school-age outcomes, neurodevelopmental impact of IVH/PVL/HIE.

Immunology

Neonatal immune system, SCID (TREC newborn screen), DiGeorge T-cell deficiency, CGD, complement deficiency, hyper-IgM syndrome, neonatal lupus (anti-Ro/La — heart block).

Bilirubin

Unconjugated hyperbilirubinemia (physiologic, breastfeeding vs breast milk jaundice, Crigler-Najjar, Gilbert), conjugated hyperbilirubinemia (biliary atresia, neonatal hepatitis, TPN cholestasis), 2022 AAP bilirubin guidelines (escalation thresholds), kernicterus/BIND, G6PD.

Skin Disorders

Neonatal rashes (erythema toxicum, TNPM, milia, dermal melanocytosis), infantile hemangioma (propranolol), PHACE, capillary malformation, epidermolysis bullosa, collodion baby, congenital syphilis rash.

Basic Principles of Pharmacology

Neonatal PK/PD, developmental changes in absorption/distribution/metabolism/elimination, TDM (vancomycin, aminoglycosides), caffeine for apnea of prematurity, inotropes (dopamine, epinephrine, milrinone), hydrocortisone for refractory hypotension, surfactant.

Health Services Delivery, Ethical Issues & Counseling

Periviable counseling (22-25 weeks — shared decision-making), ethics of NICU care (DNR, withdrawal, futility), palliative care, parental consent, health disparities in perinatal outcomes, HIPAA, breaking bad news, bereavement support.

How to Pass the ABP Neonatal-Perinatal Medicine Exam

What You Need to Know

Passing score: Criterion-referenced (scaled 1-300; ~180 pass)
Exam length: 200 questions
Time limit: 2 sessions of 2h 15m (~4h 30m)
Exam fee: $2,992 regular ($750 processing fee); $3,337 late registration

Keys to Passing

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

ABP Neonatal-Perinatal Medicine Study Tips from Top Performers

1NRP 8th edition rule: begin PPV within 60 seconds of birth if HR <100 despite stimulation; if HR <60 after effective PPV (with ETT), start chest compressions at 3:1 ratio and increase FiO2 to 100%. Epinephrine 0.02 mg/kg IV/IO (preferred) or 0.1 mg/kg ET is given if HR remains <60 after 30 seconds of compressions + PPV. Volume 10 mL/kg NS only if hypovolemia suspected. Term initial FiO2 21%; preterm <35 weeks 21-30%.

2Therapeutic hypothermia rule for HIE: cool to 33.5°C core temperature within 6 hours of birth for ≥35 weeks gestation with moderate-severe encephalopathy (Sarnat II-III) and evidence of perinatal event (acidosis pH <7.0 or base deficit ≥16, 10-min Apgar <5, or need for ventilation at 10 min). Duration 72 hours, then slow rewarm (0.5°C/hour). Reduces death or disability (NNT ~7-9) per TOBY/NICHD/CoolCap trials.

3BPD grading (Jensen 2019): at 36 weeks PMA — Grade 1 = nasal cannula ≤2 L/min, Grade 2 = NC >2 L/min or noninvasive positive pressure, Grade 3 = invasive mechanical ventilation. Risk factors: prematurity, mechanical ventilation, hyperoxia, infection, PDA. Prevention: surfactant, minimizing mechanical ventilation, caffeine, vitamin A (historical), low-dose dexamethasone if severe (DART protocol).

4Hyperbilirubinemia 2022 AAP guidelines: new nomograms raise treatment thresholds by 2-3 mg/dL vs 2004. Escalation of care initiated 2 mg/dL below exchange threshold. G6PD significantly lowers exchange thresholds. Phototherapy is first-line; exchange transfusion for severe hyperbilirubinemia or acute bilirubin encephalopathy (ABE). Kernicterus/BIND prevention is the goal — assess for hyperbilirubinemia neurotoxicity risk factors (GA <38 weeks, hemolysis, sepsis, acidosis, hypoalbuminemia).

5PPHN management: iNO (20 ppm starting dose) is indicated for OI ≥25 in term/late preterm infants with hypoxemic respiratory failure after optimization of ventilation/oxygenation. Alternatives if iNO fails: sildenafil, milrinone (pulmonary vasodilation + inotropy), prostacyclin, ECMO (OI ≥40 sustained). Avoid hypocapnia/alkalosis as adjunct therapy — they have not improved outcomes and may worsen cerebral perfusion.

Frequently Asked Questions

What is the ABP Neonatal-Perinatal Medicine subspecialty certification?

The ABP Neonatal-Perinatal Medicine subspecialty certification is awarded by the American Board of Pediatrics to diplomates who demonstrate expert-level knowledge in care of critically ill newborns — from periviable premature infants to term neonates with complex medical and surgical conditions. It covers maternal-fetal medicine, resuscitation, respiratory/cardiovascular/neurologic disorders, nutrition, genetics, infections, metabolic disease, and neurodevelopmental outcomes. Certification qualifies physicians to direct Level III and IV NICUs.

Who is eligible to take the ABP Neonatal-Perinatal Medicine exam?

Candidates must hold primary ABP General Pediatrics certification in good standing and have completed 3 years of full-time ACGME-accredited Neonatal-Perinatal Medicine fellowship training. A valid unrestricted medical license is required. Candidates must also complete a scholarly activity (Meaningful Accomplishment in Research) approved by their Scholarship Oversight Committee. No continuous absence of more than one year from training is permitted.

What is the format of the ABP Neonatal-Perinatal Medicine exam?

The exam is a computer-based examination administered at Prometric testing centers. It consists of approximately 200 single-best-answer multiple-choice questions delivered in two 2-hour-15-minute sessions (total ~4 hours 30 minutes). Questions are case-based and follow the ABP Neonatal-Perinatal Medicine content outline. All questions have one best answer.

How much does the 2026 ABP Neonatal-Perinatal exam cost?

The 2026 regular registration fee is $2,992, which includes a $750 nonrefundable processing fee. Late registration is $3,337 (additional $345 late fee). If you withdraw by the deadline (Feb 27, 2026 for Spring), you receive a $2,242 refund (total paid minus the $750 processing fee).

When is the 2026 Neonatal-Perinatal exam administered?

The 2026 ABP Neonatal-Perinatal Medicine Subspecialty Certification Exam is scheduled for April 14, 2026 at Prometric Professional Testing Centers. Regular registration is Feb 2 – April 1, 2026. Late registration is April 2 – April 30, 2026 (no exceptions). Withdrawal deadline is Feb 27, 2026.

How is the exam scored?

ABP uses criterion-referenced scoring. Raw scores are converted to a scaled score with a range of 1-300, with a passing score of approximately 180 (specific passing standard set by a committee of content experts using a modified Angoff methodology). A candidate's result depends on performance relative to the standard, not on other candidates. Results are typically released 6-8 weeks after the exam.

What are the highest-yield topics?

The largest domain is Respiratory (12%) — master RDS/surfactant, BPD definitions, PPHN (iNO management), MAS, CDH/ECMO. Cardiovascular (9%) — PDA management, ductal-dependent CHD (PGE1), critical CHD screening. Nutrition (8%) — TPN components/complications, PNALD prevention. Genetics (7%) — trisomies, 22q11.2, dysmorphology approach. Neurology (7%) — HIE/therapeutic hypothermia, IVH Papile grading, neonatal seizures. Maternal-Fetal (6%) and Infectious Diseases (6%) — TORCH, GBS sepsis. Master the NRP 8th edition algorithm cold — 4% weight but heavily clinically tested.

How should I study for this exam?

Use a structured 6-12 month plan during or after your 3-year fellowship. Lead with high-weight topics (Respiratory, Cardiovascular, Nutrition, Genetics, Neurology). Use NeoReviews (AAP), NeoPREP review course, Avery's Diseases of the Newborn, Fanaroff and Martin's Neonatal-Perinatal Medicine, and the ABP content outline as your primary references. Master the NRP 8th edition. Do 2-3 timed full-length mock exams. Practice ethics/palliative/periviable counseling scenarios. Review 2022 AAP bilirubin guidelines, Surviving Sepsis neonatal section, and current mechanical ventilation evidence (SUPPORT, TOLSURF, COIN trials).