100+ Free ABP Pediatric Cardiology Practice Questions

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Question 1

Score: 0/0

A 3-year-old has a harsh holosystolic murmur at the left lower sternal border. Echo shows a defect in the membranous interventricular septum near the aortic valve. Which VSD type?

Muscular

Perimembranous

Inlet (AV canal type)

Outlet (supracristal/conal)

to track

2026 Statistics

Key Facts: ABP Pediatric Cardiology Exam

~200

Total MCQ Items

ABP Pediatric Cardiology Subspecialty Certifying Examination

~8 hr

Total Exam Time

1-day computer-based test including breaks

~30-35%

CHD Weight

Largest domain on 2026 ABP content outline

$2,290

2026 Initial Cert Fee

ABP subspecialty certification

3 yr

Required Fellowship

ACGME Pediatric Cardiology fellowship

MOCA-Peds

Continuing Cert

Annual question-based CC replaces 10-year secure exam

The ABP Pediatric Cardiology exam is a 1-day computer-based test from the American Board of Pediatrics comprising ~200 single-best-answer MCQs over ~8 hours. The 2026 content outline emphasizes congenital heart disease (~30-35%), imaging (~10-12%), arrhythmias/EP (~10-12%), cardiomyopathy/myocarditis (~10%), heart failure/transplant (~8-10%), Kawasaki/inflammatory (~6-8%), catheterization (~6-8%), hypertension (~5%), preventive cardiology (~4-5%), fetal cardiology (~4-5%), and pulmonary hypertension (~3-4%). Initial certification fee is ~$2,290; 3-year ACGME fellowship required after ABP General Pediatrics.

Sample ABP Pediatric Cardiology Practice Questions

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

1A 3-year-old has a harsh holosystolic murmur at the left lower sternal border. Echo shows a defect in the membranous interventricular septum near the aortic valve. Which VSD type?

A.Muscular

B.Perimembranous

C.Inlet (AV canal type)

D.Outlet (supracristal/conal)

Explanation: Perimembranous VSDs are the most common type (~70-80%) and lie in the membranous septum adjacent to the tricuspid and aortic valves. They may be associated with aortic valve prolapse and aortic regurgitation. Muscular VSDs occur within the trabecular septum; inlet VSDs are seen with AV canal defects; outlet (supracristal) VSDs lie beneath the pulmonary valve and are most common in Asian patients.

2A 4-year-old is found to have fixed splitting of S2 and a soft systolic ejection murmur at the left upper sternal border. Echo shows a defect in the mid-atrial septum at the fossa ovalis. Which ASD type?

A.Sinus venosus (superior)

B.Primum

C.Secundum

D.Coronary sinus

Explanation: Secundum ASD — the most common type (~70%) — lies at the fossa ovalis and is amenable to device closure if rims are adequate. Primum ASDs are part of the AV canal spectrum with a cleft mitral valve. Sinus venosus ASDs (usually superior) are near the SVC and associated with partial anomalous pulmonary venous return. Fixed splitting of S2 reflects right ventricular volume loading.

3A premature neonate develops a continuous 'machinery' murmur at the left infraclavicular area with bounding pulses and widened pulse pressure. Which pharmacologic agent is first-line for closure?

A.Prostaglandin E1

B.Indomethacin or ibuprofen

C.Digoxin

D.Sildenafil

Explanation: A hemodynamically significant patent ductus arteriosus (PDA) in a preterm infant is treated with COX inhibitors (indomethacin or ibuprofen, with acetaminophen as an alternative) to induce closure. Prostaglandin E1 is used to KEEP the ductus OPEN in ductal-dependent CHD (e.g., HLHS, critical coarctation, pulmonary atresia, d-TGA). Surgical or transcatheter device closure is reserved for failed medical therapy.

4A 6-month-old has cyanosis, a boot-shaped heart on CXR, and an echo showing a large VSD, overriding aorta, RVOT obstruction, and right ventricular hypertrophy. Which condition?

A.Transposition of the great arteries

B.Truncus arteriosus

C.Tetralogy of Fallot

D.Tricuspid atresia

Explanation: Tetralogy of Fallot consists of the four features of VSD, overriding aorta, RVOT (pulmonary) stenosis, and RVH — classically producing a boot-shaped (coeur en sabot) heart. Severity of cyanosis correlates with degree of RVOT obstruction. 'Tet spells' respond to knee-to-chest positioning, oxygen, morphine, and phenylephrine. 22q11.2 deletion (DiGeorge) is associated.

5A newborn is cyanotic within hours of birth. Echo shows the aorta arising from the right ventricle and the pulmonary artery from the left ventricle with parallel circulations. Which emergent bedside procedure improves mixing?

A.Balloon atrial septostomy (Rashkind procedure)

B.Immediate arterial switch

C.Norwood stage 1

D.Blalock-Taussig-Thomas shunt

Explanation: In d-TGA (dextro-transposition), the great arteries are transposed and parallel circulations are incompatible with life without mixing. Prostaglandin E1 maintains ductal patency; if oxygenation remains poor, urgent balloon atrial septostomy (Rashkind) creates an ASD to improve intracardiac mixing. Definitive repair is the arterial switch (Jatene) operation within the first 2 weeks of life with coronary transfer.

6A newborn with hypoplastic left heart syndrome (HLHS) is scheduled for staged palliation. What is the correct sequence of operations?

A.Fontan → Glenn → Norwood

B.Norwood stage I → bidirectional Glenn → Fontan

C.Arterial switch → Glenn → Fontan

D.Rastelli → Glenn → Fontan

Explanation: HLHS single-ventricle palliation is Norwood stage I (neonatal — reconstruct aorta from pulmonary trunk, place BT or Sano shunt, atrial septectomy), followed by bidirectional Glenn (~4-6 months — SVC to PA), and completed by Fontan (~2-4 years — IVC to PA via extracardiac conduit or lateral tunnel). Hybrid procedure (bilateral PA banding + PDA stent) is an alternative first stage.

7A 10-year-old has upper-extremity hypertension, lower-extremity pulse delay, and rib notching on CXR. Which associated condition is most often present?

A.Bicuspid aortic valve

B.Atrial septal defect

C.Ebstein anomaly

D.Truncus arteriosus

Explanation: Coarctation of the aorta classically presents with upper-extremity hypertension, reduced/delayed femoral pulses, a systolic murmur, and (in older children) rib notching from dilated intercostal collaterals. Bicuspid aortic valve (BAV) is present in ~50-85% of coarctation patients. Turner syndrome is a frequent syndromic association. Treatment is balloon angioplasty/stenting or surgical repair.

8A neonate has severe cyanosis with apical displacement of the tricuspid valve leaflets and atrialization of the right ventricle on echo. Which arrhythmia is most commonly associated?

A.Complete heart block

B.Long QT syndrome

C.Brugada syndrome

D.Wolff-Parkinson-White syndrome

Explanation: Ebstein anomaly of the tricuspid valve — apical displacement of septal and posterior TV leaflets with atrialization of the RV — causes tricuspid regurgitation and right-sided heart failure. ~20-30% have accessory AV pathways (right-sided), producing Wolff-Parkinson-White (WPW) with delta waves on ECG and risk of SVT/atrial fibrillation with rapid conduction.

9A newborn has a single arterial trunk arising from the heart giving rise to the aorta, pulmonary arteries, and coronary arteries. A large VSD is present. Which genetic syndrome is most associated?

A.Noonan syndrome

B.Williams syndrome (7q11.23)

C.22q11.2 deletion (DiGeorge)

D.Marfan syndrome

Explanation: Truncus arteriosus — a single great artery arising from both ventricles through a VSD — is strongly associated with 22q11.2 deletion (DiGeorge/velocardiofacial) syndrome, along with interrupted aortic arch type B and TOF with pulmonary atresia. DiGeorge also has thymic hypoplasia, hypocalcemia, cleft palate, and T-cell immunodeficiency. FISH or microarray confirms.

10A neonate has severe cyanosis and respiratory distress. CXR shows a 'snowman' or 'figure-of-8' cardiac silhouette. Echo confirms all four pulmonary veins drain via a vertical vein to the innominate vein. Which anomaly?

A.Cardiac TAPVR (to coronary sinus)

B.Supracardiac TAPVR

C.Infracardiac TAPVR

D.Partial anomalous pulmonary venous return

Explanation: Total anomalous pulmonary venous return (TAPVR) has supracardiac (~50% — pulmonary veins drain to vertical vein → innominate → SVC, creating a 'snowman' silhouette), cardiac (~20% — to coronary sinus), infracardiac (~20% — below diaphragm via portal system, often obstructed), and mixed forms. Infracardiac is almost always obstructed and is a surgical emergency in the neonate.

About the ABP Pediatric Cardiology Exam

The ABP Pediatric Cardiology Subspecialty Certifying Examination validates expert-level knowledge in the diagnosis and management of pediatric heart disease, spanning congenital heart disease (VSD, ASD, PDA, TOF, TGA, HLHS, coarctation, Ebstein, truncus, TAPVR, single ventricle), cardiomyopathy (HCM, DCM, RCM, LVNC, ARVC), arrhythmias and channelopathies (WPW, long QT, Brugada, CPVT, CHB), Kawasaki disease and its coronary sequelae, acute rheumatic fever, pediatric heart failure and transplant, AAP 2017 pediatric hypertension, fetal cardiology, echocardiography/MRI/CT, catheter-based intervention, and preventive cardiology. Requires ABP General Pediatrics certification plus a 3-year ACGME-accredited Pediatric Cardiology fellowship.

Questions

200 scored questions

Time Limit

1-day CBT (~8 hours including breaks)

Passing Score

Criterion-referenced standard set by ABP (modified Angoff)

Exam Fee

~$2,290 initial certification fee (ABP 2026 subspecialty) (American Board of Pediatrics (ABP) / Pearson VUE)

ABP Pediatric Cardiology Exam Content Outline

~30-35%

Congenital Heart Disease

VSD (perimembranous/muscular/inlet/outlet), ASD (secundum/primum/sinus venosus), PDA, TOF, d-TGA vs l-TGA/ccTGA, HLHS Norwood/Glenn/Fontan, coarctation, Ebstein (WPW), truncus, TAPVR (supracardiac/cardiac/infracardiac), AVSD (trisomy 21), single ventricle, Shone complex, Williams supravalvar AS, Marfan (FBN1).

~10-12%

Arrhythmias & Electrophysiology

SVT (AVNRT/AVRT), WPW + delta wave, LQT1 (KCNQ1/swimming), LQT2 (KCNH2), LQT3 (SCN5A), Brugada (SCN5A), CPVT (RYR2), congenital complete heart block (anti-SSA/SSB), postoperative AV block, JET, vagal maneuvers, adenosine, pacemaker/ICD indications, catheter ablation.

~10-12%

Imaging (Echo, CMR, CT)

Echocardiography (M-mode, 2D, Doppler — modified Bernoulli ΔP=4v², continuity equation, strain, TEE), Z-scores for normalization, fetal echo, cardiac MRI (RV volumes in repaired TOF, Lake Louise criteria for myocarditis), cardiac CT (coronary anomalies — ALCAPA), stress imaging.

~10%

Cardiomyopathy & Myocarditis

HCM (sarcomere — MYH7, MYBPC3; SAM, LVOT obstruction), DCM (viral, TTN, LMNA, Duchenne), RCM, LVNC (Barth — TAZ), ARVC (desmosomes — PKP2, DSG2; epsilon wave), anthracycline cardiotoxicity, viral/vaccine myocarditis, MIS-C post-SARS-CoV-2, Lake Louise CMR criteria.

~8-10%

Heart Failure & Transplant

Pediatric HFrEF therapy (ACEi, carvedilol, diuretic, spironolactone), VAD (Berlin Heart EXCOR for infants, HeartMate 3 for adolescents), ECMO, transplant indications, ISHLT cellular rejection grading (1R/2R/3R), AMR (pAMR, C4d, DSA), cardiac allograft vasculopathy (IVUS), Fontan failure (PLE, plastic bronchitis, hepatic fibrosis).

~6-8%

Kawasaki Disease, Rheumatic Fever & Inflammatory

Kawasaki criteria (5 days fever + 4 of 5 features), IVIG 2 g/kg + high-dose aspirin, coronary aneurysm z-scores and thromboprophylaxis, IVIG resistance (steroids, infliximab), giant aneurysm (aspirin + warfarin), MIS-C, acute rheumatic fever (revised Jones criteria, Sydenham chorea), secondary prophylaxis (benzathine PCN), infective endocarditis (Duke), pericarditis (NSAIDs + colchicine).

~6-8%

Cardiac Catheterization & Interventional

Diagnostic cath (hemodynamics, PVR, Qp/Qs), balloon pulmonary and aortic valvuloplasty, coarctation balloon/stent, transcatheter ASD closure (Amplatzer septal occluder), PDA closure (Amplatzer Piccolo in preterm), VSD closure (muscular and selected perimembranous), balloon atrial septostomy (Rashkind).

~5%

Pediatric Hypertension

AAP 2017 definitions (<13 yr by percentile; ≥13 yr adult thresholds), 3-visit confirmation, ABPM for white-coat/masked HTN, secondary causes (coarctation BP gradient, renal parenchymal/renovascular, endocrine — CAH, pheochromocytoma), therapy (lifestyle + ACEi/ARB/CCB).

~4-5%

Preventive Cardiology

NHLBI/AAP universal lipid screening at 9-11 and 17-21 years, familial hypercholesterolemia (LDLR, APOB, PCSK9; pediatric statin; evolocumab), AHA 14-element preparticipation screening for SCD, IE prophylaxis (prosthetic, prior IE, unrepaired cyanotic CHD), childhood obesity/diabetes.

~4-5%

Fetal Cardiology

Fetal echo indications (maternal diabetes → TGA/VSD/IDM-HCM, anti-SSA/SSB → CCHB, prior CHD, teratogens — lithium/Ebstein, 22q11 → truncus/TOF, fetal extracardiac anomaly, hydrops), fetal arrhythmias (PACs, SVT, atrial flutter, CCHB), transplacental therapy (digoxin, flecainide, sotalol), fetal interventions.

~3-4%

Pulmonary Hypertension

Definition — mPAP >20 mm Hg with PVR ≥3 WU (2018 6th World Symposium), WHO groups, PAH (idiopathic, CHD-associated, Eisenmenger), PPHN (inhaled NO, sildenafil, ECMO), vasoreactivity testing, ERAs, PDE5 inhibitors, prostacyclins.

How to Pass the ABP Pediatric Cardiology Exam

What You Need to Know

Passing score: Criterion-referenced standard set by ABP (modified Angoff)
Exam length: 200 questions
Time limit: 1-day CBT (~8 hours including breaks)
Exam fee: ~$2,290 initial certification fee (ABP 2026 subspecialty)

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 Pediatric Cardiology Study Tips from Top Performers

1Master ductal-dependent CHD — remember which lesions need PGE1 to maintain ductal patency for pulmonary flow (pulmonary atresia, tricuspid atresia without VSD, critical PS) vs systemic flow (HLHS, critical coarctation, interrupted aortic arch, critical AS). In d-TGA, ductal patency alone is insufficient — mixing (ASD via Rashkind) is also needed.

2Syndrome-CHD associations to memorize: 22q11.2 deletion (DiGeorge) → truncus, interrupted aortic arch type B, TOF; Trisomy 21 → AVSD and VSD; Trisomy 18 → VSD with polyvalvular disease; Turner (45,X) → bicuspid AV, coarctation; Williams (7q11) → supravalvar AS, peripheral PS; Noonan (PTPN11) → dysplastic PV, HCM; Marfan (FBN1) → aortic root dilation; Holt-Oram (TBX5) → ASD + upper limb anomaly; Alagille (JAG1) → peripheral PS.

3Long QT gene-phenotype correlations: LQT1 (KCNQ1 — IKs) triggered by EXERTION, especially swimming; LQT2 (KCNH2 — IKr) triggered by AUDITORY startle and postpartum; LQT3 (SCN5A — late INa) events during REST/SLEEP. Nadolol is preferred beta-blocker. CPVT (RYR2) has bidirectional VT with emotion/exercise, normal resting ECG.

4Kawasaki disease treatment algorithm: diagnosis = fever ≥5 days + ≥4 of 5 features. First-line IVIG 2 g/kg + high-dose aspirin within 10 days of onset reduces aneurysm risk from ~25% to ~4%. IVIG resistance (fever persists 36h after first IVIG) → second IVIG dose, pulse steroids, or infliximab. Giant aneurysms (≥8 mm or z-score ≥10) → lifelong aspirin + warfarin (INR 2-3) or LMWH.

5Fontan physiology pearls: single-ventricle Fontan circulation has systemic venous return passively delivered to pulmonary arteries without a subpulmonary ventricle. Requires LOW PVR (<2-3 WU/m²) for success. Late complications include PLE (elevated alpha-1 antitrypsin stool clearance, hypoalbuminemia, edema), plastic bronchitis, hepatic fibrosis/cirrhosis, atrial arrhythmias, and exercise limitation. Fenestration may improve hemodynamics at cost of mild cyanosis.

Frequently Asked Questions

What is the ABP Pediatric Cardiology subspecialty certification?

The ABP Pediatric Cardiology subspecialty certification is awarded by the American Board of Pediatrics to pediatricians who demonstrate expert-level knowledge in diagnosing and managing congenital and acquired heart disease in fetuses, neonates, children, and adolescents. Scope includes CHD, cardiomyopathy, arrhythmias, Kawasaki disease, pediatric heart failure and transplant, AAP 2017 pediatric hypertension, fetal cardiology, echocardiography/MRI/CT, catheter-based intervention, and preventive cardiology. The certification qualifies pediatric cardiologists for independent clinical practice at children's hospitals and academic centers.

Who is eligible to take the ABP Pediatric Cardiology exam?

Candidates must hold ABP General Pediatrics certification in good standing and have completed 3 years of full-time training in an ACGME-accredited Pediatric Cardiology fellowship. A valid unrestricted medical license is required. The fellowship includes training in inpatient/outpatient cardiology, echocardiography, fetal cardiology, electrophysiology, cardiac catheterization, critical care cardiology, and research.

What is the format of the ABP Pediatric Cardiology exam?

The 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 8 hours (including breaks). Question stems frequently include ECGs, echocardiographic images, cardiac catheterization tracings, chest x-rays, cardiac MRI/CT images, and pathology specimens. The exam is adaptive to the ABP content outline across CHD, cardiomyopathy, arrhythmia, Kawasaki disease, heart failure/transplant, hypertension, fetal cardiology, and imaging/catheterization.

How much does the 2026 ABP Pediatric Cardiology exam cost?

The 2026 ABP Pediatric Cardiology initial subspecialty certification fee is approximately $2,290. Cancellation and refund policies follow the ABP schedule with decreasing refunds as the exam date approaches. Annual Continuing Certification fees (MOCA-Peds) apply after passing. Retakes within the 7-year qualification window require re-registration and full fee payment.

When is the 2026 exam administered?

ABP Pediatric Cardiology is typically offered during a testing window in the fall (e.g., October). Applications generally open in late winter/early spring with a submission deadline in mid-to-late spring. Candidates schedule specific appointments with Pearson VUE after application approval. Exact 2026 dates should be confirmed on the ABP dates and fees page.

How is the exam scored?

ABP uses criterion-referenced 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 subdomain performance to guide future learning. Results are typically released 6-8 weeks after the testing window closes.

What are the highest-yield topics?

Highest-yield topics: congenital heart disease (master VSD/ASD/PDA/TOF/d-TGA/HLHS/coarctation/Ebstein/truncus/TAPVR/AVSD and associated syndromes — 22q11 truncus/TOF, trisomy 21 AVSD, Turner coarctation, Williams supravalvar AS, Noonan dysplastic PV, Marfan FBN1). Master HCM sarcomere mutations, DCM workup (myocarditis, neuromuscular, metabolic), LQT1-3 gene-phenotype correlations (LQT1 swimming, LQT2 startle, LQT3 sleep), Kawasaki criteria/IVIG/coronary aneurysm management, AAP 2017 hypertension thresholds, Fontan physiology and failure, and ISHLT rejection grading.

How should I study for this exam?

Use a structured 12-18 month plan during and after fellowship. Map to the ABP content outline: lead with congenital heart disease (anatomy, physiology, surgical palliation), then cardiomyopathy/arrhythmia/channelopathies, then imaging (echo Z-scores, Doppler, CMR), catheterization, Kawasaki/inflammatory, heart failure/transplant, hypertension, fetal cardiology, and pulmonary hypertension. Integrate textbooks (Allen, Park, Nichols), AHA/ACC/AAP guidelines, and comprehensive review courses. Complete high-volume MCQs with timed practice sets. Take 2-3 full-length mock exams. Drill ECG/echo/cath/CMR image libraries.