100+ Free ABP Pediatric Critical Care Medicine Practice Questions

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A 4-year-old with pneumonia is intubated for hypoxemic respiratory failure. ABG on FiO2 0.8, PEEP 10, mean airway pressure 18 cmH2O shows PaO2 72. What is the oxygenation index (OI)?

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2026 Statistics

Key Facts: ABP Pediatric Critical Care Medicine Exam

~200

MCQ Items

Approximately 200 single-best-answer questions

~4h

Exam Time

Two timed sessions

54%

Common Conditions Weight

Largest combined domain

$2,992

2026 Regular Fee

Includes $750 processing fee

3 yr

Required Fellowship

ACGME Pediatric Critical Care Medicine

~82%

First-Time Pass Rate

ABP 2024 data

The ABP PCCM exam is ~200 MCQs delivered at Prometric. The blueprint (effective Nov 1, 2020) weights: Normal Organ Development/Anatomy/Physiology/Pharmacology 16%, Common Conditions 54% (Respiratory 6%, Cardiovascular 6%, Neurologic 6%, Multi-organ 5%, Inflammatory/Infectious 5%, Kidney/Electrolyte 5%, Hematology 4%, Endocrine/Metabolic 4%, Hepato-GI/Nutrition 4%, Trauma 4%, Toxicology 4%, Behavioral 1%), Sedation/Analgesia 6%, Organ Support/Monitoring 9%, Procedures 4%, End of Life 4%, PICU Management 1%, Professionalism 1%, Ethics 1%, Core Scholarly 4%. 2026 fee: $2,992 regular; 2026 exam date: November 10, 2026.

Sample ABP Pediatric Critical Care Medicine Practice Questions

Try these sample questions to test your ABP Pediatric Critical Care Medicine 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 with pneumonia is intubated for hypoxemic respiratory failure. ABG on FiO2 0.8, PEEP 10, mean airway pressure 18 cmH2O shows PaO2 72. What is the oxygenation index (OI)?

A.12

B.20

C.30

D.8

Explanation: OI = (MAP x FiO2 x 100) / PaO2 = (18 x 0.8 x 100) / 72 = 20. By PALICC-2 criteria an OI of 8-16 is mild PARDS, 16-32 moderate, and >32 severe. This patient meets criteria for moderate pediatric acute respiratory distress syndrome (PARDS).

2Per PALICC-2, which non-invasive SpO2-based variable can be used in place of PaO2/FiO2 when arterial access is unavailable to categorize PARDS?

A.PEEP x FiO2 ratio

B.Respiratory rate x FiO2

C.Oxygen saturation index (OSI) = (MAP x FiO2 x 100) / SpO2

D.Peak inspiratory pressure x SpO2

Explanation: PALICC-2 allows use of OSI = (MAP x FiO2 x 100) / SpO2 when SpO2 <= 97%. OSI thresholds: 5-7.5 mild PARDS, 7.5-12.3 moderate, >12.3 severe. This enables PARDS diagnosis and severity staging without arterial blood gas.

3What tidal volume target is recommended for lung-protective ventilation in pediatric ARDS with preserved respiratory system compliance?

A.3-4 mL/kg predicted body weight

B.10-12 mL/kg predicted body weight

C.5-8 mL/kg predicted body weight

D.12-15 mL/kg predicted body weight

Explanation: PALICC-2 recommends tidal volumes of 5-8 mL/kg predicted body weight (closer to 3-6 mL/kg in poor compliance), with plateau pressure <= 28 cmH2O (<= 32 cmH2O with reduced chest wall compliance), to minimize ventilator-induced lung injury in PARDS.

4In severe PARDS with refractory hypoxemia despite optimized conventional ventilation, which adjunct has the best supporting evidence for improved oxygenation and mortality in adults and is conditionally recommended in children?

A.High-frequency percussive ventilation

B.Routine inhaled nitric oxide

C.Prone positioning for >= 12 hours/day

D.Heliox therapy

Explanation: Prone positioning (PROSEVA trial in adults) improved mortality in severe ARDS. PALICC-2 suggests considering prone positioning for >= 12 hours/day in severe PARDS. iNO and HFOV are rescue therapies but have not shown mortality benefit and may worsen outcomes if used indiscriminately.

5A 10-kg child on conventional ventilation for severe PARDS has OI 42, persistent hypoxemia, and pH 7.20. Which rescue therapy is most appropriate to consider?

A.Veno-venous ECMO referral

B.Increase tidal volume to 10 mL/kg

C.Discontinue PEEP

D.Add theophylline infusion

Explanation: ECMO should be considered in severe PARDS with OI >= 40, refractory hypoxemia, and progressive respiratory/multi-organ failure when reversible cause is identified. VV-ECMO supports gas exchange while allowing lung rest. Increasing tidal volume worsens VILI.

6High-frequency oscillatory ventilation (HFOV) in pediatric ARDS is best characterized by which statement?

A.Preferred over conventional ventilation in all intubated children

B.First-line therapy for all moderate and severe PARDS

C.Recommended at OI >= 8 regardless of other parameters

D.Not recommended for routine use; may be considered as rescue in severe PARDS when plateau pressure >28 cmH2O

Explanation: The OSCILLATE and OSCAR adult trials showed no benefit or harm with routine HFOV. PALICC-2 does not recommend HFOV as routine, but suggests considering it as rescue therapy in severe PARDS when plateau pressures exceed lung-protective limits on conventional ventilation.

7Inhaled nitric oxide (iNO) is most clearly indicated in which pediatric ICU scenario?

A.Cyanide poisoning

B.Routine therapy for all PARDS

C.Sepsis-induced vasodilatory shock

D.Persistent pulmonary hypertension of the newborn or acute right heart failure from pulmonary hypertension

Explanation: iNO is a selective pulmonary vasodilator used in PPHN and acute pulmonary hypertensive crises. In PARDS, iNO improves oxygenation transiently but has not shown mortality benefit and is reserved for bridge to ECMO or documented pulmonary hypertension with RV dysfunction.

8A 3-month-old with RSV bronchiolitis is on high-flow nasal cannula at 2 L/kg/min with worsening retractions, RR 80, and apneic spells. What is the most appropriate next step?

A.Continue HFNC and recheck in 2 hours

B.Escalate to non-invasive ventilation (BiPAP) or intubation

C.Start nebulized hypertonic saline at home

D.Discharge with outpatient follow-up

Explanation: Signs of HFNC failure (worsening work of breathing, apnea, rising CO2, decreased mental status) warrant escalation to NIV or invasive ventilation. Apnea in infants with RSV is a specific indication for intubation. Delay in escalation worsens outcomes.

9A PARDS patient has persistent dyssynchrony with ventilator, worsening hypoxemia, and plateau pressure 32 cmH2O despite sedation. Which intervention is supported by evidence (ACURASYS in adults)?

A.Discontinue all sedation

B.Permanent paralysis for duration of mechanical ventilation

C.Short course (<= 48 hours) of continuous neuromuscular blockade with cisatracurium or rocuronium

D.Switch to pressure support ventilation

Explanation: ACURASYS showed a 48-hour course of cisatracurium in severe ARDS improved 90-day mortality; ROSE did not replicate this but confirmed safety. PALICC-2 suggests neuromuscular blockade for severe PARDS with dyssynchrony. Prolonged paralysis increases ICU-acquired weakness.

10According to PALICC-2, what PEEP strategy is recommended for moderate-to-severe PARDS?

A.PEEP of 5 cmH2O regardless of severity

B.Minimal PEEP (0-3 cmH2O) to reduce barotrauma

C.Fixed PEEP of 20 cmH2O for all patients

D.Moderately elevated PEEP (10-15 cmH2O) titrated to oxygenation, hemodynamics, and compliance

Explanation: PALICC-2 recommends titrating PEEP to 10-15 cmH2O in moderate-severe PARDS (higher if needed to achieve oxygenation), balanced against hemodynamic effects and plateau pressure. Too-low PEEP causes atelectrauma; too-high PEEP overdistends and reduces preload.

About the ABP Pediatric Critical Care Medicine Exam

The ABP Pediatric Critical Care Medicine (PCCM) subspecialty certification validates expert-level knowledge of shock states, PARDS/ARDS, mechanical ventilation, sedation/analgesia, DKA management, status epilepticus, TBI and ICP management, pediatric cardiac arrest and post-resuscitation care, ECMO (VA/VV), CRRT, drowning, trauma, toxicology, brain death determination, transplant ICU care, and organ support therapies/monitoring. Requires 3 years of ACGME-accredited Pediatric Critical Care Medicine fellowship following ABP Pediatrics certification.

Questions

200 scored questions

Time Limit

~4h CBT (two timed sessions)

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 Pediatric Critical Care Medicine Exam Content Outline

16%

Normal Organ Development, Physiology, Pharmacology

Age-specific physiology (respiratory mechanics, CV — CO, SVR, preload/afterload; neurologic; renal maturation; hepatic metabolism), developmental pharmacokinetics (Vd, clearance, CYP450 maturation), weight-based dosing, protein binding changes, PK/PD in children.

Organ Support Therapies & Monitoring

Mechanical ventilation (invasive/NIV), ECMO VA vs VV (ELSO guidelines, indications OI ≥40 sustained, complications — bleeding, stroke, circuit thrombosis), ventricular assist, CRRT (CVVH, CVVHD, CVVHDF), invasive/noninvasive CV monitoring, ICP monitoring (EVD, parenchymal bolt), NIRS, BIS.

Respiratory System (PARDS, Ventilation)

Pediatric ARDS/PARDS (PALICC-2 definition using OI or OSI, PaO2/FiO2, SpO2/FiO2), lung-protective ventilation (6 mL/kg PBW, permissive hypercapnia, prone positioning, HFOV rescue), severe asthma (continuous albuterol, terbutaline, ketamine, heliox, NIV, intubation avoidance), pulmonary HTN, VILI.

Cardiovascular System (Shock, CHD, Arrest)

Shock — hypovolemic, distributive/septic (2020 SSC Pediatric — fluid bolus 20 mL/kg up to 40-60 mL/kg, norepi/epi first-line; Phoenix 2024 criteria), cardiogenic, obstructive; congenital/acquired heart disease; arrhythmias (SVT adenosine 0.1 mg/kg, VT lidocaine/amiodarone); PALS cardiac arrest; post-ROSC care (TTM 36°C, hemodynamic targets).

Neurologic System (TBI, Status, Brain Death)

TBI management (BTF pediatric guidelines — ICP <20, CPP 40-50 young child/50-60 adolescent, hypertonic saline 3% preferred over mannitol, normothermia 35-37°C, avoid routine hyperventilation), status epilepticus (benzo → fospheny/levetiracetam → anesthetic drip), 2023 pediatric brain death determination (apnea test, ancillary).

Sedation & Analgesia

Agents (dexmedetomidine, ketamine, propofol — PRIS, midazolam, opioids), multimodal approach, withdrawal/delirium (CAPD screen, SOS scale, methadone/clonidine taper), neuromuscular blockade (rocuronium, cisatracurium, sugammadex for roc/vec reversal), procedural sedation safety.

Multi-Organ Dysfunction/Failure

MODS in critically ill children, thrombotic microangiopathies, cytokine storm, MIS-C (multisystem inflammatory syndrome in children, IVIG + steroids, coronary monitoring), PELOD-2/pSOFA scores, organ system interactions (cardiorenal, hepatorenal).

Inflammatory/Immunologic/Infectious (Sepsis, Transplant)

Pediatric septic shock (Surviving Sepsis 2020, Phoenix 2024 criteria, IVIG consideration), TSS, necrotizing fasciitis, HLH (H-score, dexa/etoposide), transplant ICU (solid organ, HSCT — GVHD, VOD/SOS — defibrotide, thrombotic microangiopathy), immunocompromised host, nosocomial infections.

Kidney, Fluid & Electrolyte (AKI, CRRT)

AKI (KDIGO pediatric, pRIFLE, furosemide stress test), fluid overload (>15% associated with worse outcomes), CRRT modalities and indications (AEIOU), plasmapheresis, isotonic maintenance fluids (2018 AAP), hypertonic saline, diabetes insipidus, SIADH, CSW.

Hematologic Disorders & Neoplasms

DIC, thrombocytopenia (HIT), VTE prophylaxis, TRIPICU restrictive transfusion (7 g/dL), massive transfusion protocol, oncologic emergencies (tumor lysis — rasburicase for high-risk; hyperleukocytosis; SVC syndrome), HSCT complications, CAR-T CRS (tocilizumab).

Endocrinologic & Metabolic (DKA, Adrenal)

DKA (PECARN FLUID trial — faster fluids safe, insulin 0.05-0.1 units/kg/hr, cerebral edema — hypertonic saline 3% 3-5 mL/kg or mannitol 0.5-1 g/kg), HHS, adrenal crisis (stress-dose hydrocortisone), thyroid storm, myxedema coma, decompensated IEM.

Hepatobiliary, GI & Nutrition

Acute liver failure (PALF criteria — INR>2 or >1.5 with HE; NAC for APAP; N-acetylcysteine for non-APAP), fulminant hepatitis, GI bleeding, abdominal compartment syndrome, early enteral nutrition in PICU (ASPEN guidelines), post-pyloric feeds.

Trauma (TBI, Burns, Drowning, Abuse)

Pediatric trauma primary/secondary survey, TBI care (BTF), burns (Parkland 4 mL/kg/%TBSA LR, inhalation injury, nutritional support), drowning (hypothermia — rewarm before declaring death; neuroprotection), child abuse recognition (sentinel injuries, AHT, sexual abuse).

Toxicologic Illness & Envenomations

Toxidromes and antidotes (NAC for APAP; naloxone; fomepizole for ethylene glycol/methanol; physostigmine; digoxin Fab; glucagon/calcium/HDIE for CCB/BB; bicarb for TCA; atropine+pralidoxime for organophosphates), envenomations (crotalid — CroFab), button batteries.

Procedures

Airway management (RSI, difficult airway algorithm, LMA, surgical airway), central venous/arterial line (US-guided), IO access, thoracostomy, pericardiocentesis, ICP monitor placement, ECMO cannulation, POCUS (cardiac, lung, vascular, FAST).

End of Life & Clinical Ethics

2023 pediatric brain death determination (prerequisites, clinical exam, apnea test, ancillary studies — cerebral angiography/nuclear medicine), withdrawal of life-sustaining therapy, organ donation (DCD, DBD), palliative care integration, ethics principles (autonomy, beneficence, non-maleficence, justice), futility, surrogate decision-making.

Core Knowledge in Scholarly Activities

Biostatistics (sensitivity/specificity, PPV/NPV, NNT, RR, OR, HR), study design, bias/confounding, systematic reviews/meta-analysis, QI (PDSA, SMART aims, run/control charts, common vs special cause variation), research ethics (IRB, consent/assent in critically ill children).

Behavioral Health / PICU Management / Professionalism

Common PICU behavioral/psychiatric comorbidities (1%), PICU management and coordination — triage, transport, handoffs, sequelae of critical illness (1%), professionalism/leadership/burnout/health equity (1%).

How to Pass the ABP Pediatric Critical Care Medicine Exam

What You Need to Know

Passing score: Criterion-referenced (scaled 1-300; ~180 pass)
Exam length: 200 questions
Time limit: ~4h CBT (two timed sessions)
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 Pediatric Critical Care Medicine Study Tips from Top Performers

1PALICC-2 PARDS rule: pediatric ARDS diagnosed with acute onset (within 7 days of known insult), bilateral infiltrates on imaging, not fully explained by cardiac failure/fluid overload, and oxygenation defect. For invasive ventilation: OI 4-8 mild, 8-16 moderate, ≥16 severe. For NIV: PF ratio ≤300 or SF ratio ≤264 (without full face mask exclusion). Management: low tidal volume 5-8 mL/kg PBW, plateau pressure <28 (or 29-32 in high chest wall elastance), PEEP titrated to oxygenation, permissive hypercapnia (pH ≥7.20), prone positioning for moderate-severe, HFOV as rescue.

2Phoenix sepsis criteria 2024 rule: pediatric sepsis defined by suspected/confirmed infection + Phoenix Sepsis Score ≥2 (cardiovascular, respiratory, neurologic, coagulation dysfunction). Septic shock = sepsis + cardiovascular dysfunction (vasoactive medication requirement, lactate >5, or MAP below age-specific threshold). Surviving Sepsis Pediatric 2020: crystalloid 10-20 mL/kg boluses to 40-60 mL/kg within first hour; epinephrine or norepinephrine as first-line vasoactive; hydrocortisone for catecholamine-resistant shock; antibiotics within 1 hour of recognized septic shock, within 3 hours for sepsis without shock.

3Pediatric TBI BTF management: target ICP <20 mmHg (strong recommendation), CPP 40-50 mmHg young children and 50-60 mmHg adolescents. Tier 1 therapy: hypertonic saline 3% bolus 2-5 mL/kg (strong recommendation over mannitol), elevate HOB 30°, normothermia 35-37°C, adequate analgesia/sedation. Tier 2: hypertonic saline continuous infusion, increased sedation/paralysis, CSF drainage. Tier 3: decompressive craniectomy, barbiturate coma, hypothermia (not standard). Avoid routine hyperventilation (PaCO2 30-35 only for impending herniation).

42023 pediatric brain death determination: prerequisites include normothermia (>35°C), SBP at/above 5th %ile for age, correction of metabolic/toxic derangements, and no sedatives/paralytics interfering with exam. Clinical exam: coma, absent brainstem reflexes (pupil, corneal, oculocephalic, cold caloric, cough, gag), apnea test target PaCO2 ≥60 or ≥20 above baseline. Observation period: 24 hours for neonates (37 weeks PMA to 30 days), 12 hours for >30 days. Two exams required. Ancillary testing (cerebral angiography, nuclear cerebral blood flow) when apnea test cannot be safely completed.

5PECARN FLUID DKA rule: 1/2 normal saline or 0.9% NS at 1.5x or 2x maintenance did not differ in cerebral edema incidence vs slower rehydration, supporting moderate rehydration strategies. Insulin 0.05-0.1 units/kg/hr IV (no bolus), aim for glucose decline 50-100 mg/dL/hr, add dextrose when glucose <250-300 mg/dL, potassium replacement when K <5.5 (add 20-40 mEq/L when urinating). Cerebral edema risk factors: younger age, severe acidosis pH <7.1, severe dehydration, elevated BUN, bicarbonate use. Manage cerebral edema with 3% hypertonic saline 3-5 mL/kg or mannitol 0.5-1 g/kg.

Frequently Asked Questions

What is the ABP Pediatric Critical Care Medicine subspecialty certification?

The ABP Pediatric Critical Care Medicine subspecialty certification is awarded by the American Board of Pediatrics to diplomates who demonstrate expert-level knowledge in the care of critically ill infants, children, and adolescents in the PICU. It covers shock, respiratory failure/PARDS, cardiac arrest, TBI/ICP management, status epilepticus, DKA, AKI/CRRT, ECMO, trauma, toxicology, transplant ICU care, and end-of-life/brain death. Certification qualifies physicians to direct pediatric intensive care units.

Who is eligible to take the ABP PCCM exam?

Candidates must hold primary ABP General Pediatrics certification in good standing and have completed 3 years of full-time ACGME-accredited Pediatric Critical Care Medicine fellowship training (or RCPSC in Canada). A valid unrestricted medical license is required. Candidates must complete scholarly activity (Meaningful Accomplishment in Research) approved by their Scholarship Oversight Committee. No continuous absence of more than one year from training is permitted. A combined Anesthesiology/PCCM 5-year pathway is available with case-by-case approval from both ABP and ABA.

What is the format of the ABP PCCM exam?

The exam is a computer-based examination at Prometric testing centers with approximately 200 single-best-answer multiple-choice questions delivered in two timed sessions (total ~4 hours of testing). Questions are heavily case-based and span the blueprint's 10 content domains. Questions in Domain 2 (Common Conditions) are additionally classified by one of four universal tasks: core science (20%), epidemiology/risk (5%), diagnosis/testing/monitoring (40%), or management/treatment (35%).

How much does the 2026 ABP PCCM 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). Withdrawal by the Oct 23, 2026 deadline refunds $2,242 (total paid minus the $750 processing fee). Retakes require full fee payment.

When is the 2026 PCCM exam administered?

The 2026 ABP Pediatric Critical Care Medicine Subspecialty Certification Exam is scheduled for November 10, 2026 at Prometric Testing Centers. Regular registration is Feb 2 – April 1, 2026. Late registration is April 2 – April 30, 2026 (no exceptions). Withdrawal deadline is Oct 23, 2026.

How is the exam scored?

ABP uses criterion-referenced scoring. Raw scores are converted to a scaled score (range 1-300), with a passing score of approximately 180 set by a committee of content experts using a modified Angoff methodology. Results depend on performance relative to the fixed standard, not against other candidates. Results are typically released 6-8 weeks after the exam. 2024 first-time pass rate was 82% (399 candidates).

What are the highest-yield topics?

Normal organ system development/physiology/pharmacology is the largest single domain (16%) — master developmental PK/PD and age-specific physiology. Within Common Conditions (54% total), the 'big four' are Respiratory (6% — PARDS/PALICC-2, lung-protective ventilation), Cardiovascular (6% — shock types and management, Surviving Sepsis Pediatric, PALS arrest), Neurologic (6% — TBI/ICP per BTF, status epilepticus, 2023 brain death criteria), and Inflammatory/Infectious (5% — Phoenix sepsis criteria, HLH, transplant ICU). Organ Support (9%) is heavily tested — master ECMO (VA vs VV), CRRT modalities, and mechanical ventilation. Sedation/Analgesia (6%) — know dexmedetomidine, ketamine, propofol (PRIS), and delirium assessment (CAPD).

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 content: Normal Physiology/Pharmacology (16%), then Common Conditions (especially respiratory/CV/neuro/inflammatory), then Organ Support and Sedation. Core references: Rogers' Textbook of Pediatric Intensive Care, Nichols & Shaffner's Rogers', Fuhrman & Zimmerman Pediatric Critical Care, PCCM Review/PCCM Perspectives, Society of Critical Care Medicine (SCCM) resources, and the ABP blueprint. Do 2-3 timed full-length mock exams. Master key guidelines: Surviving Sepsis Pediatric 2020, Phoenix sepsis 2024, PALICC-2 PARDS, BTF pediatric TBI, 2023 pediatric brain death, PECARN FLUID DKA, and PALS 2020 updates.