100+ Free ABP Pediatric Emergency Medicine Practice Questions

Pass your ABP Pediatric Emergency Medicine Subspecialty Certification Examination exam on the first try — instant access, no signup required.

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~88-93% first-time (ABP joint-board pass rates 2022-2025) Pass Rate

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Question 1

Score: 0/0

A 4-year-old in SVT (HR 220) is alert with adequate perfusion. Vagal maneuvers fail. IV access is established. What is the next step?

Adenosine 0.1 mg/kg rapid IV push

Synchronized cardioversion 0.5 J/kg

Amiodarone 5 mg/kg IV

Verapamil 0.1 mg/kg IV

to track

2026 Statistics

Key Facts: ABP Pediatric Emergency Medicine Exam

~200

MCQ Items

Approximately 200 single-best-answer questions

Exam Time

Two 2-hour sections

32.5%

Emergency Conditions Weight

Largest domain on blueprint

$2,992

2026 Regular Fee

Includes $750 processing fee

3 yr

Required Fellowship

ACGME Pediatric Emergency Medicine

~88-93%

First-Time Pass Rate

ABP joint-board 2022-2025

The ABP PEM exam (joint with ABEM) is ~200 MCQs delivered in two 2-hour sections (~4 hours total) at Prometric. The blueprint (effective April 1, 2021) weights: Emergency Conditions 32.5% (Infectious Disease 5%, Cardiovascular 3%, Gastrointestinal 2.5%, Neurologic 2%, Pulmonary 2%, Renal 2%, Allergic/Derm/Endocrine/Hematologic/Urologic/OB-GYN/Oncologic 1.5% each, others 1% or less), Trauma 17.5%, Resuscitation 12.5%, Procedures 6%, Toxicology 5%, Behavioral Health 5%, Child Abuse 4.5%, Environmental Emergencies 4%, Core Scholarly 4%, Special Populations 3%, Disaster Preparedness 2%, EMS/Transport 2%, ED Administration 2%. 2026 fee: $2,992 regular; joint ABP/ABEM governance.

Sample ABP Pediatric Emergency Medicine Practice Questions

Try these sample questions to test your ABP Pediatric Emergency 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 in SVT (HR 220) is alert with adequate perfusion. Vagal maneuvers fail. IV access is established. What is the next step?

A.Adenosine 0.1 mg/kg rapid IV push

B.Synchronized cardioversion 0.5 J/kg

C.Amiodarone 5 mg/kg IV

D.Verapamil 0.1 mg/kg IV

Explanation: For stable SVT unresponsive to vagal maneuvers, give adenosine 0.1 mg/kg (max 6 mg) rapid IV push, followed by saline flush; may repeat at 0.2 mg/kg (max 12 mg). Cardioversion is reserved for unstable SVT.

2A 2-year-old in SVT becomes hypotensive and poorly perfused. IV access is unavailable. What is the next step?

A.Attempt IO access for adenosine

B.Synchronized cardioversion 0.5-1 J/kg

C.Start chest compressions

D.Defibrillate at 2 J/kg

Explanation: Unstable SVT with poor perfusion requires immediate synchronized cardioversion at 0.5-1 J/kg; may increase to 2 J/kg if needed. Do not delay for IV/IO access when the child is unstable.

3A 6-year-old in pulseless VF receives CPR. What is the initial defibrillation dose?

A.1 J/kg

B.2 J/kg

C.4 J/kg

D.10 J/kg

Explanation: PALS: initial defibrillation for VF/pulseless VT is 2 J/kg; subsequent shocks at 4 J/kg; further shocks may increase up to 10 J/kg or adult max. Epinephrine 0.01 mg/kg IV/IO is given between shocks.

4During cardiac arrest in an 8-year-old, what is the correct IV/IO dose of epinephrine?

A.0.1 mg/kg of 1:1000

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

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

D.0.001 mg/kg of 1:1000

Explanation: PALS cardiac arrest epinephrine is 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO every 3-5 minutes, max 1 mg. Endotracheal dose is 10x higher (0.1 mg/kg of 1:1000) but is a less preferred route.

5A 10-month-old has symptomatic bradycardia (HR 50) with poor perfusion despite effective oxygenation and ventilation. Next step?

A.Atropine 0.02 mg/kg IV

B.Epinephrine 0.01 mg/kg IV/IO

C.Transcutaneous pacing

D.Dopamine infusion

Explanation: PALS: if bradycardia with poor perfusion persists despite oxygenation/ventilation, give epinephrine 0.01 mg/kg IV/IO and start CPR if HR <60. Atropine is used for vagal-mediated or AV-block bradycardia, minimum dose 0.1 mg.

6What is the recommended compression-to-ventilation ratio for a single rescuer performing CPR on a 5-year-old?

A.15:2

B.30:2

C.5:1

D.Continuous compressions only

Explanation: Single-rescuer CPR in children uses 30:2 compression-to-ventilation ratio. Two-rescuer CPR uses 15:2. Once advanced airway is in place, compressions are continuous at 100-120/min with ventilation every 2-3 seconds.

7A 3-year-old in PEA arrest has been receiving CPR and epinephrine. Which reversible cause should be evaluated FIRST in a previously healthy child found unresponsive at home?

A.Hypovolemia

B.Tension pneumothorax

C.Hyperkalemia

D.Thrombosis

Explanation: Hypovolemia and hypoxia are the most common reversible causes of pediatric PEA arrest. The Hs and Ts should be systematically evaluated; a 20 mL/kg isotonic fluid bolus is often given empirically.

8Post-ROSC in a child with witnessed cardiac arrest. Best targeted temperature management?

A.Active rewarming to 38°C

B.Targeted normothermia 36-37.5°C or hypothermia 32-34°C

C.Induce hyperthermia

D.No temperature control needed

Explanation: Post-ROSC pediatric care recommends either targeted normothermia (36-37.5°C) or therapeutic hypothermia (32-34°C), with active avoidance of fever. Fever worsens neurologic outcomes after cardiac arrest.

9Correct chest compression depth in a 4-year-old?

A.1/4 AP chest diameter

B.At least 1/3 AP diameter (~5 cm)

C.At least 1/2 AP diameter

D.2 cm

Explanation: Pediatric compressions should depress the chest at least one-third the AP diameter (~5 cm in children, ~4 cm in infants). Allow full chest recoil between compressions and minimize interruptions.

10A child has a wide-complex tachycardia with a pulse but poor perfusion. Best initial management?

A.Adenosine 0.1 mg/kg

B.Synchronized cardioversion 0.5-1 J/kg

C.Amiodarone bolus 5 mg/kg

D.Defibrillation 2 J/kg

Explanation: Unstable wide-complex tachycardia with a pulse requires synchronized cardioversion at 0.5-1 J/kg, escalating to 2 J/kg. Amiodarone or procainamide may be used for stable VT after expert consultation.

About the ABP Pediatric Emergency Medicine Exam

The ABP Pediatric Emergency Medicine (PEM) subspecialty certification is a joint ABP/ABEM credential for physicians providing emergency care to children. Content covers resuscitation, trauma, airway management, febrile infant evaluation, asthma/bronchiolitis, status epilepticus, DKA, ingestions/toxicology, infectious emergencies (meningitis, sepsis), non-accidental trauma recognition, orthopedic injuries, foreign bodies, burns, surgical abdomen, point-of-care ultrasound, environmental emergencies, behavioral health, and EMS/disaster preparedness. Requires 3 years of ACGME-accredited Pediatric Emergency Medicine fellowship following primary ABP (Pediatrics) or ABEM (Emergency Medicine) certification.

Questions

200 scored questions

Time Limit

4h CBT (two 2h sections)

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) with American Board of Emergency Medicine (ABEM) / Prometric)

ABP Pediatric Emergency Medicine Exam Content Outline

32.5%

Emergency Conditions (19 Subcategories)

Infectious disease 5% (bacteremia, meningitis, sepsis, herpes, RSV, influenza, STIs, neonatal HSV), Cardiovascular 3% (CHF, dysrhythmias, CHD, myocarditis, syncope), Gastrointestinal 2.5% (intussusception, pyloric stenosis, appendicitis, malrotation, Meckel's), Pulmonary 2% (asthma, bronchiolitis, pneumothorax, ARDS, PE), Renal/electrolyte 2% (HUS, AKI, electrolyte disorders, dehydration), Neurologic 2% (seizures, headaches, intracranial conditions, VP shunt, stroke), Allergic 1.5% (anaphylaxis — IM epinephrine 0.01 mg/kg q5-15 min), Derm 1.5%, Endocrine 1.5%, Hematologic 1.5%, OB/GYN 1.5%, Oncologic 1.5%, Urologic 1.5% (torsion), Musculoskeletal 1%, Ophthalmologic 1%, Otolaryngologic 1%, Rheumatologic 1% (Kawasaki, HSP), Metabolic/Genetic 1%, Dental 0.5%.

17.5%

Trauma

Trauma resuscitation (ATLS/PALS — primary survey ABCDE; secondary survey), multisystem trauma, chest trauma (pneumothorax, hemothorax, cardiac tamponade, pulmonary contusion, commotio cordis), abdominal/pelvic trauma (FAST exam, splenic/liver laceration — nonoperative management), GU trauma, neurologic trauma (pediatric GCS, TBI management, concussion/SCAT return-to-play, epidural vs subdural vs SAH), head/neck/oromaxillofacial, fractures (Salter-Harris I-V, supracondylar with NV injury, toddler's fracture), ophthalmologic (hyphema, globe rupture), wound care, burns (Parkland formula 4 mL LR/kg/%TBSA, Lund-Browder chart), injury prevention.

12.5%

Resuscitation

Circulation (IV/IO access after 2 failed attempts or 90s, fluid resuscitation 20 mL/kg NS/LR boluses), shock (cardiogenic, distributive/septic, hypovolemic, obstructive), cardiopulmonary arrest (PALS 2020 — CPR high-quality, epinephrine 0.01 mg/kg every 3-5 min, defibrillation 2 then 4 J/kg for VF/pVT, adenosine for SVT 0.1 mg/kg first then 0.2 mg/kg), airway (RSI — atropine pretreatment optional <1 yr, ketamine preferred in shock, rocuronium 1 mg/kg), respiratory failure/arrest, neurologic resuscitation, neonatal resuscitation in ED (NRP), post-resuscitation care (TTM 36°C).

Procedures

Vascular access (IV, IO with EZ-IO, central venous, umbilical), defibrillation/cardioversion, advanced airway (endotracheal intubation, surgical airway — cricothyroidotomy >10 kg, LMA, video laryngoscopy, difficult airway algorithm), pericardiocentesis, thoracostomy, procedural sedation (ketamine 1-2 mg/kg IV or 4-5 mg/kg IM; ketofol; nitrous oxide; dexmedetomidine; propofol), laceration repair (dermabond for low-tension), I&D, lateral canthotomy for orbital compartment syndrome, cardiac pacing, hernia reduction, orthopedic reduction, foreign body removal, nasal packing, POCUS (cardiac, lung, FAST, vascular, MSK, ocular, airway).

Toxicology

Toxidromes — anticholinergic (physostigmine), cholinergic (atropine + pralidoxime), sympathomimetic (benzos, no beta-blockers), opioid (naloxone 0.1 mg/kg up to 2 mg), sedative-hypnotic, serotonin syndrome (cyproheptadine), NMS (bromocriptine/dantrolene). Decontamination (activated charcoal 1 g/kg within 1 hour), whole bowel irrigation. APAP (NAC — Rumack-Matthew 4-hour level), aspirin, iron (deferoxamine), digoxin (Fab), CCBs/BBs (calcium + glucagon + high-dose insulin), TCAs (bicarb for QRS >100 ms), alcohols (fomepizole, dialysis), hydrocarbons (no lavage), organophosphates, button batteries (emergent removal if in esophagus).

Behavioral Health & Psychosocial

Approach to family-centered care, psychosocial development by age, autism in ED (sensory modifications, communication), depression, PTSD, NSSI, suicide risk assessment (ASQ — Ask Suicide-Screening Questions), ADHD, conduct disorder, agitated/aggressive patient (verbal de-escalation first; chemical restraint with ketamine, olanzapine IM, haloperidol + benzo), homicidal patient, psychosis, substance use, anxiety, eating disorders (medical stabilization, refeeding), somatoform, gender dysphoria, violence (IPV, community), colic/breath holding/hyperventilation.

4.5%

Child Abuse & Maltreatment

Physical abuse (sentinel injuries, TEN-4-FACESp bruising rule for children <4 yrs, metaphyseal corner fractures, posterior rib fractures pathognomonic, abusive head trauma — subdural + retinal hemorrhages), neglect, sexual assault/abuse (acute <72-96 hours forensic exam, STI prophylaxis, emergency contraception, safety planning), psychological abuse, bullying, Munchausen syndrome by proxy (medical child abuse), human trafficking red flags, mandated reporting (every state).

Environmental Emergencies

Altitude sickness (AMS, HAPE — nifedipine/dexamethasone/descent; HACE — descent/dexamethasone), DCI (hyperbaric O2), animal/human bites (rabies PEP — HRIG + vaccine for bats even without bite; tetanus; amoxicillin-clavulanate), envenomations (crotalid — CroFab; coral snake; black widow; brown recluse; jellyfish vinegar; scorpion), drowning (prolonged resuscitation in hypothermia — 'not dead until warm and dead'), electrical/lightning (Lichtenberg figures, keraunoparalysis, cardiac monitoring), heat stroke (evaporative cooling, ice-water immersion), hypothermia (rewarming ECMO for arrest).

Core Knowledge in Scholarly Activities

Biostatistics (sensitivity/specificity, PPV/NPV, LRs, ROC, NNT, RR, OR, HR), study design (RCT, cohort, case-control, SR/MA), bias/confounding, EBM, QI (PDSA cycles, run/control charts, SMART aims, root cause analysis, FMEA), research ethics (IRB, assent/consent), patient safety/safety reporting systems (RCA, FMEA).

Special Populations

Transplant patients (solid organ — rejection; HSCT — GVHD, VOD), medically complex children (tracheostomy emergencies — DOPE mnemonic: Displacement, Obstruction, Pneumothorax, Equipment; VP shunt malfunction; ventilator-dependent; gastrostomy tube dislodgement; baclofen pump failure), autism-specific ED approach, adult patient in pediatric ED (AMS, chest pain, syncope), palliative care patients.

Disaster Preparedness

Mass casualty triage (JumpSTART pediatric modification — respiratory first then perfusion then mental status; 15-60 second assessment), bioterrorism (anthrax — cipro/doxy; smallpox — vaccinia; plague — strep/tetra; botulism — antitoxin; tularemia; VHFs), chemical terrorism (nerve agents — atropine/pralidoxime; vesicants — sulfur mustard; cyanide — hydroxocobalamin; riot control — CS/CN), radiation exposure (ARS stages; potassium iodide for radioactive iodine), HAZMAT decon, strategic national stockpile, CHEMPACK.

EMS & Transport

EMTALA (medical screening exam obligation, stabilization, transfer requirements), EMS system organization, EMS personnel tiers, scene vs interhospital transport (ground, rotor-wing, fixed-wing — patient/crew safety), EMS for Children (EMSC) principles and pediatric readiness standards, medical direction (online vs offline), legal considerations in EMS.

ED Administration & Operations

Caregiver presence during resuscitation and procedures (evidence supports), documentation and reporting (incident reports, mandated reports), interpreter usage (CMS standards — qualified interpreter), risk management (RCA), legal/ethical (minor consent — emergency exception, mature minor doctrine, emancipated minor, treatment refusal/AMA, patient bill of rights), interpersonal skills (de-escalation, difficult conversations, cultural humility, handoffs — IPASS, informed consent).

How to Pass the ABP Pediatric Emergency 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 2h sections)
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 Emergency Medicine Study Tips from Top Performers

1AAP 2021 febrile infant guideline (8-60 days): Well-appearing, term infants. For 8-21 days — full workup (blood, urine, CSF), empiric antibiotics (ampicillin + gentamicin or cefotaxime/ceftazidime), admission; add acyclovir if HSV risk factors. For 22-28 days — blood, urine, CSF + inflammatory markers (procalcitonin, CRP, ANC); can consider selective CSF exclusion if markers normal but traditionally empirical antibiotics and admission. For 29-60 days — blood, urine + inflammatory markers first; CSF only if markers abnormal or UTI; outpatient observation if low-risk by IBI score and reliable follow-up. Use pro-calcitonin if available (>0.5 ng/mL abnormal).

2PECARN head trauma rule: Children <2 yrs are low-risk (no imaging needed) if: GCS 15, no AMS, no loss of consciousness ≥5 sec, no severe mechanism, no palpable skull fracture, no nonfrontal scalp hematoma, and normal behavior per parents. Children ≥2 yrs are low-risk if: GCS 15, no AMS, no LOC, no severe mechanism, no vomiting, no severe headache, no signs of basilar skull fracture. Severe mechanism: MVC with ejection/rollover/fatality, pedestrian/bicycle vs motor vehicle without helmet, fall >3 ft (<2 yrs) or >5 ft (≥2 yrs), high-impact object.

3Anaphylaxis management rule: first-line is intramuscular epinephrine 0.01 mg/kg (1:1000, max 0.3-0.5 mg) in the mid-anterolateral thigh. Repeat every 5-15 min. Second-line: H1 and H2 antihistamines, IV fluids for hypotension, albuterol for bronchospasm, corticosteroids (controversial — no effect on biphasic reactions). Observation for at least 4-6 hours after epinephrine administration. Discharge with 2 epinephrine autoinjectors, allergist referral, and action plan.

4PALS 2020 cardiac arrest updates: high-quality CPR (100-120/min, depth 1/3 AP diameter, full recoil, minimize interruptions), compression:ventilation 15:2 (2 rescuers) or 30:2 (1 rescuer) without advanced airway; with advanced airway: continuous compressions + 1 breath every 2-3 sec (20-30/min). Epinephrine 0.01 mg/kg IV/IO (1:10,000) every 3-5 min, first dose within 5 min. Defibrillation for VF/pulseless VT at 2 J/kg, then 4 J/kg, then up to 10 J/kg (not exceeding adult dose). Post-ROSC targeted temperature management 36°C for 48 hours (or 32-34°C for specific scenarios).

5PEM toxicology rule: Toxidromes are high-yield — anticholinergic (hot as a hare, red as a beet, dry as a bone, blind as a bat, mad as a hatter — treat with physostigmine 0.02 mg/kg if severe CNS), cholinergic (SLUDGE + killer B's bradycardia/bronchorrhea/bronchospasm — atropine + pralidoxime), sympathomimetic (benzos, no beta-blockers), opioid (naloxone 0.1 mg/kg up to 2 mg IV/IN/IM). Acetaminophen: obtain 4-hour post-ingestion level; plot on Rumack-Matthew nomogram (treatment line at 150 μg/mL at 4 hr); NAC if above treatment line or unknown time/massive ingestion. Activated charcoal most effective within 1 hour of ingestion, avoid in hydrocarbon/caustic ingestion.

Frequently Asked Questions

What is the ABP Pediatric Emergency Medicine subspecialty certification?

The Pediatric Emergency Medicine subspecialty certification is jointly governed by the American Board of Pediatrics (ABP) and the American Board of Emergency Medicine (ABEM). It validates expert-level knowledge in emergency care for infants, children, and adolescents — spanning resuscitation, trauma, airway/respiratory emergencies, febrile infant evaluation, status epilepticus, DKA, toxicology, non-accidental trauma recognition, environmental emergencies, procedural sedation and POCUS, and EMS/disaster preparedness. Certification qualifies physicians to staff and direct pediatric emergency departments.

Who is eligible to take the ABP/ABEM PEM exam?

Candidates must hold primary certification by either the ABP in Pediatrics OR the ABEM in Emergency Medicine, in good standing. Additionally, they must complete 3 years of full-time ACGME-accredited Pediatric Emergency Medicine fellowship training (or RCPSC in Canada). Part-time training may be completed over up to 6 years. A valid unrestricted medical license is required. Candidates must also complete scholarly activity (Meaningful Accomplishment in Research) approved by their Scholarship Oversight Committee. ABEM pathway candidates apply via the MyABEM Portal.

What is the format of the ABP/ABEM PEM exam?

The PEM exam is a computer-based examination at Prometric testing centers. It is approximately 4 hours total, delivered in two timed sections of 2 hours each, with approximately 200 single-best-answer multiple-choice questions. Questions are heavily case-based and span the 13 blueprint domains. Questions in Domains 1-8 are additionally classified by one of three universal tasks: Core Science (20%), Diagnosis (40%), or Patient Management (40%).

How much does the 2026 ABP PEM 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 published deadline refunds $2,242 (total paid minus the $750 processing fee). Retakes require full fee payment.

When is the PEM exam administered?

PEM examinations are administered through the ABP and ABEM. Specific 2026 exam dates and registration windows are published on the ABP Exam Dates and Fees for Subspecialties page. Candidates applying via ABEM use the MyABEM Portal for application, and ABEM forwards examination authorization to the ABP on a weekly basis for scheduling with Prometric.

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. First-time pass rates have been 88-93% in recent years (joint-board data). Results are typically released 6-8 weeks after the exam.

What are the highest-yield topics?

Emergency Conditions is the largest domain (32.5%) — within it, Infectious Disease (5%), Cardiovascular (3%), and GI (2.5%) are heavy. Trauma (17.5%) is the second-largest domain — master pediatric trauma resuscitation, TBI, fractures (Salter-Harris, supracondylar), abdominal trauma (FAST, nonoperative splenic), and burns (Parkland). Resuscitation (12.5%) — know PALS 2020 cold, shock types, RSI in children. Procedures (6%) — POCUS and procedural sedation are heavily tested. Toxicology (5%) — memorize toxidromes and antidotes. Child Abuse (4.5%) — sentinel injuries, AHT, sexual abuse, TEN-4-FACESp.

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 domains (Emergency Conditions, Trauma, Resuscitation, Procedures). Core references: Fleisher and Ludwig's Textbook of Pediatric Emergency Medicine, Tintinalli's Pediatric section, Pediatric Emergency Medicine Reports, ACEP PEM podcasts, and PEM fellow review resources. Master AAP febrile infant guideline 2021 (8-60 day workup), PALS 2020 updates, Surviving Sepsis Pediatric, PECARN decision rules (head trauma, cervical spine, abdominal trauma, intermediate-risk febrile infant), and button battery/magnet updates. Do 2-3 timed full-length mock exams. Practice ethics and POCUS.