100+ Free ABP Pediatric Infectious Diseases Practice Questions

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A term newborn develops respiratory distress, hypotension, and temperature instability at 18 hours of life. Blood culture grows gram-positive cocci in chains identified as group B Streptococcus. Which empiric regimen was most appropriate at presentation?

Piperacillin-tazobactam

Vancomycin plus cefotaxime

Ceftriaxone alone

Ampicillin plus gentamicin

to track

2026 Statistics

Key Facts: ABP Pediatric Infectious Diseases Exam

~200

Total MCQ Items

Single-best-answer, 4-5 options

~7 hr

Exam Time

1-day CBT at Pearson VUE

180

Passing Score

1-300 scale; criterion-referenced

$2,992

2026 Regular Fee

Includes $750 processing fee

3 yr

Required Fellowship

ACGME-accredited Pediatric ID fellowship

ACIP 2026

Current Vaccine Schedule

Includes nirsevimab, PCV20, HPV 2-dose

The ABP Pediatric Infectious Diseases certifying exam is a 1-day computer-based test of approximately 200 single-best-answer MCQs delivered at Pearson VUE. Scored on a 1-300 scale with 180 passing (criterion-referenced, modified Angoff). The 2026 fee is $2,992 regular ($750 processing), $3,337 late. Highest-yield domains: bacterial (~18%), viral (~18%), vaccines/ACIP (~10%), CNS infections (~7%), respiratory (~7%), fungal (~6%), bone/joint (~5%), endocarditis (~5%), immunocompromised (~5%), neonatal/perinatal (~5%), parasitic (~4%), HIV (~4%), UTI/GU (~3%), and SSTI (~3%).

Sample ABP Pediatric Infectious Diseases Practice Questions

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

1A term newborn develops respiratory distress, hypotension, and temperature instability at 18 hours of life. Blood culture grows gram-positive cocci in chains identified as group B Streptococcus. Which empiric regimen was most appropriate at presentation?

A.Piperacillin-tazobactam

B.Vancomycin plus cefotaxime

C.Ceftriaxone alone

D.Ampicillin plus gentamicin

Explanation: Early-onset neonatal sepsis (<7 days) is empirically treated with ampicillin plus an aminoglycoside (gentamicin), which covers GBS, Listeria, and most E. coli. Ceftriaxone is avoided in neonates (bilirubin displacement, calcium precipitation). Once GBS is confirmed and meningitis is excluded, therapy can be narrowed to penicillin G or ampicillin.

2According to the 2019 CDC/ACOG guidance, which of the following intrapartum antibiotic prophylaxis indications for group B Streptococcus is correct?

A.Positive GBS rectovaginal culture at 36 0/7-37 6/7 weeks

B.Positive GBS culture at 28 weeks regardless of delivery timing

C.All women with prior cesarean delivery

D.Women with GBS bacteriuria >10^2 CFU/mL at any time in pregnancy

Explanation: Universal antenatal GBS screening is now performed at 36 0/7-37 6/7 weeks (changed from 35-37 in 2019) to provide a 5-week window of culture accuracy. Other IAP indications include GBS bacteriuria >=10^5 CFU/mL in current pregnancy, prior infant with invasive GBS disease, and unknown status with risk factors (preterm <37 wk, ROM >=18 h, intrapartum fever).

3A 14-day-old presents with lethargy, poor feeding, and a seizure. CSF shows 200 WBC/mm^3 (80% mononuclear), protein 150, glucose 30. PCR is positive for HSV-2. Which is the appropriate induction therapy?

A.IV acyclovir 30 mg/kg/day for 14 days

B.IV acyclovir 60 mg/kg/day divided every 8 hours for 21 days

C.Oral valacyclovir for 10 days

D.IV ganciclovir for 14 days

Explanation: Neonatal HSV disease with CNS or disseminated involvement requires high-dose IV acyclovir at 60 mg/kg/day divided q8h for 21 days; SEM (skin/eye/mouth) disease is treated for 14 days. A repeat CSF HSV PCR at end of therapy must be negative before stopping. Oral acyclovir suppression (300 mg/m^2/dose TID) for 6 months after completing IV therapy improves neurodevelopmental outcomes per CASG trial.

4A newborn has microcephaly, hepatosplenomegaly, petechiae, and sensorineural hearing loss. Urine CMV PCR is positive within 3 weeks of birth. What is the most appropriate treatment?

A.IVIG alone

B.IV ganciclovir for 6 weeks then stop

C.Oral valganciclovir for 6 months

D.Observation without therapy

Explanation: Symptomatic congenital CMV with CNS involvement or other moderate-severe disease is treated with oral valganciclovir 16 mg/kg/dose BID for 6 months, based on the CASG trial showing improved hearing and neurodevelopmental outcomes over 6 weeks of therapy. Diagnosis requires urine or saliva CMV PCR within the first 3 weeks of life to distinguish congenital from postnatal infection. Monitor for neutropenia.

5A 4-year-old has fever, neck stiffness, and photophobia. CSF shows 2000 WBC/mm^3 (95% neutrophils), glucose 20, protein 200. Gram stain shows gram-negative diplococci. Which empiric therapy is most appropriate while awaiting culture?

A.Ceftriaxone plus vancomycin

B.Ampicillin plus gentamicin

C.Meropenem monotherapy

D.Ceftriaxone alone

Explanation: Empiric therapy for bacterial meningitis beyond the neonatal period is ceftriaxone plus vancomycin to cover S. pneumoniae (including ceftriaxone-nonsusceptible strains), N. meningitidis, and H. influenzae. Gram-negative diplococci suggest meningococcus, but vancomycin is continued until pneumococcus is excluded. Dexamethasone should be given before or with the first antibiotic dose if H. influenzae type b meningitis is suspected.

6A 6-year-old with sickle cell disease develops fever 39.5 C and a new oxygen requirement. Blood culture grows alpha-hemolytic streptococci. Which pneumococcal conjugate vaccine series reflects 2026 ACIP recommendations for healthy infants?

A.Single dose of PCV20 at 12 months

B.PCV13 only with no booster

C.PPSV23 starting at 2 months

D.PCV15 or PCV20 at 2, 4, 6, and 12-15 months

Explanation: ACIP recommends either PCV15 or PCV20 for the routine infant series at 2, 4, 6, and 12-15 months (replacing PCV13). Children with high-risk conditions such as sickle cell disease also receive PPSV23 at age 2 years with a booster 5 years later if PCV15 is used; PPSV23 is not needed when PCV20 is used. Penicillin prophylaxis continues until age 5 in SCD.

7Which vaccine is contraindicated in a child with severe combined immunodeficiency (SCID)?

A.Inactivated influenza

B.Rotavirus (live oral)

C.Hepatitis B

D.DTaP

Explanation: Live vaccines (rotavirus, MMR, varicella, live attenuated influenza, BCG, yellow fever) are contraindicated in SCID and other severe cellular immunodeficiencies because of risk of disseminated vaccine-strain disease. TREC newborn screening identifies SCID before rotavirus vaccine is given. Inactivated vaccines are safe but may have blunted immunogenicity.

8What is the maximum age for administration of the first dose of rotavirus vaccine?

A.24 weeks

B.6 weeks

C.20 weeks

D.14 weeks 6 days

Explanation: The first dose of rotavirus vaccine (RV1 or RV5) must be given before age 15 weeks (14 weeks 6 days), and the series must be completed by 8 months 0 days. These cutoffs reduce the risk of intussusception, which is highest after first doses given to older infants. Rotavirus is also contraindicated in SCID and history of intussusception.

9A 5-year-old unimmunized child presents with sudden-onset fever, drooling, and tripod positioning. Lateral neck radiograph shows a thumb sign. Which pathogen is most likely?

A.Staphylococcus aureus

B.Group A Streptococcus

C.Haemophilus influenzae type b

D.Respiratory syncytial virus

Explanation: Epiglottitis classically presents with rapid onset of fever, dysphagia, drooling, and respiratory distress; the thumb sign on lateral neck film confirms the diagnosis. H. influenzae type b was historically the main cause and is now seen mainly in unimmunized children. Management requires controlled airway intubation in the OR before examination, followed by ceftriaxone.

10According to 2026 ACIP, when is meningococcal serogroup B (MenB) vaccination recommended as routine?

A.All infants at 2, 4, and 6 months

B.Adolescents 16-23 years based on shared clinical decision-making (preferred age 16-18)

C.All children at 11-12 years along with MenACWY

D.Only after splenectomy

Explanation: MenACWY is routine at 11-12 years with a booster at 16 years. MenB is recommended based on shared clinical decision-making for adolescents and young adults 16-23 years (preferred 16-18) and for high-risk groups (complement deficiency, complement inhibitor therapy such as eculizumab, asplenia, microbiologists). A pentavalent MenABCWY vaccine is now available.

About the ABP Pediatric Infectious Diseases Exam

The ABP Pediatric Infectious Diseases subspecialty certifying exam validates expert-level knowledge of bacterial infections (GBS, pneumococcus, Hib, meningococcus, TB, MRSA, Lyme, RMSF, pertussis), viral infections (neonatal HSV, CMV — valganciclovir, EBV, HIV peds ART, RSV/nirsevimab, COVID/MIS-C, measles), fungal (Candida, Aspergillus, endemic, PJP, mucormycosis), parasitic (malaria — IV artesunate, toxoplasmosis), ACIP 2026 vaccine schedule, antimicrobial stewardship, CNS infections (bacterial meningitis, HSV encephalitis), bone/joint (Kocher, Kingella kingae), endocarditis (modified Duke, AHA 2021 prophylaxis), neonatal/TORCH, HIV in children, and immunocompromised host infections. 1-day CBT of ~200 MCQs. Requires ABP General Pediatrics certification plus a 3-year ACGME-accredited Pediatric ID fellowship.

Questions

200 scored questions

Time Limit

1-day CBT (~7 hours with breaks)

Passing Score

Scaled score of 180 on a 1-300 scale (criterion-referenced, modified Angoff)

Exam Fee

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

ABP Pediatric Infectious Diseases Exam Content Outline

~18%

Bacterial Infections

GBS (IAP penicillin), pneumococcus (PCV15/20, empiric ceftriaxone + vanc for meningitis), Hib (vaccine), meningococcus (MenACWY + MenB), MRSA, pertussis (DTaP/Tdap, cocooning), TB (IGRA/TST, INH, RIPE, MDR), Lyme (doxycycline any age per AAP 2020), RMSF (doxycycline all ages), C. diff (fidaxomicin), enteric pathogens.

~18%

Viral Infections

Neonatal HSV (acyclovir 60 mg/kg/day x14-21d + 6mo suppression post-CNS), VZV, congenital CMV (valganciclovir 6 months), EBV (mono, PTLD, HLH), parvovirus B19, enterovirus (HFMD, EV-A71), influenza (oseltamivir, baloxavir), RSV (nirsevimab ≤8mo 2023), SARS-CoV-2/MIS-C (IVIG + steroids), measles (vitamin A, post-exposure), HIV.

~10%

Vaccines and Immunization (ACIP 2026)

ACIP/AAP 2026 schedule (HepB, RV, DTaP, Hib, PCV20, IPV, influenza, MMR, varicella, HepA, HPV ≥9y — 2-dose <15y, MenACWY 11-12 + 16y, MenB SCDM), Tdap 11-12y, maternal Tdap 27-36w, RSV nirsevimab, live vaccine contraindications in immunocompromised, travel vaccines, VAERS.

~7%

CNS Infections

Bacterial meningitis empirics (ceftriaxone + vancomycin + dexamethasone; add ampicillin neonates for Listeria), duration by organism, complications (SIADH, subdural, SNHL — audiology), aseptic/viral (enterovirus), HSV encephalitis (temporal MRI, IV acyclovir), brain abscess, shunt infections (CoNS).

~7%

Respiratory Infections

AOM (AAP 2013 amoxicillin high-dose 80-90 mg/kg/day), sinusitis, GAS pharyngitis (Centor, penicillin/amoxicillin), epiglottitis, croup (dexamethasone), bronchiolitis (RSV — supportive; nirsevimab/palivizumab), CAP (amoxicillin first-line per AAP 2011; atypicals macrolide), empyema (VATS), CF pulmonary.

~6%

Fungal Infections

Invasive candidiasis (micafungin, ampho B), aspergillosis (voriconazole, galactomannan, halo sign), endemic mycoses (Histoplasma — itraconazole; Blastomyces; Coccidioides), PJP (TMP-SMX), Cryptococcus, mucormycosis (ampho B + debridement), dermatophytes.

~5%

Bone and Joint Infections

Osteomyelitis (S. aureus, Kingella kingae 6mo-3y — enriched BC/16S PCR, clinda for MSSA, vanc for MRSA, IV-to-PO transition), CRMO, septic arthritis (Kocher: fever >38.5, NWB, ESR >40, WBC >12K), synovial fluid >50K/>75% PMN, transient synovitis differential.

~5%

Endocarditis and Cardiac Infections

Modified Duke criteria, CHD/prosthetic/PICC/IDU risk, empirics (vanc + gent ± cefepime), surgery indications. AHA 2021 prophylaxis — only highest-risk (prosthetic, prior IE, cyanotic CHD unrepaired or repaired with defects, transplant valvulopathy) for dental procedures. Myocarditis, pericarditis, Kawasaki, MIS-C.

~5%

Immunocompromised Host Infections

Febrile neutropenia (pip-tazo or cefepime, vanc if MRSA risk), SOT (CMV, EBV/PTLD, BK, ADV — timing-based), HSCT (BK cystitis, CMV, Aspergillus, PJP), PID (SCID, CGD catalase+, CVID), sickle cell (pneumococcus, parvo), asplenia (encapsulated, OPSI).

~5%

Neonatal and Perinatal Infections

Early/late-onset sepsis (empiric ampicillin + gentamicin), TORCH (Toxoplasma, syphilis/parvo/Zika, Rubella, CMV, HSV), congenital syphilis (VDRL + treponemal, penicillin), congenital CMV (valganciclovir), perinatal HSV (empiric acyclovir), rubella (blueberry muffin, cataracts, PDA, SNHL), GBS IAP.

~4%

Parasitic Infections

Malaria (P. falciparum severe — IV artesunate CDC 2019; vivax/ovale primaquine after G6PD), toxoplasmosis (pyrimethamine + sulfadiazine + leucovorin), Chagas (benznidazole), Giardia, Crypto, E. histolytica, helminths (pinworm, Strongyloides — ivermectin, Schisto — praziquantel), scabies (permethrin).

~4%

HIV in Children and Adolescents

Perinatal HIV (maternal ART, elective C-section if VL >1000, neonatal ZDV+nevirapine risk-based), pediatric HIV dx (DNA/RNA PCR x2 by 4-6 mo — not serology), DHHS peds ART (dolutegravir-based), OIs (PJP — TMP-SMX prophylaxis), IRIS, PrEP (TDF/FTC ≥35 kg), PEP (<72h).

~3%

Urinary Tract and GU Infections

UTI (AAP 2011 febrile UTI 2-24mo, E. coli, cefdinir first-line, RBUS imaging, VCUG indications, RIVUR), pyelonephritis, STIs (GC/CT NAAT, syphilis congenital stages, HPV vaccine, mpox).

~3%

Skin and Soft Tissue Infections

Impetigo (mupirocin, cephalexin), cellulitis, abscess (I&D + TMP-SMX/clinda for MRSA), nec fasciitis (GAS, CA-MRSA — surgical debridement), SSSS, TSS (GAS vs menstrual S. aureus), animal bites (Pasteurella — augmentin), human bites (Eikenella).

How to Pass the ABP Pediatric Infectious Diseases Exam

What You Need to Know

Passing score: Scaled score of 180 on a 1-300 scale (criterion-referenced, modified Angoff)
Exam length: 200 questions
Time limit: 1-day CBT (~7 hours with breaks)
Exam fee: $2,992 regular ($750 processing fee); $3,337 with late fee

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 Infectious Diseases Study Tips from Top Performers

1Neonatal HSV rule: any infant ≤6 weeks with fever, lethargy, seizures, vesicles, or sepsis-like presentation → empiric IV acyclovir 60 mg/kg/day divided q8h WHILE awaiting HSV PCR (serum, CSF) and surface cultures. Treatment duration: SEM disease 14 days, CNS/disseminated 21 days. After completion of CNS treatment, give oral acyclovir suppression 300 mg/m²/dose TID for 6 months (improves neurodevelopmental outcomes per NIAID CASG). Confirm adequate neutrophil count; check LFTs/renal.

2Congenital CMV valganciclovir rule: congenital symptomatic CMV (microcephaly, chorioretinitis, SNHL, petechiae/thrombocytopenia, elevated LFTs, intracranial calcifications) benefits from 6 months of oral valganciclovir 16 mg/kg/dose BID — improves hearing and neurodevelopmental outcomes (NIAID CMV Collaborative Antiviral Study Group). Monitor ANC weekly x6 weeks then q2-4 weeks. Asymptomatic or isolated SNHL: benefit less certain, decide case-by-case.

3Kocher criteria for septic arthritis of the hip (child with hip pain): (1) fever >38.5°C, (2) non-weight-bearing, (3) ESR >40 mm/hr, (4) WBC >12,000. Probability of septic arthritis: 0 criteria <0.2%, 1 criterion 3%, 2 criteria 40%, 3 criteria 93%, 4 criteria >99%. CRP >2 mg/dL added as a 5th criterion improves accuracy. Differential: transient synovitis. Always aspirate if ≥2-3 criteria; synovial fluid WBC >50,000 with >75% PMNs supports septic arthritis. Kingella kingae is the most common cause in children 6 months to 3 years — use enriched blood culture bottles or 16S rRNA PCR.

4Modified Duke criteria (IE diagnosis): Definite = 2 major, OR 1 major + 3 minor, OR 5 minor. MAJOR — (1) typical organism from 2 separate blood cultures (viridans strep, S. aureus, HACEK, enterococci without primary focus) OR persistent bacteremia, (2) evidence of endocardial involvement (echo vegetation, abscess, new dehiscence) or new valvular regurgitation. MINOR — predisposition (CHD, IDU), fever ≥38°C, vascular phenomena (emboli, Janeway), immunologic (GN, Osler nodes, Roth spots, RF), microbiologic not meeting major, echo not meeting major. AHA 2021 prophylaxis only for highest-risk cardiac conditions undergoing dental procedures with gingival manipulation.

5RSV prevention 2023-2024 season rule (AAP): nirsevimab (Beyfortus, long-acting monoclonal) is recommended for ALL infants <8 months born during or entering first RSV season, AND for infants 8-19 months with high-risk conditions (chronic lung disease, significant CHD, severe immunocompromise, cystic fibrosis, neuromuscular disease) entering second RSV season. Palivizumab remains option if nirsevimab unavailable. Maternal RSVpreF vaccine (Abrysvo) 32-36 weeks gestation protects infant — infant should NOT receive nirsevimab if mother received Abrysvo ≥14 days before delivery (exceptions for high-risk).

Frequently Asked Questions

What is the ABP Pediatric Infectious Diseases subspecialty certification?

The ABP Pediatric Infectious Diseases certification is awarded by the American Board of Pediatrics to pediatricians who demonstrate expert knowledge in the diagnosis and management of infectious diseases in children and adolescents. It qualifies diplomates to lead hospital-based ID consult services, antimicrobial stewardship programs, infection prevention, HIV care, transplant ID, and vaccine advisory efforts.

Who is eligible to take the ABP Pediatric Infectious Diseases exam?

Candidates must hold primary ABP General Pediatrics certification in good standing and have completed 3 years of full-time training in an ACGME-accredited Pediatric Infectious Diseases fellowship. A valid unrestricted medical license is required. The fellowship includes clinical ID consultation, microbiology, HIV care, transplant ID, immunocompromised host care, and scholarly activity meeting the ABP scholarly requirement.

What is the format of the ABP Pediatric ID exam?

It is a 1-day computer-based exam administered at Pearson VUE Professional Testing Centers, consisting of approximately 200 single-best-answer multiple-choice questions. Items include clinical vignettes with microbiology (Gram stains, cultures, PCR panels), imaging (MRI osteomyelitis, chest CT, echocardiogram for Duke criteria), pharmacology (antimicrobials, antivirals, antifungals), and public health/vaccine scenarios.

How much does the 2026 ABP Pediatric Infectious Diseases exam cost?

The 2026 regular registration fee is $2,992, which includes a $750 nonrefundable processing fee. Late registration is $3,337 (includes a $345 late fee). Pediatric ID is administered as an ABP subspecialty exam at Pearson VUE centers in 2026.

How is the exam scored?

The exam is scored on a 1-300 scale with 180 designated as the passing mark. ABP uses a criterion-referenced scoring model: a panel of practicing, board-certified pediatric infectious diseases physicians determines the passing standard using the modified Angoff method. Results are reported as scaled scores, not percentile ranks.

What are the highest-yield topics?

Bacterial (~18%), viral (~18%), vaccines/ACIP (~10%), and CNS/respiratory infections (~14%) collectively cover about 60% of the exam. Master the ACIP 2026 pediatric schedule (including nirsevimab, PCV20, HPV 2-dose if <15y, MenACWY + MenB), empiric therapy for bacterial meningitis (ceftriaxone + vancomycin + dexamethasone), neonatal HSV (acyclovir 60 mg/kg/day + post-CNS oral suppression), congenital CMV (valganciclovir 6 months), Kocher criteria, modified Duke criteria, AHA 2021 endocarditis prophylaxis, pediatric HIV ART (dolutegravir-based), febrile neutropenia, and RSV nirsevimab eligibility.

How should I study for this exam?

Use a 6-12 month structured plan. Start with bacterial and viral infections (highest-volume domains), covering GBS, pneumococcus/Hib/meningococcus, MRSA, TB, Lyme/RMSF, neonatal HSV, congenital CMV, EBV, HIV, RSV/nirsevimab, and MIS-C. Move to the ACIP 2026 schedule and CNS/bone-joint/endocarditis/respiratory. Then fungal, parasitic, neonatal/TORCH, and immunocompromised host. Finish with HIV, stewardship, and resistance. Take 2-3 timed full-length mock exams. Integrate the AAP Red Book (current edition), CDC ACIP schedule, IDSA/PIDS guidelines, Nelson's Pediatric Antimicrobial Therapy, and the PIDS Board Review Course.

What are my continuing certification requirements after passing?

After initial certification, diplomates maintain certification via the ABP's Maintenance of Certification Assessment for Pediatricians (MOCA-Peds) — a longitudinal assessment with quarterly questions over a 5-year cycle. Diplomates must also complete Part 2 (self-assessment CME) and Part 4 (improvement in medical practice) activities and maintain an unrestricted license.