100+ Free ABP Pediatric Pulmonology Practice Questions

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An 8-year-old with persistent asthma is on low-dose ICS (step 2) but has symptoms >2 days/week and nighttime awakenings 3-4 times/month. Per NAEPP 2020 focused update, what is the preferred step-up therapy?

Switch to long-term oral prednisone

Double the ICS dose

Add oral montelukast

Low-dose ICS-formoterol used as both daily controller and reliever (SMART)

to track

2026 Statistics

Key Facts: ABP Pediatric Pulmonology Exam

~150

Total MCQ Items

Single-best-answer, 4-5 options

~4 hr

Exam Time

Half-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 pulmonology

Summer/Fall

2026 Administration

Listed as 2026 summer/fall subspecialty exam

The ABP Pediatric Pulmonology certifying exam is a half-day (~4-hour) CBT of approximately 150 single-best-answer MCQs 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. Content domains include asthma (~6%), cystic fibrosis (~6%), respiratory infections (~5%), congenital airway/lung malformations (~5%), pulmonary complications of other organs (~5%), sleep-disordered breathing (~4%), restrictive/neuromuscular (~4%), respiratory failure (~4%), ILD/chILD (~4%), pulmonary vascular (~4%), BPD/prematurity (~4%), non-CF bronchiectasis (~3%), and aspiration/FB/tracheomalacia (~3%). Pediatric Pulmonology is a 2026 summer/fall exam.

Sample ABP Pediatric Pulmonology Practice Questions

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

1An 8-year-old with persistent asthma is on low-dose ICS (step 2) but has symptoms >2 days/week and nighttime awakenings 3-4 times/month. Per NAEPP 2020 focused update, what is the preferred step-up therapy?

A.Switch to long-term oral prednisone

B.Double the ICS dose

C.Add oral montelukast

D.Low-dose ICS-formoterol used as both daily controller and reliever (SMART)

Explanation: NAEPP 2020 preferentially recommends SMART (Single Maintenance and Reliever Therapy) — low-dose ICS-formoterol as both daily controller and rescue — for step 3 and 4 in patients ≥4 years. SMART reduces severe exacerbations compared with ICS plus SABA PRN. Formoterol has a rapid onset (unlike salmeterol), making it suitable for rescue.

2A 14-year-old with severe eosinophilic asthma (blood eosinophils 450/µL, FeNO 60 ppb) on high-dose ICS-LABA continues to have frequent exacerbations. Which biologic targets IL-5 and is approved for children ≥6 years?

A.Tezepelumab

B.Omalizumab

C.Dupilumab

D.Mepolizumab

Explanation: Mepolizumab is an anti-IL-5 monoclonal antibody approved for severe eosinophilic asthma in patients ≥6 years. Omalizumab targets IgE. Dupilumab targets IL-4Rα (IL-4/IL-13). Tezepelumab targets TSLP and is approved only for ≥12 years. Reslizumab (anti-IL-5) is approved ≥18 years.

3The FDA issued a black-box warning in 2020 for montelukast regarding which adverse effect?

A.Neuropsychiatric events (depression, suicidal ideation, behavioral changes)

B.Hepatotoxicity

C.QT prolongation

D.Stevens-Johnson syndrome

Explanation: In March 2020 the FDA strengthened montelukast labeling with a black-box warning for serious neuropsychiatric events including agitation, depression, sleep disturbances, and suicidal thoughts. The benefit-risk balance now favors avoiding montelukast when alternatives are available, particularly for allergic rhinitis.

4A 7-year-old presents to the ED with a severe asthma exacerbation. After three back-to-back albuterol nebulizations and oral dexamethasone, she remains in moderate distress with SpO2 90%. What is the next appropriate pharmacologic step?

A.Inhaled tiotropium

B.IV aminophylline

C.IV ketamine

D.IV magnesium sulfate 25-50 mg/kg

Explanation: For moderate-to-severe pediatric asthma exacerbations not responding to initial SABA + systemic corticosteroids, IV magnesium sulfate 25-50 mg/kg (max 2 g) over 20 minutes is the next step. Magnesium is a smooth muscle relaxant. Heliox and continuous albuterol can also be considered. IV terbutaline is used for impending respiratory failure.

5Which feature distinguishes vocal cord dysfunction (VCD / inducible laryngeal obstruction) from asthma?

A.Nocturnal wheezing that awakens the patient

B.Inspiratory stridor with flattened inspiratory loop on flow-volume curve

C.Reversible airflow obstruction with bronchodilator

D.Elevated FeNO and peripheral eosinophilia

Explanation: VCD presents with inspiratory stridor, throat tightness, and paradoxical vocal cord adduction during inspiration. Flow-volume loops show a flattened (truncated) inspiratory limb. Laryngoscopy during symptoms is diagnostic. Treatment is speech therapy, not bronchodilators. Asthma causes expiratory wheeze with reversible obstruction.

6A 10-year-old develops wheeze, cough, and dyspnea 5-10 minutes into soccer practice, resolving with rest. Spirometry shows >10% fall in FEV1 after exercise challenge. Which is first-line preventive therapy?

A.Oral prednisone pre-exercise

B.Daily high-dose ICS

C.SABA (albuterol) 15 minutes before exercise

D.LABA monotherapy

Explanation: Exercise-induced bronchospasm is diagnosed by ≥10% fall in FEV1 after exercise challenge. First-line prevention is inhaled SABA (albuterol 2 puffs) 15 minutes before exercise. For patients with frequent EIB, add daily ICS or LTRA. LABA monotherapy is contraindicated. Warm-up periods and facemasks in cold weather also help.

7Which biologic is approved for moderate-to-severe asthma with a type 2 inflammatory phenotype (elevated eosinophils OR elevated FeNO) in children ≥6 years and targets IL-4 receptor alpha?

A.Mepolizumab

B.Omalizumab

C.Benralizumab

D.Dupilumab

Explanation: Dupilumab blocks IL-4Rα, inhibiting both IL-4 and IL-13 signaling. It is approved for moderate-to-severe asthma in patients ≥6 years with type 2 inflammation (eosinophils ≥150/µL or FeNO ≥20 ppb), atopic dermatitis, and eosinophilic esophagitis. Benralizumab targets IL-5Rα on eosinophils directly.

8Which step on the NAEPP asthma stepwise therapy first introduces an ICS-LABA combination (or ICS-formoterol SMART) as preferred controller for children 5-11 years?

A.Step 1

B.Step 3

C.Step 2

D.Step 5

Explanation: For 5-11 year olds, step 1 is PRN SABA (or PRN ICS-SABA per GINA). Step 2 is daily low-dose ICS. Step 3 adds LABA to low-dose ICS, or uses medium-dose ICS, or SMART with low-dose ICS-formoterol. Step 4 is medium-dose ICS-LABA. Steps 5-6 add biologics, tiotropium, or oral corticosteroids.

9Omalizumab dosing is based on which two parameters?

A.Serum total IgE and body weight

B.Serum eosinophils and FeNO

C.FEV1 and peak flow

D.Serum IL-5 and IgG

Explanation: Omalizumab (anti-IgE monoclonal antibody) is approved for moderate-to-severe allergic asthma ≥6 years. Dose (75-600 mg every 2-4 weeks subcutaneously) is determined from a table based on serum total IgE (30-1500 IU/mL) and body weight. Anaphylaxis risk warrants observation after injection.

10A preschooler has had 5 episodes of wheezing in the past year, all triggered by viral URIs, with complete resolution between episodes. Which treatment is BEST supported by evidence for episodic viral wheeze in preschoolers?

A.LABA monotherapy

B.Chronic daily high-dose ICS

C.Chronic oral prednisone

D.Short courses of high-dose ICS at onset of URI (pre-emptive ICS)

Explanation: For preschoolers with recurrent episodic viral wheeze and low between-episode symptoms, pre-emptive high-dose ICS started at the first sign of a URI for 7-10 days reduces severe exacerbations (per MIST trial and others). Daily ICS is preferred if there is a positive Asthma Predictive Index or interval symptoms. Oral corticosteroids are reserved for moderate-severe exacerbations.

About the ABP Pediatric Pulmonology Exam

The ABP Pediatric Pulmonology subspecialty certifying exam validates expert-level knowledge of asthma (GINA), cystic fibrosis (CFTR genetics, sweat test, modulators), bronchopulmonary dysplasia, bronchiolitis, pneumonia, tuberculosis, primary ciliary dyskinesia, non-CF bronchiectasis, interstitial lung disease (chILD), surfactant dysfunction disorders (SP-B, SP-C, ABCA3), sleep-disordered breathing/OSA, CCHS, apnea/BRUE, aspiration, foreign body, tracheomalacia, congenital airway/lung malformations (CPAM, BPS), pulmonary hypertension, and PFT interpretation. Half-day CBT of ~150 MCQs in ~4 hours. Requires ABP General Pediatrics certification plus a 3-year ACGME-accredited pediatric pulmonology fellowship.

Questions

150 scored questions

Time Limit

~4 hours (half-day CBT)

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 Pulmonology Exam Content Outline

~6%

Asthma

GINA 2024/2025 stepwise therapy, SMART/MART, biologics for severe asthma (omalizumab, mepolizumab, benralizumab, dupilumab, tezepelumab), exercise-induced bronchoconstriction, exacerbation management, spacer/device technique.

~6%

Cystic Fibrosis

CFTR mutation classes I-VI (F508del), sweat chloride ≥60 mmol/L diagnostic, CFTR modulators (elexacaftor/tezacaftor/ivacaftor — Trikafta; ivacaftor; tezacaftor/ivacaftor), pulmonary exacerbations (Pseudomonas, Burkholderia, NTM, ABPA), CFRD, pancreatic insufficiency, DIOS, CF bone disease, lung transplant.

~5%

Respiratory Infections

Bronchiolitis (RSV, rhinovirus, hMPV, nirsevimab/palivizumab), CAP (pneumococcus, M. pneumoniae, S. aureus), pertussis, TB (LTBI vs active, IGRA vs TST, DOT), NTM, PJP, empyema management, croup, bacterial tracheitis.

~5%

Congenital Malformations of Airways and Lungs

CPAM types 1-4 (PPB/DICER1 association), bronchopulmonary sequestration (intralobar vs extralobar), bronchogenic cyst, congenital lobar emphysema, tracheobronchomalacia, complete tracheal rings, vascular rings/slings.

~5%

Pulmonary Complications of Other Organ Systems

Sickle cell acute chest syndrome, immunodeficiency, HSCT/GVHD and IPS, rheum-associated ILD (JDM, SLE, GPA), GERD and aspiration, pulmonary-renal syndromes.

~4%

Sleep-Disordered Breathing and Control of Breathing

Pediatric OSA (AAP guideline; adenotonsillectomy first-line), central apnea, CCHS (PHOX2B polyalanine expansion), BRUE, SIDS triple-risk model, obesity hypoventilation, PSG interpretation.

~4%

Restrictive Disease Including Neuromuscular

SMA (nusinersen, onasemnogene, risdiplam), Duchenne (NIV, cough assist, corticosteroids), scoliosis/Jeune, diaphragm paralysis, thoracic insufficiency syndrome.

~4%

Respiratory Failure

PARDS (PALICC-2 criteria), HFNC, NIV/BiPAP, invasive ventilation modes, HFOV, ECMO (V-V vs V-A), prone positioning, iNO, surfactant replacement.

~4%

Interstitial Lung Disease (chILD)

Surfactant dysfunction disorders (SP-B, SP-C, ABCA3, NKX2.1 brain-lung-thyroid), NEHI, PIG, alveolar capillary dysplasia (FOXF1), hypersensitivity pneumonitis, sarcoidosis, DIP.

~4%

Pulmonary Vascular and Lymphatic Disease

Pulmonary hypertension (WSPH/PVRI pediatric classification; vasoreactivity; CCB, prostacyclin, ERA, PDE5i, riociguat), IPH/hemosiderosis, PE in children, AVMs (HHT), chylothorax, plastic bronchitis.

~4%

Pulmonary Complications of Prematurity (BPD)

Jensen 2019 BPD grades 1-3 at 36 wks PMA, new-BPD alveolar simplification, BPD-PH screening/sildenafil, DART steroids, diuretics, bronchodilators, long-term outcomes.

~3%

Non-CF Bronchiectasis

Primary ciliary dyskinesia (DNAH5/DNAH11, situs inversus, nasal nitric oxide <77 nL/min, EM of cilia), protracted bacterial bronchitis, immunodeficiency-associated, post-infectious, HRCT patterns.

~3%

Aspiration, Foreign Body, Tracheomalacia

FB aspiration (peanuts, rigid bronchoscopy), recurrent aspiration workup (swallow study, UGI, pH/MII), H-type TEF, laryngotracheal cleft, tracheomalacia (CPAP, aortopexy).

~4%

Pulmonary Function Testing and Procedures

Spirometry interpretation (obstructive vs restrictive, bronchodilator ≥12% response), plethysmography, DLCO, methacholine/exercise challenge, infant PFTs, IOS, FeNO, flexible bronchoscopy with BAL (cell counts, lipid-laden macrophages).

How to Pass the ABP Pediatric Pulmonology Exam

What You Need to Know

Passing score: Scaled score of 180 on a 1-300 scale (criterion-referenced, modified Angoff)
Exam length: 150 questions
Time limit: ~4 hours (half-day CBT)
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 Pulmonology Study Tips from Top Performers

1CFTR modulator rule: elexacaftor/tezacaftor/ivacaftor (Trikafta) is indicated for people with CF ≥2 years old with at least one F508del allele or a Trikafta-responsive mutation — approximately 90% of people with CF. Ivacaftor alone is for gating (class III) mutations (e.g., G551D). Tezacaftor/ivacaftor is for homozygous F508del. Monitor LFTs and watch for cataracts in children.

2Jensen 2019 BPD definition: at 36 weeks PMA. Grade 1 = nasal cannula <2 L/min; Grade 2 = nasal cannula ≥2 L/min or NIV (no ventilator); Grade 3 = invasive positive pressure ventilation. Based on respiratory support on day 36-week postmenstrual evaluation, not on oxygen alone. Screening echo for pulmonary hypertension is recommended for Grade 2-3 BPD.

3CCHS (Ondine's curse) key fact: PHOX2B polyalanine repeat expansion mutations. Normal = 20 alanines. Disease alleles = 24-33 alanines. Longer repeats correlate with more severe ventilator dependence. Associated with Hirschsprung disease and neuroblastoma (require screening). Do NOT respond to CO2, so rely on ventilatory support during sleep (and awake if severe).

4Primary ciliary dyskinesia: suspect with situs inversus (50% — Kartagener syndrome), neonatal respiratory distress, chronic wet cough, recurrent otitis/sinusitis, bronchiectasis. Screening: nasal nitric oxide (<77 nL/min during velum closure, ≥5 years old). Confirm with high-speed videomicroscopy + EM (outer/inner dynein arm defects) or genetic testing (DNAH5, DNAH11, DNAAF).

5Pediatric OSA AAP guideline: AHI ≥1 obstructive event/hour is abnormal (vs adult cutoff of 5). First-line therapy for moderate-severe OSA with adenotonsillar hypertrophy is adenotonsillectomy. Post-op PSG indicated in children with severe baseline OSA, obesity, Down syndrome, craniofacial anomalies. CPAP is second-line if surgery ineffective or contraindicated.

Frequently Asked Questions

What is the ABP Pediatric Pulmonology subspecialty certification?

The ABP Pediatric Pulmonology subspecialty certification is awarded by the American Board of Pediatrics to pediatricians who demonstrate expert-level knowledge in the diagnosis and management of respiratory, pulmonary, and sleep-disordered breathing conditions in children. It qualifies diplomates to lead pediatric pulmonology services, cystic fibrosis centers, chronic ventilator programs, and pediatric sleep laboratories.

Who is eligible to take the ABP Pediatric Pulmonology 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 pulmonology fellowship. A valid unrestricted medical license is required. The fellowship includes inpatient and outpatient pulmonology, sleep medicine exposure, bronchoscopy, PFT interpretation, and scholarly activity meeting the ABP scholarly requirement.

What is the format of the ABP Pediatric Pulmonology exam?

It is a half-day (~4-hour) computer-based exam administered at Pearson VUE, consisting of approximately 150 single-best-answer multiple-choice questions with four or five options. Vignettes include labs, CXR/HRCT images, PFT flow-volume loops, polysomnography tracings, and bronchoscopy/BAL findings.

How much does the 2026 ABP Pediatric Pulmonology exam cost?

The 2026 regular registration fee is $2,992 (includes a $750 nonrefundable processing fee). Late registration is $3,337 (includes a $345 late fee). Pediatric Pulmonology is scheduled as a 2026 summer/fall subspecialty exam.

How is the exam scored?

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

What are the highest-yield topics?

Asthma (GINA stepwise therapy, biologics) and cystic fibrosis (CFTR modulators, exacerbations, CFRD) together cover roughly 12% — master these deeply. Bronchiolitis (RSV, nirsevimab), pneumonia, TB/NTM, BPD (Jensen grades, BPD-PH), pediatric OSA (AAP guideline, AHI thresholds), CCHS (PHOX2B), chILD (surfactant disorders, NEHI, ACD/FOXF1), primary ciliary dyskinesia (nasal NO, DNAH genes), PARDS (PALICC-2), and PFT/HRCT interpretation are also core.

How should I study for this exam?

Use a 6-12 month structured plan during the final fellowship year. Start with asthma and CF (highest yield and daily practice). Then cover BPD, congenital lung/airway disorders, respiratory infections, and neonatal/early-childhood pulmonology. Next master sleep-disordered breathing, neuromuscular respiratory failure, PARDS, pulmonary hypertension, and chILD. Finish with PFT interpretation, HRCT patterns, and flexible bronchoscopy. Take 2-3 timed full-length mock exams. Integrate Kendig & Chernick's Disorders of the Respiratory Tract in Children, CF Foundation guidelines, GINA, AAP OSA guideline, and NHLBI/GINA updates.

What are my continuing certification requirements after passing?

After initial certification, diplomates maintain certification via MOCA-Peds — a longitudinal assessment with quarterly questions over a 5-year cycle. Diplomates also complete self-assessment CME and improvement-in-practice activities and must maintain an unrestricted medical license.