100+ Free ABP Pediatric Rheumatology Practice Questions

Pass your ABP Pediatric Rheumatology Subspecialty Certifying Examination exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

~85-90% first-attempt for ABP pediatric subspecialties (not broken out publicly) Pass Rate

100+ Questions

100% Free

1 / 100

Question 1

Score: 0/0

A 3-year-old girl presents with painless swelling of the right knee and left ankle for 8 weeks, no systemic symptoms. ANA is 1:320 speckled, RF negative. Which ILAR category is most likely and what is the single most important screening intervention?

Systemic JIA — ferritin and echocardiogram

Polyarticular RF-negative JIA — annual chest radiograph

Enthesitis-related arthritis — HLA-B27 testing only

Oligoarticular JIA — slit lamp exam every 3 months for uveitis

to track

2026 Statistics

Key Facts: ABP Pediatric Rheumatology 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 rheumatology

~22%

JIA Content Weight

Largest single domain on content outline

The ABP Pediatric Rheumatology 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 emphasizes JIA (~22%), juvenile SLE + APS (~12%), primary vasculitis (~10%), autoinflammatory/periodic fever (~8%), sJIA/MAS (~7%), Kawasaki (~7%), JDM (~7%), uveitis (~5%), noninflammatory musculoskeletal pain (~5%), pharmacology/biologics (~5%), scleroderma (~4%), IEI overlap (~4%), and bone/lysosomal disorders (~4%). Three-year ACGME fellowship required.

Sample ABP Pediatric Rheumatology Practice Questions

Try these sample questions to test your ABP Pediatric Rheumatology 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 girl presents with painless swelling of the right knee and left ankle for 8 weeks, no systemic symptoms. ANA is 1:320 speckled, RF negative. Which ILAR category is most likely and what is the single most important screening intervention?

A.Systemic JIA — ferritin and echocardiogram

B.Polyarticular RF-negative JIA — annual chest radiograph

C.Enthesitis-related arthritis — HLA-B27 testing only

D.Oligoarticular JIA — slit lamp exam every 3 months for uveitis

Explanation: Young (<6 yr) ANA-positive girls with ≤4 joints for ≥6 weeks meet ILAR oligoarticular JIA. They have the highest risk of asymptomatic chronic anterior uveitis, so AAP/ACR guidelines recommend slit-lamp exam every 3 months for the first 2 years then spacing out. Undetected uveitis causes cataracts, band keratopathy, and blindness.

2A 14-year-old girl with polyarticular RF-positive and anti-CCP-positive JIA has symmetric MCP and PIP involvement with erosions on hand radiographs. Which statement best describes her prognosis and management?

A.Clinically resembles adult rheumatoid arthritis; early MTX plus TNF inhibitor is recommended

B.Typically self-limited; NSAIDs alone sufficient

C.Most likely to develop chronic anterior uveitis — q3-month slit lamp required

D.Colchicine is first-line therapy given amyloid risk

Explanation: Polyarticular RF/anti-CCP-positive JIA behaves like early adult rheumatoid arthritis — erosive, symmetric, often aggressive. ACR 2019/2022 guidelines recommend early methotrexate with escalation to a biologic (TNFi, abatacept, or tocilizumab) using treat-to-target strategy. Uveitis is uncommon in this subgroup.

3A 4-year-old boy has 3 weeks of daily fever spikes to 40°C that return to normal between, an evanescent salmon-pink rash appearing with fever, hepatosplenomegaly, and arthritis. Labs: WBC 22k, platelets 680k, ferritin 1,800 ng/mL. Which ILAR category does he meet?

A.Enthesitis-related arthritis

B.Polyarticular RF-negative JIA

C.Kawasaki disease

D.Systemic JIA (sJIA)

Explanation: Systemic JIA (Still disease) requires arthritis plus quotidian (daily) fever for ≥2 weeks and at least one of: evanescent salmon-colored rash, lymphadenopathy, hepato/splenomegaly, or serositis. Labs typically show leukocytosis, thrombocytosis, anemia, and markedly elevated ferritin. It is now classified as an autoinflammatory disease driven by IL-1 and IL-6.

4A 6-year-old with known sJIA develops persistent (not quotidian) fever, hepatosplenomegaly worsening, falling ESR, ferritin 30,000 ng/mL, platelets dropping from 500k to 90k, AST 450, triglycerides 400, fibrinogen 120. Which complication and best initial therapy?

A.Thrombotic thrombocytopenic purpura — plasma exchange

B.Disseminated intravascular coagulation — FFP and cryoprecipitate

C.Sepsis — broad-spectrum antibiotics only

D.Macrophage activation syndrome — high-dose IV corticosteroids and anakinra

Explanation: MAS is a life-threatening HLH-like cytokine storm complicating ~10% of sJIA. 2016 PRINTO/ACR criteria: ferritin >684, plus any two of platelets ≤181, AST >48, triglycerides >156, or fibrinogen ≤360. Paradoxically the ESR falls (consumptive coagulopathy drops fibrinogen). Treat urgently with pulse methylprednisolone, IL-1 blockade (anakinra), and cyclosporine; IL-6 inhibitors may be continued/added.

5A 12-year-old boy has asymmetric lower-extremity arthritis, heel enthesitis at the Achilles insertion, and morning back stiffness. HLA-B27 is positive. Which ILAR category and preferred first-line conventional DMARD?

A.Oligoarticular JIA — intra-articular steroid only

B.Enthesitis-related arthritis (ERA) — sulfasalazine

C.Juvenile psoriatic arthritis — methotrexate only

D.Systemic JIA — anakinra

Explanation: ERA is the ILAR category analogous to adult spondyloarthropathy: asymmetric lower-limb arthritis, enthesitis, HLA-B27 association, sacroiliitis, acute symptomatic (not asymptomatic) uveitis. Sulfasalazine is the preferred conventional DMARD for peripheral arthritis in ERA; TNF inhibitors are standard if axial disease or enthesitis persists.

6A 9-year-old with extended oligoarticular JIA has failed methotrexate. Which biologic class is first-line add-on for persistent peripheral polyarticular disease in JIA per ACR 2022?

A.TNF inhibitor (adalimumab, etanercept, or infliximab)

B.IL-1 antagonist (anakinra)

C.Rituximab

D.JAK inhibitor (tofacitinib)

Explanation: For non-systemic JIA with active arthritis despite methotrexate, ACR 2022 guidelines recommend adding a TNF inhibitor (adalimumab and etanercept most commonly). IL-1 and IL-6 inhibitors are first-line for systemic JIA. Tofacitinib is approved for polyarticular JIA but typically used after TNFi failure.

7Which biologic is FDA-approved for systemic JIA and demonstrated efficacy by blocking IL-1 signaling?

A.Adalimumab

B.Canakinumab

C.Abatacept

D.Rituximab

Explanation: Canakinumab is a long-acting anti-IL-1β monoclonal antibody approved for sJIA and CAPS. Anakinra (IL-1 receptor antagonist) and rilonacept (IL-1 trap) are also IL-1-directed sJIA therapies. Tocilizumab (anti-IL-6R) is the other FDA-approved sJIA biologic. TNF inhibitors are generally ineffective for the systemic features of sJIA.

8A 7-year-old RF-negative ANA-positive girl with oligoarticular JIA (diagnosed age 4) has been on q3-month slit-lamp screening. She is now in sustained remission off medication. What is the recommended long-term ophthalmology follow-up?

A.Switch to annual dilated fundus exams only

B.Discontinue screening after arthritis remission >12 months

C.Continue only if she has symptoms (red eye or pain)

D.Continue periodic slit-lamp exams; uveitis can develop years after arthritis remission

Explanation: JIA-associated uveitis is usually asymptomatic and can develop up to 7 years after arthritis onset, including during arthritis remission. ACR/AAP guidelines therefore continue screening for years based on risk stratification (age at onset, duration, ANA status). Stopping surveillance after arthritis remission leads to preventable vision loss.

9Which composite disease activity measure is used in JIA to implement a treat-to-target strategy in children?

A.DAS28

B.Clinical Juvenile Arthritis Disease Activity Score (cJADAS-10)

C.SLEDAI-2K

D.BILAG

Explanation: cJADAS-10 combines active joint count (up to 10), physician global assessment, and patient/parent global assessment. It guides treat-to-target therapy in JIA with validated thresholds for inactive/low/moderate/high disease. DAS28 is adult RA; SLEDAI and BILAG are lupus measures.

10Abatacept blocks which costimulatory interaction and is FDA-approved for which JIA category?

A.IL-23 p19 blockade; uveitis

B.Anti-CD20 B-cell depletion; systemic JIA

C.IL-17A blockade; enthesitis-related arthritis only

D.CTLA4-Ig blocking CD80/86–CD28 costimulation; polyarticular JIA

Explanation: Abatacept is a CTLA4-Ig fusion protein that binds CD80/CD86 on antigen-presenting cells, preventing costimulation of T cells via CD28. It is FDA-approved for polyarticular JIA ≥2 years and is used when TNF inhibitors fail or are contraindicated.

About the ABP Pediatric Rheumatology Exam

The ABP Pediatric Rheumatology subspecialty certifying exam validates expert-level knowledge of juvenile idiopathic arthritis (ILAR oligoarticular, RF-/RF+ polyarticular, ERA, psoriatic, systemic sJIA, undifferentiated), sJIA/MAS 2016 criteria, juvenile SLE (2019 EULAR/ACR), antiphospholipid syndrome, juvenile dermatomyositis (MDA5, NXP2, TIF1γ), scleroderma/morphea, Kawasaki disease, IgA vasculitis/HSP, polyarteritis nodosa, DADA2, Takayasu, GPA/MPA/EGPA, Behçet, periodic fever syndromes (FMF, TRAPS, HIDS/MKD, PFAPA, CAPS, DIRA, Blau, interferonopathies), uveitis, biologics (TNF, IL-6, IL-1, JAK), methotrexate, hydroxychloroquine, and corticosteroids. Half-day CBT of ~150 MCQs in ~4 hours. Requires ABP General Pediatrics certification plus a 3-year ACGME-accredited pediatric rheumatology 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 Rheumatology Exam Content Outline

~22%

Juvenile Idiopathic Arthritis (JIA)

ILAR classification (oligoarticular, RF− and RF+ polyarticular, enthesitis-related/ERA, psoriatic, systemic-sJIA, undifferentiated), ANA-positive uveitis risk, HLA-B27 in ERA, NSAIDs, intra-articular steroids, methotrexate, TNF inhibitors, abatacept, tocilizumab, JAK inhibitors, CARRA CTPs, uveitis screening.

~12%

Juvenile SLE and Antiphospholipid Syndrome

2019 EULAR/ACR SLE classification, lupus nephritis ISN/RPS classes I-VI, induction (high-dose steroids + MMF or cyclophosphamide NIH/Euro-Lupus), maintenance (MMF, AZA), hydroxychloroquine (retinal screening), belimumab, rituximab, anifrolumab, neonatal lupus (anti-Ro/SSA, CHB), APS triple-positive.

~10%

Primary Systemic Vasculitis

IgA vasculitis/HSP, PAN (classic + DADA2/ADA2 with stroke and immunodeficiency), Takayasu, GPA (PR3/c-ANCA), MPA (MPO/p-ANCA), EGPA, Behçet (HLA-B51, pathergy), primary CNS vasculitis, cryoglobulinemia.

~8%

Autoinflammatory and Periodic Fever Syndromes

FMF (MEFV, colchicine; canakinumab for colchicine-resistant), TRAPS (TNFRSF1A), HIDS/MKD (mevalonate kinase, elevated IgD), CAPS spectrum (NLRP3 — FCAS/MWS/NOMID; anakinra/canakinumab/rilonacept), PFAPA, DIRA (IL1RN), DITRA (IL36RN), Blau (NOD2), CANDLE/SAVI (interferonopathies), DADA2.

~7%

Systemic JIA (sJIA) and Macrophage Activation Syndrome (MAS)

sJIA quotidian fevers, evanescent salmon rash, serositis, hyperferritinemia; IL-1 (anakinra, canakinumab) and IL-6 (tocilizumab) blockade; sJIA-lung disease; MAS 2016 classification criteria (ferritin, TG, AST, fibrinogen, platelets); HLH overlap; trisomy 21 sJIA lung risk.

~7%

Kawasaki Disease

AHA 2017 classic vs incomplete KD algorithm, coronary artery Z-score risk stratification, IVIG 2 g/kg + aspirin, IVIG resistance management (second IVIG, steroids, infliximab, anakinra, cyclosporine), MIS-C differentiation and overlap.

~7%

Juvenile Dermatomyositis (JDM)

Bohan & Peter / 2017 EULAR/ACR criteria, heliotrope and Gottron papules, calcinosis, nailfold capillary changes, myositis-specific antibodies (Mi-2, MDA5 with RP-ILD, NXP2 with calcinosis, TIF1γ), MRI STIR, perifascicular atrophy on biopsy, steroids + MTX, IVIG, rituximab.

~5%

Uveitis

JIA-associated chronic anterior uveitis (ANA+ young-onset oligo girls highest risk, slit-lamp screening every 3-6 months), HLA-B27 acute anterior uveitis (ERA), Blau/sarcoid granulomatous uveitis, Behçet panuveitis, step-up therapy (topical steroids, MTX, adalimumab, infliximab).

~5%

Noninflammatory Musculoskeletal and Pain Syndromes

Juvenile fibromyalgia, amplified musculoskeletal pain syndrome (AMPS), CRPS, hypermobility spectrum/Ehlers-Danlos, growing pains, CRMO, SAPHO syndrome, multidisciplinary pain management.

~5%

Pharmacology and Biologics

Methotrexate weekly dosing and monitoring, NSAIDs, corticosteroids and toxicity, hydroxychloroquine (retinal screen), DMARDs; biologics — TNF (etanercept/adalimumab/infliximab with TB screen), IL-6 (tocilizumab), IL-1 (anakinra/canakinumab/rilonacept), JAK (tofacitinib/baricitinib/upadacitinib — boxed warnings), live-vaccine contraindications.

~4%

Scleroderma and Morphea

Juvenile systemic sclerosis (limited vs diffuse, anti-Scl-70, anti-centromere, anti-RNAP III), Raynaud/nailfold capillaroscopy, ILD and PAH screening, localized scleroderma/morphea subtypes (linear, en coup de sabre, Parry-Romberg, plaque, deep), MTX first-line for progressive morphea.

~4%

Inborn Errors of Immunity and Rheum Overlap

Early complement deficiency (C1q, C2, C4) with SLE-like disease, ALPS (FAS), IPEX (FOXP3), APECED (AIRE), LRBA, CTLA4 haploinsufficiency, STAT1/STAT3 GOF, interferonopathies (AGS, CANDLE, SAVI, DADA2).

~4%

Bone, Cartilage, and Lysosomal Disorders

Osteogenesis imperfecta (COL1A1/2, bisphosphonates), CRMO/chronic nonbacterial osteomyelitis, rickets (nutritional, vitamin D, hypophosphatemic), MPS arthropathy (Hurler, Hunter), fibrodysplasia ossificans progressiva (ACVR1).

How to Pass the ABP Pediatric Rheumatology 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 Rheumatology Study Tips from Top Performers

1JIA uveitis screening rule: highest risk is oligoarticular JIA in an ANA-positive girl with onset <6 years — slit-lamp every 3 months for first 4 years, then every 6 months. ANA-negative oligo: every 6 months. Polyarticular ANA+: every 6 months. ERA: screen only if symptomatic (acute anterior uveitis, not chronic). Management: topical steroids first, then methotrexate, then adalimumab (preferred over etanercept for uveitis).

2MAS 2016 classification criteria (for sJIA): a febrile patient with known or suspected sJIA classified as MAS if ferritin >684 ng/mL AND any 2 of: platelets ≤181, AST >48 U/L, triglycerides >156 mg/dL, fibrinogen ≤360 mg/dL. Treatment: high-dose steroids + anakinra; cyclosporine and etoposide for refractory. MAS is the pediatric counterpart to HLH.

3FMF vs HIDS vs TRAPS vs CAPS key features: FMF (1-3 day attacks, erysipelas-like rash, serositis, MEFV, colchicine responsive, AA amyloidosis risk); HIDS/MKD (3-7 day attacks starting <1 yr, cervical LAD, abdominal pain, oral ulcers, elevated urinary mevalonate, MVK); TRAPS (>7 day attacks, migrating rash with myalgia, periorbital edema, TNFRSF1A); CAPS (cold-induced urticaria → NOMID/CINCA with arthropathy and chronic aseptic meningitis, NLRP3, anakinra/canakinumab/rilonacept).

4Kawasaki disease criteria (AHA 2017): fever ≥5 days + ≥4 of 5: (1) bilateral nonexudative conjunctivitis, (2) oral mucosal changes (cracked red lips, strawberry tongue), (3) polymorphous rash, (4) extremity changes (erythema/edema acute; periungual desquamation subacute), (5) unilateral cervical lymphadenopathy ≥1.5 cm. IVIG 2 g/kg + high-dose aspirin 80-100 mg/kg/d. Primary adjunctive steroids for high-risk (Kobayashi in Japan). IVIG-resistant: second IVIG, then infliximab or steroids.

5Juvenile dermatomyositis myositis-specific antibodies: anti-Mi-2 (classic JDM, good prognosis, responsive to therapy); anti-MDA5 (amyopathic or mild myositis but rapidly progressive ILD — high mortality; cutaneous ulcers, palmar papules); anti-NXP2 (more calcinosis, GI vasculopathy); anti-TIF1γ (more severe cutaneous disease; in adults associated with malignancy, not typically in children).

Frequently Asked Questions

What is the ABP Pediatric Rheumatology subspecialty certification?

The ABP Pediatric Rheumatology subspecialty certification is awarded by the American Board of Pediatrics to pediatricians who demonstrate expert-level diagnosis and management of pediatric arthritis, connective tissue disease, autoinflammatory syndromes, and systemic vasculitis. It qualifies diplomates to lead pediatric rheumatology services including JIA uveitis screening programs, IVIG-resistant Kawasaki care, and biologic therapy oversight.

Who is eligible to take the ABP Pediatric Rheumatology 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 rheumatology fellowship. A valid unrestricted medical license is required. The fellowship includes broad exposure to JIA, systemic autoimmune disease, vasculitis, autoinflammatory disease, musculoskeletal ultrasound, and scholarly activity meeting the ABP scholarly requirement.

What is the format of the ABP Pediatric Rheumatology 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 answer options. Vignettes include lab panels, autoantibody patterns, imaging (MRI, nailfold capillaroscopy), musculoskeletal exam findings, and pharmacology scenarios.

How much does the 2026 ABP Pediatric Rheumatology 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). Check the ABP Exam Dates and Fees page for the specific 2026 testing window for pediatric rheumatology.

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 rheumatologists determines the passing standard using the modified Angoff method. Results are scaled scores, not percentile ranks, and a 180 represents the minimum level of knowledge required to pass.

What are the highest-yield topics?

JIA (~22%), juvenile SLE + APS (~12%), primary vasculitis (~10%), and autoinflammatory/periodic fever syndromes (~8%) together cover roughly 52% of the exam. Master ILAR JIA subtypes and uveitis risk, 2019 EULAR/ACR SLE classification, lupus nephritis ISN/RPS classes, MAS 2016 classification, Kawasaki AHA 2017 criteria and IVIG resistance, FMF (MEFV/colchicine) vs CAPS (NLRP3/anakinra) vs HIDS/MKD, and biologic pharmacology (TNF, IL-1, IL-6, JAK).

How should I study for this exam?

Use a 6-12 month structured plan during the final fellowship year. Start with JIA (ILAR subtypes, uveitis screening, CARRA CTPs) and sJIA/MAS — the single largest topic area. Then master juvenile SLE, JDM myositis-specific antibodies, scleroderma/morphea, and Kawasaki disease. Next cover vasculitides (IgA vasculitis, PAN/DADA2, Takayasu, ANCA-associated, Behçet) and autoinflammatory/periodic fever syndromes (FMF, TRAPS, HIDS, PFAPA, CAPS, interferonopathies). Finish with pharmacology and biologics, uveitis, and noninflammatory pain. Take 2-3 timed full-length mock exams. Integrate Textbook of Pediatric Rheumatology (Cassidy), CARRA consensus treatment plans, ACR/EULAR guidelines, and the ABP content outline.

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.