100+ Free ABR Pediatric Radiology Practice Questions

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Question 1

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A term neonate born at 40 weeks develops tachypnea shortly after C-section delivery. Chest radiograph shows hyperinflation, streaky perihilar opacities, fluid in the right minor fissure, and small pleural effusions. Symptoms resolve by 48 hours. What is the most likely diagnosis?

Respiratory distress syndrome (RDS)

Transient tachypnea of the newborn (TTN)

Meconium aspiration syndrome (MAS)

Group B streptococcal pneumonia

to track

2026 Statistics

Key Facts: ABR Pediatric Radiology Exam

~200

Total MCQ Items

ABR Pediatric Radiology CAQ

$1,950

2026 Exam Fee

ABR Pediatric Radiology CAQ

1 yr

Fellowship Training

ACGME-accredited Pediatric Radiology fellowship

Image Gently

Dose Reduction

Pediatric CT protocols per SPR/ACR

2 wk

NAT Follow-up Survey

ACR skeletal survey for suspected abuse

Pearson VUE

Test Delivery

Computer-based testing at authorized centers

The ABR Pediatric Radiology CAQ is a 1-day computer-based test at Pearson VUE with ~200 single-best-answer MCQs. The 2026 content outline emphasizes pediatric chest (~12%), GI (~15%), GU (~12%), MSK (~15%), CNS (~15%), H&N (~5%), vascular anomalies/CHD/IR (~5%), trauma including NAT (~3%), radiation safety/Image Gently (~4%), contrast and fluoroscopy safety (~4%), pediatric technique and artifacts (~5%), and informatics/reporting/ethics (~5%). Exam fee is ~$1,950; requires primary ABR Diagnostic Radiology certification plus 1-year ACGME Pediatric Radiology fellowship.

Sample ABR Pediatric Radiology Practice Questions

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

1A term neonate born at 40 weeks develops tachypnea shortly after C-section delivery. Chest radiograph shows hyperinflation, streaky perihilar opacities, fluid in the right minor fissure, and small pleural effusions. Symptoms resolve by 48 hours. What is the most likely diagnosis?

A.Respiratory distress syndrome (RDS)

B.Transient tachypnea of the newborn (TTN)

C.Meconium aspiration syndrome (MAS)

D.Group B streptococcal pneumonia

Explanation: TTN (retained fetal lung fluid) is classic after C-section delivery in term or near-term infants. Imaging shows hyperinflation, perihilar streaky opacities, fluid in the fissures, and small pleural effusions, with rapid resolution within 24-72 hours. RDS has low lung volumes with granular ground-glass opacities in preterm infants.

2A preterm infant born at 28 weeks has progressive respiratory distress within hours of birth. Chest radiograph shows low lung volumes, diffuse granular ground-glass opacities, and air bronchograms. What is the most likely diagnosis?

A.Pulmonary hemorrhage

B.Respiratory distress syndrome (RDS) / surfactant deficiency

C.Congenital pneumonia

D.TTN

Explanation: Classic RDS (hyaline membrane disease) from surfactant deficiency in preterm infants shows LOW lung volumes, diffuse granular/ground-glass opacities, and air bronchograms. Treatment is exogenous surfactant and CPAP/mechanical ventilation. TTN has hyperinflation, not low volumes.

3A post-term infant delivered through meconium-stained fluid develops severe respiratory distress. Chest radiograph shows patchy, asymmetric, ropy opacities with areas of hyperinflation and atelectasis. What is the most likely diagnosis?

A.TTN

B.RDS

C.Pulmonary sequestration

D.Meconium aspiration syndrome (MAS)

Explanation: MAS is seen in term/post-term infants exposed to meconium-stained amniotic fluid. Chest radiograph shows patchy, asymmetric, ropy or coarse opacities with admixed hyperinflation from ball-valve obstruction and atelectasis. Pneumothorax is a common complication. MAS can lead to persistent pulmonary hypertension (PPHN).

4A former 26-week preterm infant, now 3 months old and still ventilator-dependent, has a chest radiograph showing diffuse coarse interstitial opacities with scattered lucent/cystic areas. What is the most likely diagnosis?

A.Bronchopulmonary dysplasia (BPD)

B.Congenital lobar emphysema

C.Recurrent pulmonary hemorrhage

D.Wilson-Mikity syndrome

Explanation: BPD (chronic lung disease of prematurity) develops in preterm infants requiring prolonged oxygen or ventilation. Imaging shows coarse interstitial opacities with scattered cystic/lucent lesions reflecting alveolar simplification, fibrosis, and hyperinflation. Modern 'new BPD' may appear more diffusely hazy.

5A 6-year-old with fever and cough has a chest radiograph showing a well-defined round opacity in the right lower lobe without volume loss. The child responds to antibiotics. What is the most likely diagnosis?

A.Congenital pulmonary airway malformation (CPAM)

B.Pulmonary metastasis

C.Round pneumonia

D.Pulmonary hamartoma

Explanation: Round pneumonia is most common in children <8 years because of incomplete development of pores of Kohn and canals of Lambert, which limit collateral air drift and contain infection to a spherical focus. Streptococcus pneumoniae is the classic organism. Treat empirically; follow-up imaging if atypical to exclude mass.

6A 2-year-old with sudden-onset wheezing has chest radiographs. On the inspiratory film lung volumes look symmetric; on the expiratory film the right lung remains hyperlucent and hyperexpanded. What is the most likely diagnosis?

A.Right tension pneumothorax

B.Congenital lobar emphysema

C.Foreign body aspiration with ball-valve obstruction

D.Swyer-James syndrome

Explanation: An aspirated foreign body producing ball-valve obstruction allows air to enter on inspiration but traps it on expiration. The expiratory film (or lateral decubitus with the affected side down) shows persistent hyperinflation and air trapping of the obstructed lung. Bronchoscopy is diagnostic and therapeutic.

7A 15-year-old with cystic fibrosis has a chest CT showing predominantly upper-lobe cylindrical and varicose bronchiectasis, peribronchial cuffing, and mucus plugging. Which finding is most characteristic of CF?

A.Upper-lobe predominant bronchiectasis

B.Lower-lobe predominant bronchiectasis

C.Bilateral hilar adenopathy

D.Septal thickening with Kerley B lines

Explanation: Cystic fibrosis classically causes UPPER-LOBE predominant bronchiectasis (opposite of non-CF bronchiectasis like primary ciliary dyskinesia, which is lower-lobe). Additional findings include peribronchial cuffing, mucus plugging with 'finger-in-glove' sign, and air-trapping/mosaic attenuation.

8A prenatal ultrasound identifies a multicystic lung mass. Postnatal CT shows multiple cysts of varying sizes in the left lower lobe with a normal pulmonary arterial supply. Which entity is most likely?

A.Congenital diaphragmatic hernia

B.Pulmonary sequestration

C.Congenital pulmonary airway malformation (CPAM), formerly CCAM

D.Bronchogenic cyst

Explanation: CPAM (formerly CCAM) is a hamartomatous lung lesion with cystic and solid components, typed 1-4 by Stocker by cyst size. Blood supply is from the PULMONARY artery, distinguishing it from sequestration (systemic arterial supply from aorta). Hybrid lesions exist.

9An asymptomatic infant has a lower-lobe lung mass. CT angiography shows the mass receives arterial supply from the descending thoracic aorta. Which diagnosis is most likely?

A.Pulmonary sequestration

B.CPAM type 1

C.Bronchogenic cyst

D.Pulmonary AVM

Explanation: The hallmark of pulmonary sequestration is SYSTEMIC arterial supply — usually from the descending thoracic or abdominal aorta. Intralobar sequestration shares pleura with normal lung and drains via pulmonary veins; extralobar has its own pleura and systemic venous drainage, more often left-sided and associated with CDH.

10A neonate has respiratory distress. Chest radiograph shows bowel loops in the left hemithorax, mediastinal shift to the right, and a scaphoid abdomen. What is the most likely diagnosis?

A.Morgagni hernia

B.Congenital pulmonary lymphangiectasia

C.Eventration of the diaphragm

D.Bochdalek congenital diaphragmatic hernia

Explanation: Bochdalek CDH is the most common congenital diaphragmatic hernia (~90%), occurring through a posterolateral defect, and is usually LEFT-SIDED. Neonates present with respiratory distress, scaphoid abdomen, and chest radiograph showing bowel loops in the hemithorax with mediastinal shift. Morgagni is rarer, anterior/retrosternal, and usually right-sided.

About the ABR Pediatric Radiology Exam

The ABR Pediatric Radiology Subspecialty Certificate of Added Qualification (CAQ) is a 1-day computer-based test for diagnostic radiologists who have completed a 1-year ACGME-accredited Pediatric Radiology fellowship after primary ABR Diagnostic Radiology certification. The exam contains approximately 200 single-best-answer MCQs covering pediatric chest (RDS, TTN, MAS, BPD, CPAM, pulmonary sequestration, CDH, chest masses, neuroblastoma), GI (neonatal bowel obstruction, malrotation/volvulus, pyloric stenosis, intussusception, appendicitis, NEC, cystic fibrosis GI, choledochal cyst, biliary atresia), GU (UTI/VCUG/DMSA, VUR grading, Wilms vs neuroblastoma, mesoblastic nephroma, MCDK, UPJ, PUV, torsion), MSK (Salter-Harris, toddler's fracture, NAT metaphyseal corner/bucket-handle and posterior rib fractures, DDH, Perthes, SCFE, osteosarcoma, Ewing, LCH, rickets, sickle cell, NF1, achondroplasia), CNS (holoprosencephaly, Dandy-Walker, Chiari, lissencephaly, TS, NF, HIE, IVH Papile grading, CMV, pediatric brain tumors JPA/medulloblastoma/ependymoma/ATRT/DIPG/craniopharyngioma), H&N (retropharyngeal abscess, epiglottitis, croup, thyroglossal duct cyst, cystic hygroma), vascular anomalies (ISSVA — infantile hemangioma GLUT1+, RICH/NICH, venous/lymphatic/AVM), CHD imaging (TOF boot, TGA egg-on-string, TAPVR snowman), NAT imaging including skeletal survey, Image Gently dose reduction, and pediatric contrast and fluoroscopy safety.

Questions

200 scored questions

Time Limit

1-day CBT

Passing Score

Criterion-referenced scaled score set by ABR

Exam Fee

~$1,950 ABR Pediatric Radiology CAQ exam fee (2026) (American Board of Radiology (ABR) / Pearson VUE)

ABR Pediatric Radiology Exam Content Outline

~12%

Pediatric Chest

Neonatal lung disease — RDS (ground-glass, low volumes, air bronchograms), TTN (wet lung, fluid in fissures), MAS (patchy), PPHN, BPD (crescentic lucencies). Pneumonia patterns — lobar bacterial, round pneumonia, atypical mycoplasma reticulonodular, viral hyperinflation. Foreign body aspiration (unilateral hyperinflation on expiration, decubitus views). CF (peribronchial cuffing, upper-lobe bronchiectasis). Congenital — CPAM types 1-4, intralobar vs extralobar pulmonary sequestration (systemic arterial supply), CDH (Bochdalek posterolateral L-sided vs Morgagni anterior R-sided), bronchogenic cyst. Mediastinal masses by compartment and neuroblastoma (paraspinal, 30% calcified, spinal canal extension, MIBG).

~15%

Pediatric GI

Neonatal bowel obstruction — duodenal atresia 'double bubble' + T21/polyhydramnios, jejunal/ileal atresia, meconium ileus in CF, Hirschsprung transition zone. Malrotation/volvulus — ligament of Treitz not at L of L1, corkscrew UGI, Ladd procedure. Pyloric stenosis — 4-wk projectile vomiting, hypochloremic hypokalemic metabolic alkalosis, US muscle >4 mm and length >14 mm. Intussusception — 6 mo-3 yr ileocolic, target/doughnut US, air enema reduction, lead points in <3 mo or >5 yr. Appendicitis — US noncompressible >6 mm. NEC — Bell staging, pneumatosis, portal venous gas, Rigler/football sign. Biliary atresia — HIDA no excretion at 24 h, triangular cord sign, Kasai by 60 days. Choledochal cyst Todani I-V.

~12%

Pediatric GU

UTI imaging — VCUG after anomaly or 2nd febrile UTI (AAP 2011), DMSA for scarring. VUR grades I-V. Wilms — claw sign, 1-5 yo, WT1, nephrogenic rests, COG staging, triphasic, favorable vs anaplastic. Neuroblastoma vs Wilms — NB extrarenal, calcified 30%, crosses midline encasing vessels without displacing; Wilms displaces vessels with claw sign. Mesoblastic nephroma (<3 mo), MCDK, SFU hydronephrosis grading, UPJ obstruction. PUV — keyhole bladder, dilated posterior urethra in boys. Testicular torsion (absent intratesticular flow — emergent) vs epididymo-orchitis (hyperemia). Ovarian torsion — enlarged ovary with peripheralized follicles, whirlpool sign.

~15%

Pediatric MSK

Salter-Harris I-V fractures; toddler's spiral tibia. NAT red flags — metaphyseal corner/bucket-handle (<1 yr non-ambulatory), posterior rib fractures, skull fractures, fractures in varied healing stages; ACR skeletal survey + 2-wk follow-up. DDH — US <6 mo (Graf α>60, β<55), XR after 4-6 mo (Hilgenreiner/Perkin lines). Legg-Calvé-Perthes (2-10 yo, Herring lateral pillar). SCFE (10-15 yo, Klein line). Osteosarcoma (metaphysis, sunburst, Codman) vs Ewing (diaphysis, onion-skin, permeative). LCH (geographic skull, vertebra plana). Rickets (cupping/fraying metaphysis). Sickle cell (H-shaped vertebrae, AVN). NF1 (ribbon ribs, tibial pseudarthrosis). Achondroplasia (rhizomelic, narrow interpediculate).

~15%

Pediatric CNS

Malformations — holoprosencephaly (alobar/semilobar/lobar), Dandy-Walker, Chiari I/II/III, corpus callosum dysgenesis, lissencephaly, polymicrogyria, schizencephaly, heterotopia, TS (tubers/SEGAs/subependymal). Leukodystrophies (ALD, MLD, Canavan, Alexander). Neurocutaneous — NF1 (UBOs, optic pathway glioma), NF2 (bilateral vestibular schwannomas), Sturge-Weber (pial angiomatosis, tram-track calcification). HIE — term (deep gray, parasagittal, ulegyria), preterm (PVL). IVH Papile grades I-IV. Congenital CMV (periventricular calcifications, polymicrogyria). Peds brain tumors — JPA (cerebellum, cystic + mural nodule), medulloblastoma (midline cerebellum), ependymoma (4th ventricle through Luschka/Magendie), ATRT (SMARCB1), DIPG, craniopharyngioma (suprasellar calcifications).

~5%

Head, Neck & Airway

Retropharyngeal abscess (thickened prevertebral soft tissue), epiglottitis (thumb sign), croup (steeple sign), tonsillar hypertrophy/OSA, branchial cleft cyst (2nd at mandibular angle), thyroglossal duct cyst (midline, elevates with swallowing), lymphatic malformation/cystic hygroma.

~5%

Vascular Anomalies, CHD & Pediatric IR

ISSVA classification — infantile hemangioma GLUT1+, congenital NICH/RICH GLUT1-, vascular malformations (venous/lymphatic macro/microcystic, AVM Schobinger). CHD chest radiograph patterns — boot-shaped heart (TOF), egg-on-string (TGA), snowman (TAPVR). Pediatric CTA for congenital anomalies. Pediatric vascular access (PICC, port). Sclerotherapy for lymphatic/venous malformations.

~3%

Pediatric Trauma & NAT

Pediatric trauma imaging with non-operative management of spleen/liver (AAST grading). C-spine peds (pseudosubluxation C2-C3). NAT skeletal survey per ACR — infant + 2-wk follow-up. Abusive head trauma — SDH, subarachnoid, retinal hemorrhages. Age-differential hemorrhage (HIE parasagittal in term, IVH in preterm, epidural biconvex, subdural crescentic).

~4%

Radiation Safety & Image Gently

Pediatric dose reduction via Image Gently campaign — size-based CT protocols, PED-ATLAS, dose modulation. MR > CT when possible. ALARA principles. Bismuth shielding no longer recommended (ACR 2019). Gadolinium considerations in pediatrics.

~4%

Contrast & Fluoroscopy Safety

Water-soluble vs barium — water-soluble for suspected perforation, but osmotic pulmonary edema risk with gastrografin aspiration. VCUG technique and indications. UGI for malrotation. Pediatric IV contrast dosing 2 mL/kg. Pediatric-specific contrast reactions and pre-medication.

~5%

Pediatric Technique & Artifacts

Motion mitigation — sedation/general anesthesia in pediatrics, feed-and-wrap in infants, awake protocols in older kids. MRI protocols for peds. US first approach for most pediatric indications (pyloric stenosis, appendicitis, DDH, intussusception). Age-appropriate coil selection and CT kVp/mA adjustments.

~5%

Informatics, Reporting & Ethics

Critical findings communication in pediatrics, structured reporting, peer review, Imaging 3.0 pediatric concepts, AI applications in pediatric imaging, informed consent and assent in pediatrics.

How to Pass the ABR Pediatric Radiology Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABR
Exam length: 200 questions
Time limit: 1-day CBT
Exam fee: ~$1,950 ABR Pediatric Radiology CAQ exam fee (2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABR Pediatric Radiology Study Tips from Top Performers

1Malrotation/volvulus is a surgical emergency. On UGI, the normal ligament of Treitz should cross midline to the left side of L1 at the height of the duodenal bulb. Any position right of midline or below the duodenal bulb is abnormal. Corkscrew appearance of distal duodenum/proximal jejunum indicates midgut volvulus — call the surgeon immediately. Ladd procedure: lysis of Ladd bands, broadening of mesentery, appendectomy, small bowel on right and colon on left.

2Pyloric stenosis US criteria: muscle thickness >3-4 mm and channel length >14-16 mm. Additional signs include the 'cervix sign' (elongated pyloric channel protruding into gastric antrum), failure of channel to open during real-time observation, and gastric hyperperistalsis with retained fluid. Classic presentation: 3-6 week old (usually firstborn male) with non-bilious projectile vomiting, palpable 'olive,' and hypochloremic hypokalemic metabolic alkalosis.

3NAT imaging red flags: the most specific findings are metaphyseal corner/bucket-handle fractures (classic metaphyseal lesions) in infants <1 year, posterior rib fractures (from AP compression of thorax), fractures in varied stages of healing, and skull fractures crossing suture lines in infants. The ACR appropriateness guideline recommends a full skeletal survey (~20 views) for any child <2 years with suspected abuse, and a follow-up skeletal survey in 2 weeks to detect occult fractures that have begun healing.

4Image Gently pediatric CT principles: (1) Image only when needed — consider MR or US first for most indications. (2) Size-based pediatric CT dose protocols using weight or diameter — NOT adult protocols. (3) Single-phase CT rather than multiphase when possible. (4) Automatic tube current modulation (ATCM) and low kVp (80-100) for small patients. (5) Iterative reconstruction to lower dose. Bismuth shielding is no longer recommended by the ACR (2019) — use organ dose modulation instead. The SPR PED-ATLAS provides reference protocols.

5Wilms vs neuroblastoma differentiation: Wilms is intrarenal with the 'claw sign' (renal parenchyma cups the mass), rarely calcifies (~10%), displaces adjacent vessels, and peaks 1-5 years. Neuroblastoma is extrarenal (adrenal or paraspinal sympathetic chain), calcifies ~30%, crosses midline and ENCASES/ELEVATES vessels without displacing them, occurs younger (median age 2 years), and shows MIBG uptake. Metastatic pattern differs — Wilms to lungs, neuroblastoma to bone/marrow (skull sutures, orbit raccoon eyes).

Frequently Asked Questions

What is the ABR Pediatric Radiology Subspecialty CAQ?

The ABR Pediatric Radiology Subspecialty Certificate of Added Qualification (CAQ) is a 1-day computer-based test administered by the American Board of Radiology at Pearson VUE test centers. It certifies expertise in the full breadth of pediatric diagnostic imaging including fetal through adolescent radiography, fluoroscopy, ultrasound, CT, MRI, and pediatric interventional radiology. The exam is taken after primary ABR Diagnostic Radiology certification and a 1-year ACGME-accredited Pediatric Radiology fellowship.

Who is eligible to sit for the Pediatric Radiology CAQ?

Candidates must hold primary ABR Diagnostic Radiology certification, have completed a 1-year ACGME-accredited Pediatric Radiology fellowship with program director attestation of satisfactory completion, and hold a valid unrestricted medical license at the time of examination. Application is submitted through the ABR website during the designated eligibility window.

What is the format of the exam?

The exam is a 1-day computer-based test delivered at Pearson VUE test centers. It consists of approximately 200 single-best-answer multiple-choice items covering the full ABR Pediatric Radiology content outline. Questions frequently include pediatric images (radiographs, fluoroscopy, ultrasound, CT, MRI) with clinical vignettes, differential-diagnosis scenarios, and management questions on Image Gently dose reduction and NAT imaging workflows.

How much does the 2026 ABR Pediatric Radiology CAQ cost?

The 2026 exam fee is approximately $1,950. Cancellation and refund policies follow the ABR schedule with decreasing refunds as the exam date approaches. Retakes within the eligibility window require full re-registration and fee payment. Enrollment in the ABR Online Longitudinal Assessment (OLA) continuing certification program includes annual participation.

What are the highest-yield topics?

Highest-yield topics include: neonatal lung disease (RDS, TTN, MAS, BPD); CPAM types, pulmonary sequestration, and CDH; malrotation/volvulus with Ladd procedure; pyloric stenosis US criteria (>4 mm, >14 mm); intussusception with air enema reduction; NEC with pneumatosis and portal venous gas; biliary atresia triangular cord sign and HIDA; Wilms vs neuroblastoma differential; PUV keyhole bladder; NAT metaphyseal corner and posterior rib fractures with ACR skeletal survey; DDH Graf US; SCFE Klein line; Perthes; osteosarcoma vs Ewing; HIE patterns and IVH Papile grading; pediatric brain tumor locations (JPA cerebellum, medulloblastoma midline, ependymoma 4th ventricle, craniopharyngioma suprasellar); ISSVA vascular anomaly classification with GLUT1 marker; CHD chest radiograph patterns; and Image Gently dose-reduction principles.

How should I study for the Pediatric Radiology CAQ?

Plan 200-400 hours over 6-12 months during and after fellowship. Core resources include Caffey's Pediatric Diagnostic Imaging, Donnelly's Fundamentals of Pediatric Imaging, the SPR (Society for Pediatric Radiology) core curriculum, RSNA case collections, STATdx, and the ABR Pediatric Radiology study guide. Drill high-volume MCQs with timed sets, master Image Gently principles and NAT imaging workflow, and complete 2-3 full-length timed mock exams focused on image-heavy cases.

When is the 2026 exam administered?

ABR subspecialty CAQ exams are typically offered annually. Applications open months before the exam with a submission deadline prior to the testing window, after which candidates schedule specific Pearson VUE appointments. Exact 2026 dates should be confirmed on the ABR Pediatric Radiology page.

How is the exam scored?

ABR uses a criterion-referenced scaled scoring system with a passing standard set by subject-matter experts. A candidate's pass/fail result depends on performance relative to the fixed cut-score rather than on other test-takers. Score reports include subdomain performance to guide future learning. Results are typically released several weeks after the testing window closes.