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100+ Free HERMES Paediatric Respiratory Practice Questions

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2026 Statistics

Key Facts: HERMES Paediatric Respiratory Exam

90 questions

ERS HERMES paediatric respiratory exam has 90 multiple-choice questions in English

ERS - HERMES examination structure

3 hours

The examination is sat over three hours, proctored and without breaks

ERS - HERMES examination structure

Type-A and K-prime

Items are Type-A (five options, one correct) and K-prime (four true/false statements)

ERS - HERMES examination structure

No negative marking

The HERMES paediatric exam applies no negative marking

ERS - HERMES examination structure

EUR 360

2026 standard European Diploma fee for ERS members (EUR 500 non-member)

ERS - HERMES examination 2026 registration fees

Since 2008

HERMES paediatric examination has run annually since 2008

ERS - About the HERMES examinations

51 CME credits

European Diploma category carries 51 CME credits

ERS - Register for the HERMES examinations

100

Free original practice questions in this bank

OpenExamPrep

The ERS HERMES Paediatric Respiratory Medicine Examination is a 90-question, 3-hour, English-language multiple-choice exam run by the European Respiratory Society. It mixes Type-A single-best-answer items (five options) with K-prime true/false items (four statements) and applies no negative marking. There is no fixed pass percentage; the cut score is set by a modified Angoff standard-setting method and candidates get topic-level feedback. Standard 2026 fees are EUR 360 (member) or EUR 500 (non-member) for the European Diploma, which is open to specialists who have finished national training or are in their final training year. This 100-question bank gives original practice across the whole paediatric respiratory syllabus, kept distinct from the separate adult HERMES exam.

Sample HERMES Paediatric Respiratory Practice Questions

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

1A 6-year-old has recurrent wheeze, cough and breathlessness that vary over time and improve with a bronchodilator. Which single objective test most strongly supports a diagnosis of asthma at this age?
A.A raised total serum IgE
B.Bronchodilator reversibility of FEV1 of 12% or more on spirometry
C.A normal chest radiograph
D.A positive skin-prick test to house dust mite
Explanation: In school-age children able to perform spirometry, demonstrating bronchodilator reversibility of FEV1 of 12% or more (from baseline) provides objective support for variable airflow obstruction characteristic of asthma. Symptom pattern plus this objective evidence is the recommended approach.
2A 3-year-old has episodes of wheeze only with viral upper respiratory infections, is symptom-free between episodes, and has no atopic features. This pattern is best described as:
A.Multiple-trigger wheeze
B.Episodic (viral) wheeze
C.Severe therapy-resistant asthma
D.Protracted bacterial bronchitis
Explanation: Episodic (viral) wheeze describes preschool wheezing that occurs only with viral colds with no interval symptoms. It is distinguished from multiple-trigger wheeze, which also occurs between colds with triggers such as exercise, allergens or laughter.
3A 9-year-old with asthma remains poorly controlled despite regular low-dose inhaled corticosteroid. Before stepping up therapy, the most important first action is to:
A.Add a long-acting beta-agonist
B.Start a leukotriene receptor antagonist
C.Check adherence and inhaler technique
D.Refer for omalizumab
Explanation: Apparent poor control most often reflects modifiable factors. Checking adherence, inhaler technique and ongoing trigger exposure is essential before escalating pharmacotherapy, because many children improve once these are addressed.
4A 12-year-old with severe eosinophilic allergic asthma and high IgE remains uncontrolled on high-dose ICS/LABA. Which biologic targets immunoglobulin E and is licensed in this setting?
A.Omalizumab
B.Mepolizumab
C.Dupilumab
D.Benralizumab
Explanation: Omalizumab is an anti-IgE monoclonal antibody used for severe allergic (IgE-mediated) asthma in children, with dosing based on weight and serum IgE level. The other listed agents act on the IL-5 or IL-4/13 pathways.
5A 7-year-old presents with an acute asthma attack: too breathless to complete sentences, oxygen saturation 90% in air, and a heart rate of 150. This severity is best classified as:
A.Mild
B.Moderate
C.Acute severe
D.Life-threatening
Explanation: Inability to complete sentences, SpO2 below 92% in air, and tachycardia indicate an acute severe exacerbation. Life-threatening features would include a silent chest, poor respiratory effort, cyanosis, exhaustion, hypotension or altered consciousness.
6In the acute management of a child with severe asthma not responding to repeated inhaled salbutamol and ipratropium plus oral steroids, which intravenous agent is commonly given next as a bolus?
A.Intravenous magnesium sulphate
B.Intravenous adrenaline
C.Intravenous furosemide
D.Intravenous adenosine
Explanation: Intravenous magnesium sulphate is a recognised second-line treatment for acute severe or life-threatening childhood asthma not responding to inhaled bronchodilators and systemic steroids. Other options such as IV salbutamol or aminophylline may follow.
7Exhaled nitric oxide (FeNO) is sometimes used in paediatric asthma assessment. An elevated FeNO most directly reflects:
A.Neutrophilic airway inflammation
B.Eosinophilic (type 2) airway inflammation
C.Fixed airflow obstruction
D.Bronchial hyper-reactivity to exercise
Explanation: FeNO is a marker of eosinophilic, type 2 (IL-13 driven) airway inflammation and tends to be raised in atopic, corticosteroid-responsive asthma. It does not measure obstruction or hyper-reactivity directly.
8A teenager reports cough and chest tightness only during and after running, with normal resting spirometry. The most appropriate confirmatory investigation for exercise-induced bronchoconstriction is:
A.A standardised exercise (or eucapnic voluntary hyperpnoea) challenge with serial spirometry
B.A single resting FeNO measurement
C.An overnight oximetry study
D.A chest CT angiogram
Explanation: Exercise-induced bronchoconstriction is confirmed by an exercise or eucapnic voluntary hyperpnoea challenge showing a fall in FEV1 (commonly 10% or more) after the stimulus. Resting spirometry is often normal in these children.
9Which feature in a child labelled as having 'difficult asthma' should most prompt reconsideration of the diagnosis rather than simply escalating treatment?
A.Atopic eczema and allergic rhinitis
B.A clear history of viral-triggered exacerbations
C.Persistent focal monophonic wheeze and a normal response to bronchodilators
D.Family history of asthma
Explanation: Persistent focal monophonic wheeze that does not respond to bronchodilators suggests a fixed lesion such as an inhaled foreign body, vascular ring or airway anomaly rather than asthma, and should trigger reassessment and possibly bronchoscopy or imaging.
10For a 4-year-old prescribed a pressurised metered-dose inhaler, which delivery method gives the most reliable lung deposition?
A.Direct actuation into the mouth
B.A spacer with a tight-fitting mask or mouthpiece
C.A dry powder inhaler
D.A nebuliser only
Explanation: Young children cannot coordinate actuation with inhalation, so a pMDI should be used with a valved holding chamber (spacer), with a mask for the youngest and a mouthpiece once the child can seal their lips and breathe through it. This greatly improves and standardises lung deposition.

About the HERMES Paediatric Respiratory Exam

The ERS HERMES Paediatric Respiratory Medicine Examination is the main European-level, knowledge-based assessment for paediatric respiratory (paediatric pulmonology) specialists and trainees. Created within the ERS HERMES project, it consists of 90 multiple-choice questions sat over three hours, combining Type-A single-best-answer items with K-prime true/false items. Questions are clinical-case based and mapped to the consensus European paediatric respiratory medicine syllabus and examination blueprint. Candidates can sit it for the European Diploma (open to those who have completed national training or are in their final training year), for in-training assessment, or for self-assessment. The examination is accredited by EBAP and approved by UEMS and the European Academy of Paediatrics, and the Swiss Society of Paediatric Pulmonology uses it as a mandatory exit exam.

Assessment

90 multiple-choice questions in English divided into Type-A items (five options, one best answer) and K-prime items (four true/false statements). Questions are case-based and mapped to the European paediatric respiratory syllabus blueprint. No negative marking.

Time Limit

3 hours (180 minutes), proctored and invigilated without breaks.

Passing Score

There is no fixed percentage pass mark. The cut score is set with a modified Angoff criterion-referenced standard-setting process, so the passing standard adapts to the difficulty of each sitting. Candidates receive detailed feedback by syllabus topic.

Exam Fee

2026 standard fees: European Diploma EUR 360 (ERS member) / EUR 500 (non-member); In-Training and Self-Assessment EUR 210 (member) / EUR 320 (non-member). An early-bird member Diploma fee of EUR 320 applied until 1 June 2026. (European Respiratory Society (ERS), HERMES programme; accredited by the European Board for Accreditation in Pneumology (EBAP) and approved by UEMS and the European Academy of Paediatrics (EAP).)

HERMES Paediatric Respiratory Exam Content Outline

14%

Asthma and wheezing disorders

Paediatric asthma diagnosis and phenotyping, preschool wheeze, ICS and add-on therapy, biologics for severe asthma, exercise-induced bronchoconstriction, acute exacerbation management and difficult-to-treat asthma.

12%

Cystic fibrosis, PBB and non-CF bronchiectasis

CF pathophysiology, newborn screening and sweat testing, CFTR modulator therapy, airway clearance and infection management, plus protracted bacterial bronchitis and non-CF bronchiectasis.

13%

Bronchiolitis and respiratory infections

Viral bronchiolitis, community-acquired pneumonia and empyema, croup, pertussis, tuberculosis in children, and immunisation and prevention.

10%

Paediatric lung function

Spirometry interpretation, body plethysmography, FeNO, multiple-breath washout and lung clearance index, infant and preschool testing, bronchial challenge and cardiopulmonary exercise testing.

7%

Developmental lung biology

Stages of lung development, alveolarisation, surfactant biology, fetal and postnatal lung growth, and the impact of prematurity and early-life events on later lung function.

9%

Neonatal respiratory disease

Respiratory distress syndrome and surfactant therapy, bronchopulmonary dysplasia, transient tachypnoea, meconium aspiration, persistent pulmonary hypertension and chronic lung disease of prematurity.

8%

Congenital lung malformations

Congenital pulmonary airway malformation, bronchopulmonary sequestration, congenital lobar emphysema, bronchogenic cyst, congenital diaphragmatic hernia and major airway anomalies.

6%

Primary ciliary dyskinesia

PCD pathophysiology, situs anomalies, diagnostic algorithm including nasal nitric oxide, high-speed video microscopy and genetics, and long-term airway management.

8%

Sleep-disordered breathing

Obstructive sleep apnoea in children, adenotonsillar hypertrophy, polysomnography and oximetry interpretation, central hypoventilation, and non-invasive and long-term ventilation.

6%

Children's interstitial lung disease (chILD)

Classification of chILD, surfactant protein and ABCA3 disorders, neuroendocrine cell hyperplasia of infancy, diagnostic imaging and biopsy, and management principles.

7%

Foreign body aspiration and airway endoscopy

Recognition and management of foreign body aspiration, indications for flexible and rigid bronchoscopy, airway endoscopy findings, and bronchoalveolar lavage in children.

How to Pass the HERMES Paediatric Respiratory Exam

What You Need to Know

  • Passing score: There is no fixed percentage pass mark. The cut score is set with a modified Angoff criterion-referenced standard-setting process, so the passing standard adapts to the difficulty of each sitting. Candidates receive detailed feedback by syllabus topic.
  • Assessment: 90 multiple-choice questions in English divided into Type-A items (five options, one best answer) and K-prime items (four true/false statements). Questions are case-based and mapped to the European paediatric respiratory syllabus blueprint. No negative marking.
  • Time limit: 3 hours (180 minutes), proctored and invigilated without breaks.
  • Exam fee: 2026 standard fees: European Diploma EUR 360 (ERS member) / EUR 500 (non-member); In-Training and Self-Assessment EUR 210 (member) / EUR 320 (non-member). An early-bird member Diploma fee of EUR 320 applied until 1 June 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

HERMES Paediatric Respiratory Study Tips from Top Performers

1Map your revision to the European paediatric respiratory medicine syllabus and the HERMES blueprint, which show the average percentage of questions devoted to each topic so you can prioritise high-weight areas.
2Practise interpreting paediatric lung function, including spirometry, plethysmography and multiple-breath washout (LCI), because these are commonly tested through clinical scenarios.
3Learn the K-prime format: treat each of the four statements as a separate true/false decision, since partial credit depends on how many you get right.
4Keep up to date with rapidly changing areas such as CFTR modulators in cystic fibrosis and biologics for severe paediatric asthma, where guidance has shifted recently.
5Use the ERS Academy of paediatric respiratory medicine modules and self-assessment courses, which deliver case-based MCQs drawn from the same question pool style.
6Drill rare-disease topics such as primary ciliary dyskinesia, children's interstitial lung disease and congenital malformations, since they are heavily weighted overall and easy to under-prepare.

Frequently Asked Questions

How many questions are on the ERS HERMES paediatric respiratory exam?

The examination has 90 multiple-choice questions in English, taken over three hours. They are divided into Type-A items with five options and one best answer, and K-prime items with four statements that are each true or false.

Is the HERMES paediatric exam the same as the adult HERMES exam?

No. The European Respiratory Society runs separate HERMES examinations in adult and paediatric respiratory medicine. Each uses its own European syllabus and blueprint, and candidates may sit only one HERMES examination per year.

What is the pass mark for the HERMES paediatric exam?

There is no fixed percentage pass mark. The cut score is set using a modified Angoff criterion-referenced standard-setting method, so the passing standard reflects the difficulty of the questions in each sitting. Candidates receive feedback by syllabus topic.

Who is eligible for the European Diploma category?

European Diploma candidates must have completed their national paediatric respiratory training programme or be in their final year of speciality training. In-Training and Self-Assessment categories are open to others but do not lead to the Diploma.

How much does the HERMES paediatric examination cost in 2026?

Standard 2026 fees are EUR 360 for ERS members and EUR 500 for non-members in the European Diploma category. In-Training and Self-Assessment cost EUR 210 for members and EUR 320 for non-members; an early-bird member Diploma fee of EUR 320 applied until 1 June 2026.

Is there negative marking on the HERMES paediatric exam?

No. There is no negative marking. For K-prime items, four correct true/false decisions score full marks, three correct decisions score partial marks, and fewer than three score no marks for that item.