ABP Pediatric Cardiology Certification Examination
Full-Length Practice Exam Questions And Correct Answers
(Verified Answers) Plus Rationales Q&A Instant Download Pdf
Full-length practice examination for the American Board of Pediatrics Pediatric Cardiology Certification
Examination, covering fetal cardiology, congenital and acquired heart disease, imaging, catheterization and
intervention, electrophysiology, heart failure and transplantation, preventive cardiology, and intensive care
cardiology. Questions emphasize 2026 guideline-based, high-complexity clinical reasoning. It contains 98
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Questions are organized into clearly labelled sections that mirror the major content areas of
the course. Targeted learning outcomes include: Apply current ACC/AHA and AHA pediatric cardiology
guidelines to complex diagnostic and management decisions; Interpret advanced cardiac imaging, catheterization
hemodynamics, and electrophysiology data in pediatric patients; Synthesize multidisciplinary evidence for
congenital, acquired, and critical care cardiology scenarios. Every item has been reviewed for clinical accuracy,
current guidelines, and clarity so that students can study with confidence and self-correct as they work through
the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool during the
unit - the rationales double as concise teaching notes. The recommended writing time is 4 hours, with a passing
score of 70% (standardized scaled score). Aligned with Aligned with US R1 university and ABP board
certification standards; content reflects ABP Pediatric Cardiology Content Outline (2025), ACC/AHA Pediatric
Section 1: General (Questions 1-98)
1 Fetal echocardiogram shows absent pulmonary valve with severe right ventricular
dilation and ductal-dependent pulmonary blood flow. What delivery strategy is
optimal?
A) Planned vaginal delivery with prostaglandin E1 infusion available immediately
B) Ex utero intrapartum treatment (EXIT) to airway with prostaglandin E1
infusion
C) Elective cesarean delivery at 39 weeks with prostaglandin E1 infusion
D) Planned delivery at a center with immediate catheterization and prostaglandin
E1 infusion
Answer: B
Rationale: Absent pulmonary valve with severe right ventricular dilation and
ductal-dependent pulmonary blood flow carries a high risk of airway compression
and critical desaturation at birth; EXIT-to-airway with immediate prostaglandin E1
provides controlled airway stabilization and pulmonary blood flow. Options A, C,
and D do not address the immediate airway compromise and risk of ductal closure
before intervention.
2 Which echocardiographic parameter best predicts adverse outcomes in pediatric
dilated cardiomyopathy?
A) Left ventricular ejection fraction
,B) Left ventricular end-diastolic dimension z-score
C) Global longitudinal strain
D) Mitral E/A ratio
Answer: C
Rationale: Global longitudinal strain (GLS) detects subclinical myocardial
dysfunction and has superior prognostic value over ejection fraction and chamber
dimensions in pediatric dilated cardiomyopathy. While z-scores and E/A ratios
provide useful information, GLS is the most robust predictor of adverse events in
current pediatric heart failure literature.
3 During cardiac catheterization for pulmonary hypertension, which hemodynamic
finding best distinguishes pre-capillary from post-capillary etiology?
A) Mean pulmonary artery pressure >25 mmHg
B) Pulmonary vascular resistance index >3 Wood units-m²
C) Pulmonary artery wedge pressure 15 mmHg with transpulmonary gradient >12
mmHg
D) Cardiac index <2.5 L/min/m²
Answer: C
Rationale: Pre-capillary pulmonary hypertension is defined by a pulmonary artery
wedge pressure 15 mmHg and a transpulmonary gradient >12 mmHg, indicating
elevated pulmonary vascular resistance without left heart congestion. The other
options are nonspecific and can occur in both pre- and post-capillary forms.
4 Which ECG finding most reliably indicates a concealed accessory pathway in a
pediatric patient with supraventricular tachycardia?
A) Delta wave during sinus rhythm
B) Retrograde P wave in the ST segment during tachycardia
C) QRS alternans during tachycardia
D) PR interval prolongation during sinus rhythm
Answer: B
Rationale: A retrograde P wave inscribed in the ST segment during tachycardia
suggests retrograde conduction over an accessory pathway, a hallmark of concealed
pathways. Delta waves are absent in concealed pathways, and QRS alternans or PR
prolongation are nonspecific findings.
5 A child with Fontan circulation develops protein-losing enteropathy. Which
intervention has the strongest evidence for improving outcomes?
A) High-dose corticosteroids
,B) Fontan fenestration creation
C) Oral budesonide and octreotide
D) Thoracic duct ligation
Answer: B
Rationale: Creating a Fontan fenestration reduces systemic venous pressure and
improves cardiac output, which can ameliorate protein-losing enteropathy in Fontan
patients. Corticosteroids, octreotide, and thoracic duct ligation have limited and
inconsistent evidence in this population.
6 Which statement best describes the role of cardiac magnetic resonance (CMR) in
pediatric myocarditis?
A) CMR is the gold standard for diagnosis
B) CMR can detect myocardial edema and fibrosis using Lake Louise criteria
C) CMR is contraindicated in children under 5 years
D) CMR is only useful for follow-up after biopsy-proven myocarditis
Answer: B
Rationale: The updated Lake Louise criteria allow CMR to identify myocardial
edema (T2-weighted imaging) and nonischemic fibrosis (late gadolinium
enhancement), supporting the diagnosis of myocarditis. CMR is not a gold standard,
is not age-contraindicated, and is useful at initial presentation, not just follow-up.
7 Which lipid screening strategy is recommended for children with a family history
of premature cardiovascular disease?
A) Universal screening at 9-11 years and again at 17-21 years
B) Selective screening only if BMI >95th percentile
C) Screening at 2 years of age if parent has hypercholesterolemia
D) Screening only after 18 years of age
Answer: A
Rationale: The 2025 ACC/AHA pediatric preventive guidelines endorse universal
lipid screening at 9-11 years and again at 17-21 years, regardless of family history or
obesity status. Selective or delayed screening misses opportunities for early
intervention in familial hypercholesterolemia.
8 In a pediatric patient with acute decompensated heart failure, which vasoactive
agent is most appropriate for afterload reduction and inotropy?
A) Dopamine
B) Epinephrine
C) Milrinone
, D) Norepinephrine
Answer: C
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that provides both inotropy
and afterload reduction, making it ideal for acute decompensated heart failure with
elevated systemic vascular resistance. Dopamine and epinephrine increase afterload,
and norepinephrine is a potent vasoconstrictor.
9 Which catheterization-derived parameter best predicts need for reintervention
after balloon aortic valvuloplasty in congenital aortic stenosis?
A) Peak-to-peak gradient reduction >50%
B) Post-procedure aortic regurgitation grade
C) Left ventricular end-diastolic pressure
D) Aortic valve annulus z-score
Answer: B
Rationale: The degree of post-procedure aortic regurgitation is the strongest predictor
of reintervention, as significant regurgitation often progresses and requires surgical
valve replacement. Gradient reduction and annulus size influence initial success but
are less predictive of long-term reintervention.
10 Which factor most strongly predicts mortality in pediatric heart transplant
recipients with graft dysfunction?
A) Donor age
B) Recipient pre-transplant mechanical ventilation
C) Development of donor-specific antibodies
D) Ischemic time >4 hours
Answer: C
Rationale: Donor-specific antibodies are a major risk factor for antibody-mediated
rejection and graft failure, and their presence significantly increases mortality in
pediatric heart transplant recipients. While ischemic time and pre-transplant
ventilation impact outcomes, donor-specific antibodies have the strongest
independent association with graft loss.
11 Which fetal intervention most improves survival in hypoplastic left heart with
intact atrial septum?
A) Maternal hyperoxygenation to promote antegrade pulmonary blood flow
B) Fetal aortic valvuloplasty to recruit the left ventricle
C) Creation of an atrial septal communication by fetal cardiac catheterization
D) Maternal indomethacin to delay ductal constriction
Full-Length Practice Exam Questions And Correct Answers
(Verified Answers) Plus Rationales Q&A Instant Download Pdf
Full-length practice examination for the American Board of Pediatrics Pediatric Cardiology Certification
Examination, covering fetal cardiology, congenital and acquired heart disease, imaging, catheterization and
intervention, electrophysiology, heart failure and transplantation, preventive cardiology, and intensive care
cardiology. Questions emphasize 2026 guideline-based, high-complexity clinical reasoning. It contains 98
multiple-choice questions, each with four distractors and a fully worked rationale that explains why the keyed
answer is correct. Questions are organized into clearly labelled sections that mirror the major content areas of
the course. Targeted learning outcomes include: Apply current ACC/AHA and AHA pediatric cardiology
guidelines to complex diagnostic and management decisions; Interpret advanced cardiac imaging, catheterization
hemodynamics, and electrophysiology data in pediatric patients; Synthesize multidisciplinary evidence for
congenital, acquired, and critical care cardiology scenarios. Every item has been reviewed for clinical accuracy,
current guidelines, and clarity so that students can study with confidence and self-correct as they work through
the bank. Use it as a high-yield review immediately before the exam, or as a structured practice tool during the
unit - the rationales double as concise teaching notes. The recommended writing time is 4 hours, with a passing
score of 70% (standardized scaled score). Aligned with Aligned with US R1 university and ABP board
certification standards; content reflects ABP Pediatric Cardiology Content Outline (2025), ACC/AHA Pediatric
Section 1: General (Questions 1-98)
1 Fetal echocardiogram shows absent pulmonary valve with severe right ventricular
dilation and ductal-dependent pulmonary blood flow. What delivery strategy is
optimal?
A) Planned vaginal delivery with prostaglandin E1 infusion available immediately
B) Ex utero intrapartum treatment (EXIT) to airway with prostaglandin E1
infusion
C) Elective cesarean delivery at 39 weeks with prostaglandin E1 infusion
D) Planned delivery at a center with immediate catheterization and prostaglandin
E1 infusion
Answer: B
Rationale: Absent pulmonary valve with severe right ventricular dilation and
ductal-dependent pulmonary blood flow carries a high risk of airway compression
and critical desaturation at birth; EXIT-to-airway with immediate prostaglandin E1
provides controlled airway stabilization and pulmonary blood flow. Options A, C,
and D do not address the immediate airway compromise and risk of ductal closure
before intervention.
2 Which echocardiographic parameter best predicts adverse outcomes in pediatric
dilated cardiomyopathy?
A) Left ventricular ejection fraction
,B) Left ventricular end-diastolic dimension z-score
C) Global longitudinal strain
D) Mitral E/A ratio
Answer: C
Rationale: Global longitudinal strain (GLS) detects subclinical myocardial
dysfunction and has superior prognostic value over ejection fraction and chamber
dimensions in pediatric dilated cardiomyopathy. While z-scores and E/A ratios
provide useful information, GLS is the most robust predictor of adverse events in
current pediatric heart failure literature.
3 During cardiac catheterization for pulmonary hypertension, which hemodynamic
finding best distinguishes pre-capillary from post-capillary etiology?
A) Mean pulmonary artery pressure >25 mmHg
B) Pulmonary vascular resistance index >3 Wood units-m²
C) Pulmonary artery wedge pressure 15 mmHg with transpulmonary gradient >12
mmHg
D) Cardiac index <2.5 L/min/m²
Answer: C
Rationale: Pre-capillary pulmonary hypertension is defined by a pulmonary artery
wedge pressure 15 mmHg and a transpulmonary gradient >12 mmHg, indicating
elevated pulmonary vascular resistance without left heart congestion. The other
options are nonspecific and can occur in both pre- and post-capillary forms.
4 Which ECG finding most reliably indicates a concealed accessory pathway in a
pediatric patient with supraventricular tachycardia?
A) Delta wave during sinus rhythm
B) Retrograde P wave in the ST segment during tachycardia
C) QRS alternans during tachycardia
D) PR interval prolongation during sinus rhythm
Answer: B
Rationale: A retrograde P wave inscribed in the ST segment during tachycardia
suggests retrograde conduction over an accessory pathway, a hallmark of concealed
pathways. Delta waves are absent in concealed pathways, and QRS alternans or PR
prolongation are nonspecific findings.
5 A child with Fontan circulation develops protein-losing enteropathy. Which
intervention has the strongest evidence for improving outcomes?
A) High-dose corticosteroids
,B) Fontan fenestration creation
C) Oral budesonide and octreotide
D) Thoracic duct ligation
Answer: B
Rationale: Creating a Fontan fenestration reduces systemic venous pressure and
improves cardiac output, which can ameliorate protein-losing enteropathy in Fontan
patients. Corticosteroids, octreotide, and thoracic duct ligation have limited and
inconsistent evidence in this population.
6 Which statement best describes the role of cardiac magnetic resonance (CMR) in
pediatric myocarditis?
A) CMR is the gold standard for diagnosis
B) CMR can detect myocardial edema and fibrosis using Lake Louise criteria
C) CMR is contraindicated in children under 5 years
D) CMR is only useful for follow-up after biopsy-proven myocarditis
Answer: B
Rationale: The updated Lake Louise criteria allow CMR to identify myocardial
edema (T2-weighted imaging) and nonischemic fibrosis (late gadolinium
enhancement), supporting the diagnosis of myocarditis. CMR is not a gold standard,
is not age-contraindicated, and is useful at initial presentation, not just follow-up.
7 Which lipid screening strategy is recommended for children with a family history
of premature cardiovascular disease?
A) Universal screening at 9-11 years and again at 17-21 years
B) Selective screening only if BMI >95th percentile
C) Screening at 2 years of age if parent has hypercholesterolemia
D) Screening only after 18 years of age
Answer: A
Rationale: The 2025 ACC/AHA pediatric preventive guidelines endorse universal
lipid screening at 9-11 years and again at 17-21 years, regardless of family history or
obesity status. Selective or delayed screening misses opportunities for early
intervention in familial hypercholesterolemia.
8 In a pediatric patient with acute decompensated heart failure, which vasoactive
agent is most appropriate for afterload reduction and inotropy?
A) Dopamine
B) Epinephrine
C) Milrinone
, D) Norepinephrine
Answer: C
Rationale: Milrinone is a phosphodiesterase-3 inhibitor that provides both inotropy
and afterload reduction, making it ideal for acute decompensated heart failure with
elevated systemic vascular resistance. Dopamine and epinephrine increase afterload,
and norepinephrine is a potent vasoconstrictor.
9 Which catheterization-derived parameter best predicts need for reintervention
after balloon aortic valvuloplasty in congenital aortic stenosis?
A) Peak-to-peak gradient reduction >50%
B) Post-procedure aortic regurgitation grade
C) Left ventricular end-diastolic pressure
D) Aortic valve annulus z-score
Answer: B
Rationale: The degree of post-procedure aortic regurgitation is the strongest predictor
of reintervention, as significant regurgitation often progresses and requires surgical
valve replacement. Gradient reduction and annulus size influence initial success but
are less predictive of long-term reintervention.
10 Which factor most strongly predicts mortality in pediatric heart transplant
recipients with graft dysfunction?
A) Donor age
B) Recipient pre-transplant mechanical ventilation
C) Development of donor-specific antibodies
D) Ischemic time >4 hours
Answer: C
Rationale: Donor-specific antibodies are a major risk factor for antibody-mediated
rejection and graft failure, and their presence significantly increases mortality in
pediatric heart transplant recipients. While ischemic time and pre-transplant
ventilation impact outcomes, donor-specific antibodies have the strongest
independent association with graft loss.
11 Which fetal intervention most improves survival in hypoplastic left heart with
intact atrial septum?
A) Maternal hyperoxygenation to promote antegrade pulmonary blood flow
B) Fetal aortic valvuloplasty to recruit the left ventricle
C) Creation of an atrial septal communication by fetal cardiac catheterization
D) Maternal indomethacin to delay ductal constriction
