LATEST PEDIATRIC PULMONOLOGY
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 6-month-old infant presents with a 2-day history
of cough, rhinorrhea, and wheezing. On examination,
the infant has tachypnea (respiratory rate 60),
subcostal retractions, and expiratory wheezing.
Oxygen saturation is 89% on room air. What is the
most likely diagnosis?
A) Viral bronchiolitis (respiratory syncytial virus,
RSV)
B) Asthma (first episode)
C) Foreign body aspiration
D) Bacterial pneumonia
Correct answer: A
Rationale: RSV bronchiolitis is common in infants <1
year, presenting with wheezing, retractions, and
hypoxemia. Treatment is supportive (oxygen,
hydration). Palivizumab prophylaxis for high-risk
infants.
,2. A 5-year-old child with a history of asthma presents
with a severe exacerbation. He is on albuterol
nebulization (2.5 mg) and ipratropium bromide (0.5
mg). His peak expiratory flow (PEF) is 40% of
predicted. What is the most appropriate next step?
A) Oral corticosteroids (prednisone 2 mg/kg, max 60
mg)
B) Intravenous magnesium sulfate (50 mg/kg)
C) Intubation and mechanical ventilation
D) Inhaled corticosteroids (fluticasone)
Correct answer: A
Rationale: Moderate-to-severe asthma exacerbation
(PEF 40-69%) requires systemic corticosteroids (oral
prednisone). IV magnesium (B) for severe
exacerbation (PEF <40%) unresponsive to initial
therapy. Intubation (C) for impending respiratory
failure.
3. A 2-year-old child presents with a 2-day history of
fever, barking cough, and inspiratory stridor.
Symptoms are worse at night. The child is sitting
upright, alert, and has no drooling. What is the most
appropriate initial treatment?
A) Dexamethasone (0.6 mg/kg orally or IM) and
supportive care (for mild-to-moderate croup)
,B) Racemic epinephrine (nebulized) (for moderate-to-
severe croup with stridor at rest)
C) Intubation (for impending airway obstruction)
D) Antibiotics (amoxicillin) (for bacterial tracheitis)
Correct answer: A
Rationale: Viral croup (laryngotracheobronchitis) is
treated with dexamethasone (oral or IM). Racemic
epinephrine (B) is added if stridor at rest or
respiratory distress. Intubation (C) for severe croup.
4. A 10-year-old child with a history of cystic fibrosis
(CF) presents with a 2-week history of increased
cough, sputum production, and weight loss. Sputum
culture grows mucoid Pseudomonas aeruginosa.
What is the most appropriate treatment for this
exacerbation?
A) Intravenous antibiotics (tobramycin + ceftazidime
or meropenem) (for pulmonary exacerbation)
B) Oral ciprofloxacin alone (for mild exacerbation)
C) Inhaled tobramycin alone (chronic suppression)
D) Azithromycin (macrolide) (anti-inflammatory)
Correct answer: A
Rationale: Acute pulmonary exacerbation in CF
requires IV antibiotics (antipseudomonal beta-lactam
, + tobramycin). Inhaled tobramycin (C) is for chronic
suppression. Azithromycin (D) is used as chronic
anti-inflammatory.
5. A 6-year-old child with a history of asthma is on
fluticasone (low dose) and albuterol as needed. He
has had 3 exacerbations requiring oral
corticosteroids in the past year. What is the most
appropriate step up in therapy?
A) Add long-acting beta-agonist (LABA, salmeterol)
to fluticasone (combination inhaler)
B) Increase fluticasone to medium dose
C) Add montelukast (leukotriene receptor antagonist)
D) Add tiotropium (LAMA)
Correct answer: A
Rationale: Step 3 therapy for uncontrolled asthma on
low-dose ICS: medium-dose ICS or low-dose ICS +
LABA. For children 5-11 years, medium-dose ICS or
ICS+LABA are options. LABA is added to ICS
(combination inhaler).
6. A 4-year-old child presents with a 3-day history of
fever, cough, and tachypnea. Chest X-ray shows a
round pneumonia in the right lower lobe. The child is
CERTIFICATION EXAM OFFERED BY
AMERICAN BOARD OF PEDIATRICS |
COMPLETE EXAM Q&A WITH RATIONALES
1. A 6-month-old infant presents with a 2-day history
of cough, rhinorrhea, and wheezing. On examination,
the infant has tachypnea (respiratory rate 60),
subcostal retractions, and expiratory wheezing.
Oxygen saturation is 89% on room air. What is the
most likely diagnosis?
A) Viral bronchiolitis (respiratory syncytial virus,
RSV)
B) Asthma (first episode)
C) Foreign body aspiration
D) Bacterial pneumonia
Correct answer: A
Rationale: RSV bronchiolitis is common in infants <1
year, presenting with wheezing, retractions, and
hypoxemia. Treatment is supportive (oxygen,
hydration). Palivizumab prophylaxis for high-risk
infants.
,2. A 5-year-old child with a history of asthma presents
with a severe exacerbation. He is on albuterol
nebulization (2.5 mg) and ipratropium bromide (0.5
mg). His peak expiratory flow (PEF) is 40% of
predicted. What is the most appropriate next step?
A) Oral corticosteroids (prednisone 2 mg/kg, max 60
mg)
B) Intravenous magnesium sulfate (50 mg/kg)
C) Intubation and mechanical ventilation
D) Inhaled corticosteroids (fluticasone)
Correct answer: A
Rationale: Moderate-to-severe asthma exacerbation
(PEF 40-69%) requires systemic corticosteroids (oral
prednisone). IV magnesium (B) for severe
exacerbation (PEF <40%) unresponsive to initial
therapy. Intubation (C) for impending respiratory
failure.
3. A 2-year-old child presents with a 2-day history of
fever, barking cough, and inspiratory stridor.
Symptoms are worse at night. The child is sitting
upright, alert, and has no drooling. What is the most
appropriate initial treatment?
A) Dexamethasone (0.6 mg/kg orally or IM) and
supportive care (for mild-to-moderate croup)
,B) Racemic epinephrine (nebulized) (for moderate-to-
severe croup with stridor at rest)
C) Intubation (for impending airway obstruction)
D) Antibiotics (amoxicillin) (for bacterial tracheitis)
Correct answer: A
Rationale: Viral croup (laryngotracheobronchitis) is
treated with dexamethasone (oral or IM). Racemic
epinephrine (B) is added if stridor at rest or
respiratory distress. Intubation (C) for severe croup.
4. A 10-year-old child with a history of cystic fibrosis
(CF) presents with a 2-week history of increased
cough, sputum production, and weight loss. Sputum
culture grows mucoid Pseudomonas aeruginosa.
What is the most appropriate treatment for this
exacerbation?
A) Intravenous antibiotics (tobramycin + ceftazidime
or meropenem) (for pulmonary exacerbation)
B) Oral ciprofloxacin alone (for mild exacerbation)
C) Inhaled tobramycin alone (chronic suppression)
D) Azithromycin (macrolide) (anti-inflammatory)
Correct answer: A
Rationale: Acute pulmonary exacerbation in CF
requires IV antibiotics (antipseudomonal beta-lactam
, + tobramycin). Inhaled tobramycin (C) is for chronic
suppression. Azithromycin (D) is used as chronic
anti-inflammatory.
5. A 6-year-old child with a history of asthma is on
fluticasone (low dose) and albuterol as needed. He
has had 3 exacerbations requiring oral
corticosteroids in the past year. What is the most
appropriate step up in therapy?
A) Add long-acting beta-agonist (LABA, salmeterol)
to fluticasone (combination inhaler)
B) Increase fluticasone to medium dose
C) Add montelukast (leukotriene receptor antagonist)
D) Add tiotropium (LAMA)
Correct answer: A
Rationale: Step 3 therapy for uncontrolled asthma on
low-dose ICS: medium-dose ICS or low-dose ICS +
LABA. For children 5-11 years, medium-dose ICS or
ICS+LABA are options. LABA is added to ICS
(combination inhaler).
6. A 4-year-old child presents with a 3-day history of
fever, cough, and tachypnea. Chest X-ray shows a
round pneumonia in the right lower lobe. The child is
