10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The PEM exam has 200 questions and runs 4 hours 30 minutes.
These 10 free PEM questions are organized by exam domain, so you can see how each part of the Pediatric Emergency Medicine blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Trauma 12% of exam
Question 1
A previously healthy, well-appearing 34-day-old former term infant is brought in with a rectal temperature of 38.3°C. Physical examination is normal. Urinalysis is negative, procalcitonin is 0.3 ng/mL, C-reactive protein is 11 mg/L, and the absolute neutrophil count is 3,100/mm3. Blood and urine cultures are pending and the family is reliable with assured follow-up. According to the 2021 AAP clinical practice guideline, which of the following is the MOST appropriate management?
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Correct answer: C - Discharge home without antibiotics with follow-up within 24 hours
Question 2
A 7-month-old former term infant has three days of rhinorrhea and cough, now with wheezing and diffuse crackles. Temperature is 37.9°C, respiratory rate 48/min, with mild subcostal retractions and SpO2 of 92% on room air. He is taking about 75% of his usual feeds and has had normal urine output. Which management step is MOST consistent with the 2014 AAP bronchiolitis clinical practice guideline?
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Correct answer: A - Provide supportive care without bronchodilators or corticosteroids
Question 3
A 6-day-old term infant presents with poor feeding, mottling, and lethargy. Heart rate is 190/min and respiratory rate is 70/min. Femoral pulses are markedly diminished compared with brachial pulses. Preductal oxygen saturation is 94% and postductal saturation is 82%. Two 20 mL/kg boluses of normal saline have produced no improvement in perfusion. Which is the MOST appropriate next intervention?
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Correct answer: D - Begin an infusion of prostaglandin E1
Question 4
A 13-year-old in diabetic ketoacidosis has received intravenous fluids and an insulin infusion for six hours. She develops a severe headache and becomes difficult to arouse. Her heart rate falls from 120/min to 68/min while her blood pressure rises. Which is the MOST appropriate immediate intervention?
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Correct answer: B - Administer intravenous hypertonic saline
Question 5
A 12-day-old term infant has had three episodes of green emesis over the past four hours. He is afebrile and mildly tachycardic. The abdomen is soft and non-distended, and he has continued to pass normal stools. Which is the MOST appropriate next diagnostic step?
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Correct answer: D - Upper gastrointestinal contrast series
Question 6
A 3-year-old has had fever for five days. Examination shows bilateral non-exudative bulbar conjunctival injection, cracked erythematous lips with a strawberry tongue, a polymorphous truncal rash, and erythema with edema of the hands and feet. No cervical lymphadenopathy is present. Which is the MOST appropriate management?
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Correct answer: C - Administer intravenous immunoglobulin and aspirin
Domain 2: Resuscitation 10% of exam
Question 7
A 14 kg child is in pulseless electrical activity. High-quality CPR is in progress and intraosseous access has been established. Which dose of epinephrine should be administered?
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Correct answer: B - 0.14 mg
Question 8
A term infant is delivered precipitously in the emergency department. After drying, warming, and stimulation, the infant remains apneic. Following 30 seconds of positive-pressure ventilation with visible chest rise, the heart rate is 48/min. Which is the MOST appropriate next step?
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Correct answer: A - Begin chest compressions with a 3:1 compression-to-ventilation ratio
Question 9
A 2-year-old with three days of vomiting and diarrhea has a heart rate of 175/min, capillary refill of four seconds, and cool mottled extremities. Blood pressure is 92/58 mm Hg. He is irritable but consolable. Which statement BEST characterizes this child's status?
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Correct answer: D - He is in compensated shock and requires immediate fluid resuscitation
Domain 3: Infectious Diseases 8% of exam
Question 10
A 5-year-old is brought in 30 hours after falling from a swing and striking his head. He vomited twice on the day of injury but has been well since. His Glasgow Coma Scale score is 15, the neurologic examination is normal, and there is no scalp hematoma. His parents ask whether the PECARN head injury rule means CT can be avoided. Which is the MOST accurate response?
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Correct answer: C - The rule does not apply because he presented more than 24 hours after the injury