Pediatric Pulmonology Exam Domains 2026: Complete Guide to All 19 Content Areas

How the 19-Domain Outline Works

The Certification in Pediatric Pulmonology is administered by the American Board of Pediatrics (ABP) and delivered through Prometric. Unlike a syllabus written by a test-prep company, the content outline is the board's own statement of what an entry-level pediatric pulmonologist is expected to know. It divides the exam into 19 domains, each with an approximate published weight, and the weights total 100%.

Two details matter before you read any further. First, the outline that governs the upcoming sitting is the one effective November 1, 2026, which applies to the initial-certification examination on November 5, 2026. The October 2025 subboard approval date you may see referenced is when the outline was approved, not when it takes effect. Second, the board notes that versions may vary slightly, so always confirm against the official ABP content outline and the official version directory.

This guide walks through every domain by name, explains where the weight is concentrated, and shows how to turn percentages into a preparation plan. If you want the broader strategy first, start with our Pediatric Pulmonology Study Guide 2026: How to Pass on Your First Attempt, then return here for the domain-by-domain detail.

Domain Weights at a Glance

The table below lists all 19 domains with their approximate published weights. Treat the numbers as guides to emphasis, not exact question counts; with about 200 questions, a 5% domain means roughly ten items, but the exact number on any given form can differ.

The distribution is notably flat. No domain exceeds 9%, and the smallest is 3%. That flatness is the defining feature of this exam: you cannot pass by mastering two or three topics and gambling on the rest. It also helps explain why candidates ask how hard the Pediatric Pulmonology exam really is; breadth, not any single peak of difficulty, is the challenge.

The Heavy Hitters: Asthma, Symptoms, and Diagnostics

Three domains together account for roughly a quarter of the exam: Asthma (9%), Common Signs and Symptoms (8%), and Core Principles of Pulmonary Diagnosis and Monitoring Techniques (8%). These deserve disproportionate attention, but for different reasons.

Domain 18 pairs naturally with every disease domain, so time invested here pays off repeatedly. If a question asks you to interpret a flow-volume loop or a diffusing capacity result, the clinical context is almost always drawn from one of the disease domains below.

Core Disease Domains in Depth

Lung Development and Physiology (6%)

Domain 1 covers embryologic stages of lung development, alveolarization, postnatal growth, and the mechanics of breathing. Questions often link developmental timing to clinical consequences, such as why disruption at a particular stage produces a particular malformation or why prematurity alters long-term lung function. Review respiratory mechanics, gas exchange, ventilation-perfusion relationships, and the control of ventilation.

Respiratory Infections (6%) and Cystic Fibrosis (6%)

Domain 5 spans viral and bacterial pneumonia, bronchiolitis, pertussis, tuberculosis, fungal disease, and infections in immunocompromised hosts. Know diagnostic approaches, organism-specific therapy, and complications such as effusion and empyema.

Domain 6, Cystic Fibrosis, is a perennial subspecialty favorite. Focus on:

• Diagnosis, including sweat testing and genetic interpretation, and newborn screening follow-up
• Modulator therapy: mechanism, eligibility concepts, and monitoring
• Airway infection management and pulmonary exacerbation treatment
• Extrapulmonary disease: pancreatic insufficiency, nutrition, CF-related diabetes, liver disease

Respiratory Disorders of the Neonate and Infant (5%) and Congenital and Acquired Malformations (5%)

Domains 3 and 4 reward candidates who think developmentally. Neonatal topics include bronchopulmonary dysplasia, surfactant deficiency, and persistent neonatal respiratory issues. The malformation domain covers conditions such as congenital pulmonary airway malformation, sequestration, congenital diaphragmatic hernia, tracheoesophageal anomalies, tracheomalacia, and laryngeal and airway abnormalities. Know the typical presentation, the imaging or endoscopic signature, and the timing of intervention.

Mid-Weight Domains Candidates Underestimate

A cluster of 5% domains collectively makes up a large share of the exam and is easy to under-prepare for because each looks small on its own.

Interstitial lung disease and respiratory failure also tend to be where candidates report the steepest learning curves, so budget extra review time for them even though their weights are modest.

Small Domains That Still Cost Points

The 4% and 3% domains are tempting to skip. Resist that urge: with a flat distribution, several of these together approach the weight of Asthma and Common Signs and Symptoms combined.

• Non-CF Bronchiectasis (4%): Causes including primary ciliary dyskinesia, immunodeficiency, aspiration, and post-infectious disease; evaluation strategy and airway clearance.
• Sleep-Disordered Breathing and Control of Breathing Disorders (4%): Obstructive sleep apnea evaluation and treatment, adenotonsillectomy considerations, central hypoventilation syndromes, and interpretation of polysomnography.
• Pulmonary Vascular and Lymphatic Diseases (4%): Pulmonary hypertension in children, pulmonary embolism, arteriovenous malformations, and lymphatic disorders such as chylothorax and plastic bronchitis.
• Lung Disease Associated with Systemic Disorders (4%): Pulmonary manifestations of rheumatologic, hematologic, oncologic, and other systemic conditions, including sickle cell disease and treatment-related lung injury.
• Environmental Injuries and Exposures, Acute and Chronic (4%): Smoke and vaping exposures, inhalational injury, drowning, aspiration, and chronic environmental contributors to lung disease.
• Respiratory System Under Stress (3%): The smallest domain, covering how the respiratory system responds to physiologic stressors such as exercise, altitude, and other challenges.

Scholarly Activities and Health Equity

Domain 19, Core Knowledge in Scholarly Activities and Health Equity, carries 4% and is the domain most unlike a traditional clinical topic. It reflects the fact that subspecialty certification expects competence in research and evidence appraisal, not only bedside knowledge. Expect material along these lines:

• Study design, bias, and basic biostatistics needed to appraise the literature
• Interpreting diagnostic test performance and clinical trial results
• Quality improvement and patient safety concepts
• Health equity as it applies to pediatric respiratory care, including disparities in access, outcomes, and environmental exposures

Candidates who recently completed fellowship scholarly projects often find this domain approachable, but a short dedicated review of biostatistics terminology is worth the time. For eligibility details tied to fellowship and scholarly requirements, see Pediatric Pulmonology Requirements 2026.

Exam Format, Scoring, and Registration

Understanding the container helps you prepare for the content. The exam consists of approximately 200 multiple-choice questions delivered at Prometric. Results are reported as a scaled score on a 1-300 scale, and the passing scaled score is 180. That figure is not a raw percentage, so you should not interpret it as needing a particular percent of items correct. Our article on the Pediatric Pulmonology passing score explains scaling in more detail.

The pass-rate figures come from a 2026 primary paper citing ABP data; read what the pass-rate data shows for context on how to interpret them. For a full financial picture, see the Pediatric Pulmonology certification cost breakdown, and confirm current dates on the exam dates and scheduling page and the official ABP exam dates and fees page.

Traditional eligibility involves a medical or osteopathic degree, general pediatrics certification, a three-year subspecialty fellowship, and scholarly requirements. After initial certification, continuing certification runs on a five-year cycle using either MOCA-Peds or an examination pathway, so the domain knowledge you build now carries forward.

Sequencing Your Preparation by Domain

Because the weights are flat, a sensible plan front-loads the foundational and high-weight domains, then cycles through disease clusters, and ends with integration. The timeline below is one way to map domains to weeks; adjust it to your own gaps.

Finish with mixed-domain practice so you are not relying on the cue of knowing which chapter a question comes from. A one-page recap such as our Pediatric Pulmonology cheat sheet is useful for the final days. When you are ready for exam-style questions across all 19 areas, our Pediatric Pulmonology practice tests let you drill by domain or in mixed sets, and you can track weak areas against the weights above.

Frequently Asked Questions

For a broader view of the credential itself, read what Pediatric Pulmonology certification is, and if you are weighing the career side, see whether the certification is worth it.