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.
These 10 free PHM questions are organized by exam domain, so you can see how each part of the Certification in Pediatric Hospital Medicine (PHM) blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Medical Conditions 55% of exam
Question 1
Three hours into treatment for an asthma exacerbation, an 8-year-old receiving continuous nebulized albuterol has markedly improved air entry, minimal retractions, and only scattered wheezing. Nevertheless, the respiratory rate has increased from 30 to 44/min. The child is alert, afebrile, warm, and well perfused, with an oxygen saturation of 97% on room air. Lactate has risen from 1.6 to 6.2 mmol/L, bicarbonate is 15 mmol/L, and potassium is 2.9 mmol/L. Which mechanism best explains the discordance between the respiratory rate and lung examination?
Show answer & explanation
Correct answer: C - Albuterol-induced lactic acidosis driving the rise in ventilation
Question 2
A previously healthy 41-day-old infant born at term is evaluated for a rectal temperature of 38.2°C. The infant is well appearing, feeds normally, and has no focal findings other than catheterized urine containing leukocyte esterase and 25 white blood cells per high-power field. Procalcitonin is 0.12 ng/mL, C-reactive protein is 6 mg/L, and the absolute neutrophil count is 2,800/µL. Blood and urine cultures are pending. There has been no prior antibiotic exposure, and no exclusion from the AAP well-appearing febrile-infant pathway applies. Does the abnormal urinalysis change the need for lumbar puncture?
Show answer & explanation
Correct answer: D - No; a positive urinalysis alone does not require lumbar puncture when inflammatory markers are normal
Question 3
An 11-year-old with new-onset diabetes has a glucose concentration of 486 mg/dL, venous pH of 7.14, and beta-hydroxybutyrate of 6.0 mmol/L. After the first hour of isotonic fluids, perfusion has improved and urine output is established. Repeat potassium is 2.7 mmol/L, confirmed on a nonhemolyzed specimen. No insulin has been administered. The next treatment order should be:
Show answer & explanation
Correct answer: C - Replace potassium before beginning the intravenous insulin infusion
Question 4
An 11-month-old is brought in after several episodes of abruptly becoming pale and unusually sleepy. Each lasts a few minutes, with near-normal interaction between episodes. There have been two episodes of nonbilious vomiting and one loose stool, but no visible blood. Glucose and vital signs are normal, and the abdomen is soft without a palpable mass. During observation, the infant briefly cries, draws up the legs, and again becomes pale. Which investigation should take priority?
Show answer & explanation
Correct answer: D - Abdominal ultrasound
Question 5
A 9-year-old recovering from septic shock had a documented baseline creatinine of 0.40 mg/dL. Creatinine is now 0.90 mg/dL, 48 hours later. Despite restored circulation, accurately measured urine output through a patent catheter has remained 0.20 mL/kg/hour for 27 consecutive hours. There is no urinary obstruction, and kidney replacement therapy has not begun. Using the published KDIGO 2012 criteria, how should the acute kidney injury be staged?
Show answer & explanation
Correct answer: A - Stage 3, because the urine-output criterion determines the higher stage
Domain 2: Behavioral and Mental Health Conditions 6% of exam
Question 6
During routine inpatient screening, a medically stable 15-year-old answers yes to the ASQ question about a lifetime suicide attempt, describing an attempt 8 months ago. The adolescent answers no to recent wishes to be dead, recent thoughts of killing themself, and current suicidal thoughts. No immediate behavioral safety concern is evident, and this is the first disclosure of the attempt. The screening result should lead to which disposition-assessment step?
Show answer & explanation
Correct answer: A - Perform a brief suicide safety assessment before determining disposition
Domain 3: Newborn Care 8% of exam
Question 7
At exactly 48 hours of age, a newborn delivered at 38 weeks has a total serum bilirubin of 15.4 mg/dL. The mother is blood group O and the infant is group A. A positive direct antiglobulin test, falling hemoglobin, and reticulocytosis support isoimmune hemolysis. The infant is feeding adequately and has no neurologic abnormalities. At this age and gestation, the AAP 2022 phototherapy threshold is 16.0 mg/dL without an additional neurotoxicity risk factor and 14.0 mg/dL with one; the exchange-transfusion threshold with a risk factor is 20.1 mg/dL. What treatment is indicated now?
Show answer & explanation
Correct answer: A - Begin intensive phototherapy and monitor the bilirubin response
Domain 4: Children with Medical Complexity 6% of exam
Question 8
A 7-year-old with an established tracheostomy is breathing comfortably without ventilator support before a supervised speaking-valve trial. Within seconds of valve placement, the child develops forceful respiratory effort and rapidly increasing distress. The tracheostomy cuff is found to remain inflated. Oxygen and skilled airway assistance are being obtained. Which bedside action most directly relieves the immediate mechanical problem?
Show answer & explanation
Correct answer: B - Remove the speaking valve immediately to restore an expiratory route
Domain 6: Patient- and Family-Centered Care 2% of exam
Question 9
A 6-month-old hospitalized with bronchiolitis needs supplemental hydration because feeding is inadequate. There is no shock or impending respiratory failure. The team determines that nasogastric and intravenous hydration are both medically reasonable, but the parents fear that a nasal tube will worsen breathing and request another IV attempt after two unsuccessful attempts. The hospitalist has not yet discussed the comparative burdens of the two routes. Which response best supports shared decision-making?
Show answer & explanation
Correct answer: B - Explore their concern, compare both routes, and agree on treatment and reassessment
Domain 8: Quality Improvement, Patient Safety, and Systems-Based Improvement 4% of exam
Question 10
A ward uses a p-chart with Western Electric signal rules to follow the proportion of discharge prescriptions containing a concentration error. After a pharmacist-led reconciliation intervention, nine consecutive weekly proportions fall below the original center line; none is outside the three-sigma control limits. The points fluctuate rather than declining steadily. Eligibility criteria and data collection have not changed. At the quality meeting, which interpretation is justified?
Show answer & explanation
Correct answer: B - The sequence signals a process shift, not proof of the intervention's causality