by Morgan Leafe, MD, MHA
After many years of debate and anticipation, the Pediatric Hospital Medicine Certification Exam is here, and test takers will get their first opportunity to sit for the exam in the fall of 2019. As with any new board exam, potential test takers have many questions, so here are some answers:
When is the exam being offered?
November 12 and November 13, 2019. After the initial administration, it will be offered every other year, so the next administration will be in 2021.
When can I register?
Registration is open from February to April 2019.
Who is eligible to take the exam?
The exam is offered by the American Board of Pediatrics (ABP), and the first requirement for eligibility is that you have to be currently certified in general pediatrics with the ABP.
Beyond this, there are three pathways to eligibility:
1. The training pathway
2. The practice pathway
3. The combined pathway
The training pathway consists of two years of pediatric hospital medicine training beyond residency and chief residency.
The practice pathway is open to those who have four years of clinical experience in pediatric hospital medicine.
The combined pathway offers eligibility to those who have completed less than two years of fellowship training but have an additional two years of clinical experience in addition to their fellowship experience.
More details about dates and availability can be found here:
What content will be covered on the exam?
About half of the questions (55%) are about medical conditions with attention to the subtopics of core science and pathophysiology, epidemiology and risk assessment, diagnosis and evaluation, and management and treatment.
The remainder of the exam covers some clinical topics such as newborn care, medical procedures, and behavioral health in addition to leadership and research topics such as quality improvement, advocacy, family-centered care, and ethics.
More details about exam content can be found here:
Any time a new specialty or subspecialty certification exam is released, the biggest question test takers have after the logistics of dates and eligibility are addressed is “What do I study?”
Established certification exams typically have multiple well-known and broadly utilized Qbanks to study from, but this is not often the case for newer certification exams. While there are plenty of high-quality textbooks for pediatric hospital medicine, reading through these to study for an exam is not practical.
That’s why, in keeping with our tradition of staying ahead of the curve, Rosh Review spent the last year developing our comprehensive Pediatric Hospital Medicine Qbank!
How many questions?
It consists of 300 board-style questions covering all of the topics that will be tested on the exam.
Who developed the content?
A team of experienced pediatric hospitalists who are up to date with current clinical practice and guidelines.
What is the best way to schedule my study time?
Everyone has different needs for making a study schedule in advance of the exam. There’s no right way to study, but the most important thing is to make a plan and stick to it. Maybe scheduling five hours per week for 10 weeks leading up to the exam fits best with your lifestyle, or maybe you are able to take off work for a week or two before your exam date and study the entire time. No matter your approach, sit down and make a schedule on paper or in your phone well in advance of your anticipated study time. Make sure it’s realistic and ensure that you will be able to avoid interruptions during this time to maximize your success. And then stick to it! Treat your study schedule just as you would an appointment or a work shift.
Rosh Review created a dedicated Qbank for the Pediatric Hospital Medicine exam. In addition to using textbooks, lecture notes, and review guides, using a Qbank to prepare for this exam is essential. The more questions you get through, the better your brain will encode the information for exam day.
The Rosh Review Pediatric Hospital Medicine Qbank provides 300 ABP board-style questions with comprehensive explanations, which serves as a simplified review book.
The content you’ll access in the Qbank is built from the ABP blueprint.
Questions are vignette-based ABP format. See how you do:
A 6-year-old girl is admitted to the pediatric inpatient floor from the emergency room with abdominal pain and a rash that developed over the past 48 hours. She has been afebrile during this time, and her vital signs are within age-appropriate limits and stable. She complains of colicky abdominal pain but denies nausea. She also reports aching of her left knee and right ankle. Neither joint has an associated effusion, and range of motion in both is preserved. On skin exam, she has purpuric lesions over her bilateral lower extremities, most notably in the more dependent regions including her bilateral lower buttocks, which are palpable and nontender. There is also moderate nonpitting edema of her hands and feet. Her mucous membranes are spared, as are her palms and soles. Which of the following is the most likely pathologic etiology of this child’s presentation?
A. A cryoglobulinemic vasculitis
B. A granulomatous vasculitis
C. A hypocomplementemic vasculitis
D. A leukocytoclastic vasculitis
Explanations provide a comprehensive review of the topic so that you’ll take away all of the high-yield, critical information to succeed on the exam.
You’ll note high-yield terms and other important phrases are bolded.
The answer to the above questions is choice D. The explanation is as follows:
Immunoglobulin A vasculitis (formerly known as Henoch-Schönlein purpura) is the result of a small-vessel vasculitis seen most often in children, typically in those less than 10 years old. Cases are frequently noted after upper respiratory tract infections (either viral or bacterial), and thus peak incidence is in the fall and winter. Symptoms are directly related to IgA deposition in vessel walls with a resultant leukocytoclastic vasculitis, leading to signs and symptoms of the skin, gastrointestinal tract, joints, and kidneys. Immunoglobulin A vasculitis is most often a clinical diagnosis, with its hallmark finding being the presence of palpable purpura. Also seen in other less common leukocytoclastic vasculitides, palpable purpura are caused by local perivascular edema with extravasation of red blood cells. This mechanism is also the cause of the associated peripheral edema (as opposed to hypoproteinemia, though proteinuria may also be observed if there is renal involvement). In males, scrotal edema may be significant enough to raise concern for underlying testicular torsion. Additionally, perivascular edema within the bowel wall leads to the common complaint of diffuse abdominal pain and to the frequent finding of positive fecal occult blood testing. The inflammation in the GI tract may also lead, in rare cases, to intussusception, bowel necrosis, or bowel perforation as complications of immunoglobulin A vasculitis. Joint involvement is typically oligoarticular, with arthralgia being more predominant than true arthritis, and does not classically lead to permanent joint damage or deformity. Kidney involvement ranges from mild microscopic hematuria to frank glomerulonephritis, which can progress to end-stage renal disease. As a result, frequent follow-up with monitoring of urinalyses for subclinical kidney disease is critical. The extent of renal disease is the most predictive correlate of long-term prognosis in immunoglobulin A vasculitis. In most children, the disease is self-limiting and resolves with supportive care, including NSAIDs or, if indicated by clinical presentation, corticosteroids, in four to six weeks.
Knowing why the correct answer is correct is important, of course. But knowing why the incorrect answer choices are incorrect is just as valuable. Every incorrect answer choice in the Qbank is explained so you understand the nuances of the topic and also learn about related topics.
The incorrect answer choice explanations are as follows:
Cryoglobulinemic vasculitis (A) may also present with purpuric skin manifestations, but these are typically nonpalpable. Weakness, arthralgias, and multi-organ involvement are frequently seen in this entity, which is closely associated with systemic infection, including hepatitis C, autoimmune disease, or malignancy. Granulomatous vasculitis (B) is seen in systemic granulomatous diseases, which are uncommon in the pediatric population, including granulomatosis with polyangiitis or Churg-Strauss syndrome (allergic granulomatosis). Hypocomplementemic vasculitis (C) is a subset of the urticarial vasculitides, seen in association with angioedema and other systemic symptoms.
After you attempt the question, find out if you answered it correctly or incorrectly, and review the rationale, you are provided a custom teaching image that graphically highlights the most important aspects of the topic that are critical to learn for the exam.
After reviewing the correct and incorrect answer choices, the in-depth explanation, and the custom teaching image, you are provided another question related to the main topic to help reinforce what you just read. This is called the One Step Further question.
Which bacterial agent is the most commonly identified trigger for immunoglobulin A vasculitis?
And the answer is:
Group A Streptococcus.
Have you had enough? There’s more! Before you move on to the next question, you can read through the Rapid Review, which summarizes the key elements of the topic. In this case, immunoglobulin A vasculitis.
Immunoglobulin A vasculitis (formerly Henoch-Schönlein Purpura)
- Patient will be 4–12 years old
- With a history of recent URI
- Complaining of abdominal pain, arthralgia, and a rash that began on buttocks and lower extremities
- Physical exam will show maculopapular rash (palpable purpura) that is nonpruritic
- Most commonly caused by IgA mediated vasculitis
- Treatment is supportive care
- Comments: Complications include nephropathy, intussusception
Now you’re ready!
You should leave this question with a firm understanding of how to answer questions about immunoglobulin A vasculitis correctly on the Pediatric Hospital Medicine exam.
Since there are other options for you to work with to prepare for your Pediatric Hospital Medicine exam, before you decide to spend money with Rosh Review, get your free trial to the Pediatric Hospital Medicine Qbank and get a better idea if this Qbank is right for you.
The full Qbank will be ready on June 1, 2019.
Please let us know if you have any questions. Reach out by emailing firstname.lastname@example.org for insights about preparing for the Pediatric Hospital Medicine exam or about any of Rosh Review’s Qbanks.