THE AMERICAN BOARD OF PEDIATRICS
CONTENT OUTLINE
Pediatric Pulmonology
Subspecialty In-Training, Certification, and Maintenance of Certification (MOC) Examinations
INTRODUCTION
This document was prepared by the American Board of Pediatrics Subboard of Pediatric
Pulmonology for the purpose of developing in-training, certification, and maintenance of
certification examinations. The outline defines the body of knowledge from which the Subboard
samples to prepare its examinations. The content specification statements located under each
category of the outline are used by item writers to develop questions for the examinations; they
broadly address the specific elements of knowledge within each section of the outline.
Pediatric Pulmonology
Each Pediatric Pulmonology exam is built to the same specifications, also known as the blueprint. This blueprint is used to ensure that, for the initial certification and in-training exams, each exam measures the same depth and breadth of content knowledge. Similarly, the blueprint ensures that the same is true for each Maintenance of Certification exam form. The table below shows the percentage of questions from each of the content domains that will appear on an exam. Please note that the percentages are approximate; actual content may vary.
Content Categories
Initial Certification
and In-Training
Maintenance of
Certification (MOC)
1. Clinical Diseases 35% 35%
2. Evaluation/Diagnosis 11% 12%
3. Therapy 8% 9%
4. Prevention 2% 2%
5. Lung Growth and Development 4% 4%
6. Structure and Function of the Respiratory System 5% 5%
7. Lung Defense Mechanisms 4.5% 4.5%
8. Cell Biology and Biochemistry 3.5% 3.5%
9. Gas Exchange, Ventilation-perfusion Distribution, Acid-base 6.5% 6.5%
10. Respiratory Mechanics 6% 6%
11. Control of Breathing 3.5% 3.5%
12. Pulmonary Vascular Physiology 3.5% 3.5%
13. Mechanics of Lung Inflammation, Injury, and Repair 2.5% 2.5%
14. Core Knowledge in Scholarly Activities 5% 3%
Pulmonology
1. Clinical DiseasesA. Disorders of the upper airways
1. Congenital abnormalitiesa. Choanal atresia/stenosis
1. Epidemiologya. Know the association between choanal atresia and other congenital defects
2. Etiology/Genetics3. Pathophysiology
a. Pathologyb. Path mechanisms and consequences
4. Diagnosis and clinical manifestationsa. History
1. Recognize choanal atresia as a cause of cardiorespiratory failure on thefirst day after birth
2. Recognize choanal atresia as a cause of apnea, cyanosis, and respiratorydistress relieved with crying in a neonate
b. Physical examination1. In assessing choanal patency, recognize the importance of assessing
nasal airflow while the patient's mouth is closed2. Recognize that choanal atresia or stenosis may be unilateral or bilateral
c. Imaging1. Recognize the radiographic appearance of choanal atresia on radiopaque
dye studies or CT scansd. Other investigations
1. Recognize that the simplest way to establish the diagnosis of choanalatresia in infants is by attempting to pass a small catheter through eachnostril
2. Recognize that the finding that only a catheter smaller than a #8 Frenchcan be passed through the nasal passage of an infant is consistent withthe diagnosis of choanal stenosis
e. Diagnostic criteria - NAf. Complications
1. Recognize that infants with choanal atresia are at risk for cyanosis andaspiration during feeding
5. Therapeutic approacha. Recognize that endotracheal intubation is the most effective initial treatment
of choanal atresia in a symptomatic infantb. Recognize that the definitive treatment of both membranous and bony
choanal obstruction is surgical excision with prolonged placement of aSilastic tube (for weeks) to prevent recurrence
6. Prognosisa. Natural history
1. Recognize that untreated choanal atresia may result in life- threateningapnea, cyanosis, and death
b. Prognosis with therapyb. Craniofacial abnormalities with micrognathia
1. Epidemiology2. Etiology/Genetics3. Pathophysiology
a. Pathologyb. Path mechanisms and consequences
4. Diagnosis and clinical manifestationsa. History
1. Recognize the risk of obstructive sleep apnea in children withmicrognathia
2. Recognize that upper airway obstruction may occur in infants withsevere micrognathia
b. Physical examination1. Describe the effect of positioning on breathing in children with
micrognathia2. Recognize the physical features of mandibular hypoplasia
c. Other investigations1. Recognize the role of polysomnography in evaluating the severity of the
respiratory compromise associated with micrognathia that occurs duringsleep
d. Diagnostic criteriae. Complications
1. Recognize the difficulties associated with feeding in infants with severemicrognathia and cleft palate (Pierre Robin sequence)
2. Recognize that micrognathia may cause hypoventilation and hypoxemiain the absence of apnea
5. Prevention and therapeutic approacha. Preventionb. Therapeutic approach
1. Recognize that management of severe micrognathia includes pronepositioning, placement of a nasopharyngeal airway, and ultimately atracheostomy for persistent, severe airway obstruction
c. Side effects of therapy1. Recognize that palate repair without anterior tongue displacement is
likely to cause airflow obstruction in children with micrognathia2. Recognize that pharyngeal flap surgery may worsen upper airway
obstruction during sleep in patients with micrognathia and cleft palate6. Prognosis
a. Natural history1. Recognize that the natural history of micrognathia involves improvement
associated with mandibular growthb. Prognosis with therapy
1. Recognize that resolution of airway obstruction in patients with severemicrognathia is dependent on growth
2. Recognize that assessment of readiness for decannulation of a child withsevere micrognathia must include nocturnal polysomnography andassessment of the airway both awake and asleep
c. Laryngeal web1. Diagnosis and clinical manifestations
a. Historyb. Physical examination
1. Recognize the clinical manifestations of complete laryngeal web(aphonia; severe airway obstruction at birth without inspiratory airflowor stridor)
2. Recognize the clinical presentation of partial laryngeal web (inspiratorystridor, weak/hoarse voice, respiratory distress)
c. Imagingd. Pulmonary function testse. Other investigations
1. Recognize the appearance of a laryngeal web on fiberoptic laryngoscopy2. Know that endoscopic evaluation is the investigation of choice in
patients with laryngeal webf. Diagnostic criteriag. Complications
2. Prevention and therapeutic approacha. Preventionb. Therapeutic approach
1. Recognize that emergency tracheostomy is required to relieveobstruction caused by a complete laryngeal web
2. Recognize that an endotracheal tube can perforate a laryngeal web,providing transient relief of the obstruction
c. Side effects of therapy1. Recognize that a laryngeal web may redevelop after perforation with an
endotracheal tube once the tube is removedd. Laryngeal cysts
1. Epidemiology2. Etiology3. Pathophysiology
a. Pathologyb. Path mechanisms and consequences
4. Diagnosis and clinical manifestationsa. History
1. Recognize that laryngeal cysts are included in the differential diagnosisof congenital stridor
b. Physical examinationc. Imagingd. Pulmonary function testse. Other investigations
1. Recognize the appearance of laryngeal cysts on fiberoptic laryngoscopyf. Diagnostic criteria
g. Complications5. Prevention and therapeutic approach
a. Preventionb. Therapeutic approach
1. Recognize that excision is the treatment of choice for laryngeal cystc. Side effects of therapy
1. Recognize that there is a risk of recurrence of laryngeal cyst followingsimple needle aspiration of the contents of the cyst
e. Laryngomalacia1. Epidemiology
a. Recognize that laryngomalacia is the most common cause of stridor ininfants
2. Etiology/Genetics3. Pathophysiology
a. Pathologyb. Path mechanisms and consequences
4. Diagnosis and clinical manifestationsa. History
1. Recognize that the clinical presentation of laryngomalacia includes onsetof stridor shortly after birth, minimal respiratory distress, positionaleffects, and marked reduction of noise when the infant is at rest
2. Describe the effect of position on stridor secondary to laryngomalacia(worse in supine position)
b. Physical examination1. Recognize that laryngomalacia is associated with normal voice quality
and pitchc. Imaging
1. Recognize that the diagnosis of laryngomalacia cannot be established onthe basis of standard x-ray studies of the neck
d. Pulmonary function testse. Other investigations
1. Recognize the role of fiberoptic laryngoscopy in establishing thediagnosis of laryngomalacia
f. Diagnostic criteriag. Complications
1. Know that symptoms of laryngomalacia can include apnea and feedingproblems
5. Prevention and therapeutic approacha. Preventionb. Therapeutic approach
1. Recognize the indications for surgical intervention in infants withlaryngomalacia
2. Know that in most instances no therapy is required for laryngomalacia6. Prognosis
a. Natural history
1. Recognize that the natural history of laryngomalacia includes resolutionof symptoms without therapy in early childhood
b. Prognosis with therapyf. Vocal cord paralysis
1. Epidemiol
