- The 2026 PP exam has 235 total questions across 170 written/practical and 65 virtual-microscopy items.
- Fetal/Neonatal pathophysiology (Domain 2) is the single largest written/practical category at 15%.
- Passing requires a scaled score of 500, not a fixed raw percentage correct.
- The 2026 fee is USD 2,100, including a USD 200 nonrefundable administrative portion.
Exam Format Snapshot
Before you memorize a single fact, lock in the shape of the exam itself. The Certification in Pathology: Pediatric Pathology (PP) exam administered by the American Board of Pathology is a computer-based, in-person test delivered at Pearson VUE Professional Centers. It is not a take-home or remotely proctored exam, and it is not a glass-slide microscopy exam - every image-based question is presented as digital virtual microscopy on-screen.
The 2026 schedule breaks into two timed components:
- Written/Practical section: 170 questions in 3 hours 8 minutes
- Virtual Microscopy section: 65 questions in 3 hours 15 minutes
That's 235 questions and 6 hours 23 minutes of active testing spread across six sections in one day. Factor in instructions, a survey, and breaks, and the total scheduled seat time runs 8 hours 53 minutes. Plan your travel and lodging around a full testing day, not a half-day appointment.
For a section-by-section walkthrough of what each portion actually tests, see How Hard Is the PP Exam? Complete Difficulty Guide 2026.
Fees and Registration Mechanics
The 2026 initial application/examination fee for PP is USD 2,100, which bundles in a USD 200 nonrefundable administrative fee. That administrative portion is charged regardless of outcome, so treat your application timing and eligibility documentation as final before you submit - this isn't a fee structure that rewards last-minute guesses about readiness.
Because testing is exclusively at Pearson VUE Professional Centers, budget for travel, and check test-center availability early relative to your target window. For the full breakdown of what's included in that fee and how it compares across the certification lifecycle, read PP Certification Cost 2026: Complete Pricing Breakdown, and confirm specific testing windows in PP Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
Domain Weight Cheat Sheet
The official 2026 blueprint lists 23 shared content headings, each carrying two separate approximate weights - one for the Written/Practical component and one for the Virtual Microscopy component. Neither column represents a blended whole-exam distribution; treat them as two independent study targets pulling from the same content list. This table is the fastest way to see relative emphasis at a glance.
| Domain | Written/Practical % | Virtual Microscopy % |
|---|---|---|
| D1 - Placental-maternal-fetal relationships | 7% | 10% |
| D2 - Fetal/Neonatal pathophysiology | 15% | 10% |
| D3 - General Pathologic Principles and Syndromes | 5% | 5% |
| D4 - Cardiovascular System | 6% | 3% |
| D5 - Respiratory System and Mediastinum | 6% | 6% |
| D6 - Central Nervous System | 5% | 6% |
| D7 - Skin | 3% | 5% |
| D8 - Special Senses (Eye and Ear) | 1% | 2% |
| D9 - Alimentary Tract (GI) | 7% | 8% |
| D10 - Hepatobiliary System and Pancreas | 6% | 8% |
| D11 - Kidney and Urinary System | 5% | 6% |
| D12 - Endocrine System (excl. ovary/testis) | 3% | 3% |
| D13 - Hematopoietic System | 6% | 9% |
| D14 - Breast | 1% | 2% |
| D15 - Female Reproductive System | 2% | 2% |
| D16 - Disorders of Sexual Development | 1% | 2% |
| D17 - Male Reproductive System | 1% | 2% |
| D18 - Soft Tissue, Peripheral Nerve, Muscle | 4% | 6% |
| D19 - Skeletal System | 3% | 3% |
| D20 - Diagnostic/Technical Procedures | 7% | 2% |
| D21 - Laboratory Management-Pediatric Pathology | 2% | 0% |
| D22 - Forensic Pathology | 2% | 0% |
| D23 - Management & Informatics-General | 2% | 0% |
Notice the pattern: Domains 21-23 carry no virtual-microscopy weight at all, because they cover laboratory operations, forensic workflow, and informatics rather than histologic interpretation. If you want the long-form breakdown of what's actually tested inside each of these 23 headings, bookmark PP Exam Domains 2026: Complete Guide to All 23 Content Areas.
High-Yield Domains to Master First
With 23 domains competing for finite study hours, weight should drive sequencing. Four domains deserve disproportionate attention.
Domain 2: Fetal/Neonatal Pathophysiology
This is the single heaviest written/practical category at 15%, plus a full 10% on virtual microscopy. Candidates should be fluent in stillbirth workup, prematurity-related organ pathology, and neonatal autopsy findings.
- Placental correlation with neonatal outcome
- Common causes of perinatal death and their histologic signatures
Domain 1: Placental-Maternal-Fetal Relationships
Paired with Domain 2 as perinatal pathology, this carries 7% written/practical and a notably higher 10% on virtual microscopy - each perinatal category holds 10% on the microscopy side, making placental slide interpretation a near-guaranteed testing area.
- Maternal vascular malperfusion patterns
- Villitis, chorioamnionitis, and cord pathology recognition
Domain 13: Hematopoietic System
At 6% written/practical and 9% virtual microscopy, this domain rewards strong slide-recognition skills for bone marrow, lymph node, thymus, and spleen pathology in pediatric patients.
- Pediatric lymphoma and leukemia morphology
- Thymic and splenic developmental abnormalities
Domain 9: Alimentary Tract (GI)
A steady 7% written/practical and 8% virtual microscopy make GI pathology one of the more consistently tested organ systems.
- Congenital GI malformations
- Pediatric inflammatory and motility disorders
The Passing Standard
PP uses a scaled score of 500 as its passing standard - not a fixed raw percentage of correct answers. This matters for how you interpret practice performance: getting "80% correct" on a practice set doesn't map directly to passing, because scaling accounts for item difficulty across the two components. For a full explanation of how the scaled score is derived and what it implies for study targets, see PP Passing Score 2026: Exactly What You Need to Pass.
Reported outcomes for 2025 showed all 17 examinees passing, including all 13 first-time examinees, with both reported pass rates at 100% - though these figures come from a small cohort size, which candidates should keep in context rather than treating as a guaranteed baseline. A deeper dive into these numbers and what they do and don't tell you is available in PP Pass Rate 2026: What the Data Shows.
Key Takeaway
Study toward mastering content across both components separately rather than chasing a single combined percentage - the written/practical and virtual microscopy sections are scored and weighted independently.
Eligibility Checklist
Before you can sit for PP, confirm each of the following applies to you:
- Primary certification in AP/CP or AP through the American Board of Pathology, or an accepted Royal College of Physicians and Surgeons of Canada certification in Anatomic Pathology or General Pathology
- 12 months of ACGME-accredited Pediatric Pathology fellowship training
- Applicable medical education, licensure, and training-verification requirements completed and documented
Because eligibility gaps are the most common cause of application delays, review the full requirement set - including documentation timelines - in PP Requirements 2026: Eligibility, Prerequisites & How to Qualify before you pay the nonrefundable administrative fee.
After You Pass: Continuing Certification
Current ABPath certificates carry no fixed expiration date, but they remain conditional on ongoing participation in Continuing Certification. That means passing the exam is the beginning of an obligation, not the end of one. Two tracks matter most:
- Biennial PATHway reporting: maintaining professional standing, lifelong learning, and improvement-in-medical-practice activities every two years
- Standard CME route: 70 qualifying credits per two-year reporting period, with at least 80% related to your scope of practice (approved training and research alternatives also exist)
- ABPath CertLink: a quarterly assessment format requiring a cumulative performance of at least 60% over four years, rather than a single high-stakes retest
Understanding this lifecycle before you sit for the exam helps frame the certification as a career-long commitment - a point worth weighing when you evaluate Is the PP Certification Worth It? Complete ROI Analysis 2026 and its relationship to PP Salary Guide 2026: Complete Earnings Analysis.
Final-Week Review Plan
In the last stretch before test day, structure review around domain weight rather than alphabetical order or personal comfort. A compact final push might look like this:
Perinatal Pathology (D1-D2)
- Drill placental slide sets since perinatal categories carry 10% each on virtual microscopy
- Review fetal/neonatal autopsy findings tied to D2's 15% written/practical weight
Mid-weight organ systems (D9, D10, D13)
- Alternate written/practical question sets with virtual microscopy image review
- Use short, timed review blocks rather than open-ended reading sessions
Low-weight, no-microscopy domains (D21-D23)
- Cover laboratory management, forensic pathology, and informatics quickly since they carry 0% virtual-microscopy weight
- Prioritize recall over slide practice here
Full-length timed practice
- Simulate the 6-hour-23-minute active testing block in one sitting
- Confirm Pearson VUE center logistics and required identification
If you need a more complete week-by-week curriculum rather than just a final review sprint, PP Study Guide 2026: How to Pass on Your First Attempt covers the earlier preparation phases in depth. You can also run full-length timed drills modeled on the real question mix over at the PP practice test platform to get comfortable with pacing before test day.
FAQ
No. All 2026 testing is in person at Pearson VUE Professional Centers; there is no at-home or remote option.
The exam uses digital virtual microscopy for its image-based questions, not a glass-slide microscopy format.
235 total: 170 written/practical questions and 65 virtual-microscopy questions, across six sections.
Domain 2, Fetal/Neonatal pathophysiology, carries the highest written/practical weight at 15%, making it the single most valuable domain to master.
Your certificate has no fixed expiration but requires ongoing Continuing Certification, including biennial PATHway reporting and either standard CME credits or participation in ABPath CertLink.
Keep this page bookmarked as your one-glance reference, and pair it with focused practice through the full PP practice question bank as you count down to your Pearson VUE appointment.