PFCCS Exam ACTUAL EXAM
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100% Verified & Detailed Rationales |
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Section A: Recognition & Assessment of the Critically Ill Child (Q1–15)
Q1: A 6-month-old presents with lethargy, grunting respirations, and mottled skin. The pediatric
assessment triangle (PAT) reveals abnormal appearance, abnormal breathing, and abnormal circulation.
The immediate next step is:
A. Obtain a full set of vital signs
B. Begin bag-mask ventilation with 100% oxygen [CORRECT]
C. Start an IV and draw blood cultures
D. Place the child on a cardiac monitor
Correct Answer: B
Rationale: An abnormal PAT with all three components indicates a critically ill child requiring immediate
life support; airway and breathing (bag-mask ventilation) take priority over IV access, monitoring, or
vital signs.
Q2: A 2-year-old with suspected increased ICP has a heart rate of 50 bpm, systolic blood pressure of 150
mmHg, and irregular respirations. These findings are best described as:
A. Normal compensated shock
B. Cushing's triad [CORRECT]
C. Autonomic dysreflexia
D. Paroxysmal sympathetic hyperactivity
Correct Answer: B
Rationale: Cushing's triad (bradycardia, hypertension, irregular respirations) is a late sign of increased
ICP with impending herniation, requiring immediate intervention.
,Q3: A 10 kg child with septic shock remains hypotensive after two 20 mL/kg boluses of isotonic fluid. The
next most appropriate intervention is:
A. Third fluid bolus of 20 mL/kg
B. Start epinephrine infusion at 0.05 mcg/kg/min [CORRECT]
C. Administer dexamethasone
D. Intubate for airway protection
Correct Answer: B
Rationale: After fluid-refractory septic shock, vasoactive support (epinephrine or norepinephrine) is
indicated per PFCCS guidelines to restore perfusion pressure.
Q4: The Pediatric Early Warning Score (PEWS) is designed to:
A. Diagnose specific diseases in children
B. Identify early signs of clinical deterioration and trigger timely intervention [CORRECT]
C. Replace physical examination by physicians
D. Determine discharge readiness
Correct Answer: B
Rationale: PEWS is a standardized, validated scoring system that tracks pediatric vital signs, behavior,
and clinical observations to detect early deterioration before progression to critical illness, enabling
timely escalation of care.
Q5: A 4-year-old has a respiratory rate of 45/min, heart rate of 140 bpm, and capillary refill of 4 seconds
with cool extremities. The most accurate classification is:
A. Compensated shock
B. Decompensated shock [CORRECT]
C. Normal pediatric vital signs
D. Respiratory failure
Correct Answer: B
Rationale: Tachycardia, tachypnea, and delayed capillary refill (>3 seconds) with cool extremities
indicate decompensated shock where compensatory mechanisms are failing to maintain adequate
perfusion, and hypotension may be imminent.
Q6: The pediatric assessment triangle (PAT) consists of three components evaluated within seconds of
entering the room. These are:
,A. Heart rate, blood pressure, respiratory rate
B. Appearance, breathing, circulation [CORRECT]
C. Airway, breathing, circulation
D. Temperature, oxygen saturation, pain score
Correct Answer: B
Rationale: The PAT is a rapid visual and auditory assessment tool evaluating appearance (muscle tone,
interactiveness, consolability, look/gaze, speech/cry), breathing (airway sounds, positioning,
retractions), and circulation (color, mottling, bleeding) without touching the child.
Q7: A 3-year-old presents with stridor at rest, tripod positioning, and drooling. The most appropriate
initial action is:
A. Immediately attempt oropharyngeal intubation
B. Allow the child to maintain their position of comfort and avoid agitation [CORRECT]
C. Force the child supine for examination
D. Obtain a lateral neck X-ray before any intervention
Correct Answer: B
Rationale: A child with stridor, tripod positioning, and drooling likely has epiglottitis or severe upper
airway obstruction. Forcing the child supine or agitating them can precipitate complete airway
obstruction. The child should remain in their position of comfort with minimal disturbance while
preparing for controlled airway management.
Q8: A 5-year-old has a Glasgow Coma Scale (GCS) score of 8 (E2, V2, M4). The priority intervention is:
A. CT scan of the head
B. Endotracheal intubation for airway protection [CORRECT]
C. Lumbar puncture
D. Administration of mannitol
Correct Answer: B
Rationale: A GCS of 8 or less indicates a significantly altered level of consciousness with high risk of
airway compromise, aspiration, and hypoventilation. Endotracheal intubation is indicated for airway
protection and controlled ventilation before diagnostic procedures.
Q9: A 2-month-old infant presents with poor feeding, irritability, and a bulging fontanelle. The most
likely cause of these findings is:
, A. Normal infant behavior
B. Increased intracranial pressure [CORRECT]
C. Gastroesophageal reflux
D. Colic
Correct Answer: B
Rationale: A bulging fontanelle in an infant with altered behavior and poor feeding is a cardinal sign of
increased intracranial pressure. The open fontanelles and unfused sutures in infants allow ICP
manifestations that differ from older children, including head circumference enlargement, sun-setting
eyes, and high-pitched cry.
Q10: A 7-year-old has been vomiting for 24 hours. Vital signs show HR 150, BP 78/45, RR 32, capillary
refill 5 seconds. The most appropriate initial fluid resuscitation is:
A. D5 0.45% saline at maintenance rate
B. 20 mL/kg isotonic crystalloid bolus [CORRECT]
C. 10 mL/kg albumin bolus
D. Oral rehydration solution
Correct Answer: B
Rationale: Hypovolemic shock from gastroenteritis requires rapid restoration of intravascular volume
with isotonic crystalloid boluses of 20 mL/kg, which may be repeated based on response. Isotonic fluids
expand plasma volume effectively without causing osmolar shifts.
Q11: A child with suspected sepsis has the following: temperature 38.8°C, HR 160, RR 40, WBC 4,200/μL
(low for age). These findings meet the SIRS criteria with:
A. One criterion
B. Two criteria
C. Three criteria [CORRECT]
D. Four criteria
Correct Answer: C
Rationale: Pediatric SIRS criteria require two or more of: temperature instability, tachycardia or
bradycardia, tachypnea or mechanical ventilation, and leukocytosis/leukopenia or bandemia. This child
meets three criteria (fever, tachycardia, tachypnea, leukopenia—actually four), indicating systemic
inflammatory response.
2026/2027 | Complete Exam-Style Q&A |
100% Verified & Detailed Rationales |
Pass Guaranteed - A+ Graded
Section A: Recognition & Assessment of the Critically Ill Child (Q1–15)
Q1: A 6-month-old presents with lethargy, grunting respirations, and mottled skin. The pediatric
assessment triangle (PAT) reveals abnormal appearance, abnormal breathing, and abnormal circulation.
The immediate next step is:
A. Obtain a full set of vital signs
B. Begin bag-mask ventilation with 100% oxygen [CORRECT]
C. Start an IV and draw blood cultures
D. Place the child on a cardiac monitor
Correct Answer: B
Rationale: An abnormal PAT with all three components indicates a critically ill child requiring immediate
life support; airway and breathing (bag-mask ventilation) take priority over IV access, monitoring, or
vital signs.
Q2: A 2-year-old with suspected increased ICP has a heart rate of 50 bpm, systolic blood pressure of 150
mmHg, and irregular respirations. These findings are best described as:
A. Normal compensated shock
B. Cushing's triad [CORRECT]
C. Autonomic dysreflexia
D. Paroxysmal sympathetic hyperactivity
Correct Answer: B
Rationale: Cushing's triad (bradycardia, hypertension, irregular respirations) is a late sign of increased
ICP with impending herniation, requiring immediate intervention.
,Q3: A 10 kg child with septic shock remains hypotensive after two 20 mL/kg boluses of isotonic fluid. The
next most appropriate intervention is:
A. Third fluid bolus of 20 mL/kg
B. Start epinephrine infusion at 0.05 mcg/kg/min [CORRECT]
C. Administer dexamethasone
D. Intubate for airway protection
Correct Answer: B
Rationale: After fluid-refractory septic shock, vasoactive support (epinephrine or norepinephrine) is
indicated per PFCCS guidelines to restore perfusion pressure.
Q4: The Pediatric Early Warning Score (PEWS) is designed to:
A. Diagnose specific diseases in children
B. Identify early signs of clinical deterioration and trigger timely intervention [CORRECT]
C. Replace physical examination by physicians
D. Determine discharge readiness
Correct Answer: B
Rationale: PEWS is a standardized, validated scoring system that tracks pediatric vital signs, behavior,
and clinical observations to detect early deterioration before progression to critical illness, enabling
timely escalation of care.
Q5: A 4-year-old has a respiratory rate of 45/min, heart rate of 140 bpm, and capillary refill of 4 seconds
with cool extremities. The most accurate classification is:
A. Compensated shock
B. Decompensated shock [CORRECT]
C. Normal pediatric vital signs
D. Respiratory failure
Correct Answer: B
Rationale: Tachycardia, tachypnea, and delayed capillary refill (>3 seconds) with cool extremities
indicate decompensated shock where compensatory mechanisms are failing to maintain adequate
perfusion, and hypotension may be imminent.
Q6: The pediatric assessment triangle (PAT) consists of three components evaluated within seconds of
entering the room. These are:
,A. Heart rate, blood pressure, respiratory rate
B. Appearance, breathing, circulation [CORRECT]
C. Airway, breathing, circulation
D. Temperature, oxygen saturation, pain score
Correct Answer: B
Rationale: The PAT is a rapid visual and auditory assessment tool evaluating appearance (muscle tone,
interactiveness, consolability, look/gaze, speech/cry), breathing (airway sounds, positioning,
retractions), and circulation (color, mottling, bleeding) without touching the child.
Q7: A 3-year-old presents with stridor at rest, tripod positioning, and drooling. The most appropriate
initial action is:
A. Immediately attempt oropharyngeal intubation
B. Allow the child to maintain their position of comfort and avoid agitation [CORRECT]
C. Force the child supine for examination
D. Obtain a lateral neck X-ray before any intervention
Correct Answer: B
Rationale: A child with stridor, tripod positioning, and drooling likely has epiglottitis or severe upper
airway obstruction. Forcing the child supine or agitating them can precipitate complete airway
obstruction. The child should remain in their position of comfort with minimal disturbance while
preparing for controlled airway management.
Q8: A 5-year-old has a Glasgow Coma Scale (GCS) score of 8 (E2, V2, M4). The priority intervention is:
A. CT scan of the head
B. Endotracheal intubation for airway protection [CORRECT]
C. Lumbar puncture
D. Administration of mannitol
Correct Answer: B
Rationale: A GCS of 8 or less indicates a significantly altered level of consciousness with high risk of
airway compromise, aspiration, and hypoventilation. Endotracheal intubation is indicated for airway
protection and controlled ventilation before diagnostic procedures.
Q9: A 2-month-old infant presents with poor feeding, irritability, and a bulging fontanelle. The most
likely cause of these findings is:
, A. Normal infant behavior
B. Increased intracranial pressure [CORRECT]
C. Gastroesophageal reflux
D. Colic
Correct Answer: B
Rationale: A bulging fontanelle in an infant with altered behavior and poor feeding is a cardinal sign of
increased intracranial pressure. The open fontanelles and unfused sutures in infants allow ICP
manifestations that differ from older children, including head circumference enlargement, sun-setting
eyes, and high-pitched cry.
Q10: A 7-year-old has been vomiting for 24 hours. Vital signs show HR 150, BP 78/45, RR 32, capillary
refill 5 seconds. The most appropriate initial fluid resuscitation is:
A. D5 0.45% saline at maintenance rate
B. 20 mL/kg isotonic crystalloid bolus [CORRECT]
C. 10 mL/kg albumin bolus
D. Oral rehydration solution
Correct Answer: B
Rationale: Hypovolemic shock from gastroenteritis requires rapid restoration of intravascular volume
with isotonic crystalloid boluses of 20 mL/kg, which may be repeated based on response. Isotonic fluids
expand plasma volume effectively without causing osmolar shifts.
Q11: A child with suspected sepsis has the following: temperature 38.8°C, HR 160, RR 40, WBC 4,200/μL
(low for age). These findings meet the SIRS criteria with:
A. One criterion
B. Two criteria
C. Three criteria [CORRECT]
D. Four criteria
Correct Answer: C
Rationale: Pediatric SIRS criteria require two or more of: temperature instability, tachycardia or
bradycardia, tachypnea or mechanical ventilation, and leukocytosis/leukopenia or bandemia. This child
meets three criteria (fever, tachycardia, tachypnea, leukopenia—actually four), indicating systemic
inflammatory response.
