PFCCS FINAL EXAM – COMPLETE 200 ACTUAL EXAM
QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (PEDIATRIC FUNDAMENTAL
CRITICAL CARE SUPPORT
1. A 6‑year‑old child presents with respiratory distress, nasal flaring, and
intercostal retractions. Which of the following is the most appropriate initial
intervention?
A) Chest X‑ray
B) High‑flow nasal cannula oxygen
C) Intubation
D) Bronchodilators
✅ Correct Answer: B. High‑flow nasal cannula oxygen
Rationale: Oxygen delivery should be the first step. HFNC provides warmed,
humidified oxygen and some positive pressure, often avoiding intubation.
2. A previously healthy 2‑year‑old is brought to the PICU with fever, respiratory
distress, and a barking cough. Stridor is present at rest. The most appropriate
next step is:
A) Racemic epinephrine and dexamethasone
B) Immediate intubation
C) Nebulized albuterol
D) Chest X‑ray
✅ Correct Answer: A. Racemic epinephrine and dexamethasone
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, Rationale: Moderate to severe croup (stridor at rest) is treated with racemic
epinephrine and corticosteroids.
3. A 4‑year‑old with asthma presents in severe respiratory distress. On exam,
breath sounds are barely audible, and the child is sleepy. The most appropriate
next step is:
A) Continuous albuterol nebulization
B) Non‑invasive ventilation
C) Intubation and mechanical ventilation
D) Intravenous magnesium sulfate
✅ Correct Answer: C. Intubation and mechanical ventilation
Rationale: Altered mental status and poor air movement indicate impending
respiratory failure requiring intubation.
4. In a child with septic shock, which of the following is the most important
initial therapy?
A) Broad‑spectrum antibiotics
B) Intravenous fluid bolus
C) Norepinephrine infusion
D) Hydrocortisone
✅ Correct Answer: B. Intravenous fluid bolus
Rationale: Volume resuscitation is the first priority in septic shock to
restore intravascular volume and improve cardiac output.
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,5. A 3‑month‑old infant presents with fever, irritability, and a bulging fontanelle.
A lumbar puncture is performed. Which of the following cerebrospinal fluid
findings is most consistent with bacterial meningitis?
A) WBC 10/µL, normal glucose, normal protein
B) WBC 500/µL, glucose 20 mg/dL, protein 200 mg/dL
C) WBC 100/µL, glucose 60 mg/dL, protein 50 mg/dL
D) WBC 5/µL, glucose 70 mg/dL, protein 30 mg/dL
✅ Correct Answer: B. WBC 500/µL, glucose 20 mg/dL, protein 200 mg/dL
Rationale: Bacterial meningitis typically presents with elevated WBC (mostly
neutrophils), low glucose, and elevated protein.
6. A 10‑kg child in septic shock is unresponsive to a 20 mL/kg fluid bolus. The
next appropriate fluid bolus should be:
A) 5 mL/kg
B) 10 mL/kg
C) 20 mL/kg
D) 40 mL/kg
✅ Correct Answer: C. Another 20 mL/kg bolus
Rationale: In septic shock, up to 60 mL/kg of fluid may be given in the first
hour in 20 mL/kg aliquots.
7. A 5‑year‑old child is intubated for respiratory failure. The ventilator is set
to pressure control. The child desaturates to 85%, and breath sounds are absent
on the left. The most likely cause is:
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, A) Pneumothorax
B) Mucous plug
C) Endotracheal tube in the right main bronchus
D) Pulmonary edema
✅ Correct Answer: C. Endotracheal tube in the right main bronchus
Rationale: Absent breath sounds on the left after intubation suggests mainstem
intubation (tube advanced too far). The tube should be withdrawn.
8. A 2‑month‑old infant with bronchiolitis is on high‑flow nasal cannula (HFNC).
The respiratory rate increases from 40 to 70 breaths/min, and the infant is
now grunting. The most appropriate next step is:
A) Increase HFNC flow
B) Start heliox
C) Non‑invasive ventilation (NIV)
D) Intubation and mechanical ventilation
✅ Correct Answer: D. Intubation and mechanical ventilation
Rationale: Grunting indicates impending respiratory failure; HFNC failure
warrants escalation to intubation.
9. Which of the following is a contraindication to non‑invasive ventilation (NIV)
in a child?
A) Obstructive sleep apnea
B) Altered mental status with inability to protect airway
C) Status asthmaticus
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QUESTIONS AND CORRECT VERIFIED ANSWERS/
ALREADY GRADED A+ (PEDIATRIC FUNDAMENTAL
CRITICAL CARE SUPPORT
1. A 6‑year‑old child presents with respiratory distress, nasal flaring, and
intercostal retractions. Which of the following is the most appropriate initial
intervention?
A) Chest X‑ray
B) High‑flow nasal cannula oxygen
C) Intubation
D) Bronchodilators
✅ Correct Answer: B. High‑flow nasal cannula oxygen
Rationale: Oxygen delivery should be the first step. HFNC provides warmed,
humidified oxygen and some positive pressure, often avoiding intubation.
2. A previously healthy 2‑year‑old is brought to the PICU with fever, respiratory
distress, and a barking cough. Stridor is present at rest. The most appropriate
next step is:
A) Racemic epinephrine and dexamethasone
B) Immediate intubation
C) Nebulized albuterol
D) Chest X‑ray
✅ Correct Answer: A. Racemic epinephrine and dexamethasone
1|Page
, Rationale: Moderate to severe croup (stridor at rest) is treated with racemic
epinephrine and corticosteroids.
3. A 4‑year‑old with asthma presents in severe respiratory distress. On exam,
breath sounds are barely audible, and the child is sleepy. The most appropriate
next step is:
A) Continuous albuterol nebulization
B) Non‑invasive ventilation
C) Intubation and mechanical ventilation
D) Intravenous magnesium sulfate
✅ Correct Answer: C. Intubation and mechanical ventilation
Rationale: Altered mental status and poor air movement indicate impending
respiratory failure requiring intubation.
4. In a child with septic shock, which of the following is the most important
initial therapy?
A) Broad‑spectrum antibiotics
B) Intravenous fluid bolus
C) Norepinephrine infusion
D) Hydrocortisone
✅ Correct Answer: B. Intravenous fluid bolus
Rationale: Volume resuscitation is the first priority in septic shock to
restore intravascular volume and improve cardiac output.
2|Page
,5. A 3‑month‑old infant presents with fever, irritability, and a bulging fontanelle.
A lumbar puncture is performed. Which of the following cerebrospinal fluid
findings is most consistent with bacterial meningitis?
A) WBC 10/µL, normal glucose, normal protein
B) WBC 500/µL, glucose 20 mg/dL, protein 200 mg/dL
C) WBC 100/µL, glucose 60 mg/dL, protein 50 mg/dL
D) WBC 5/µL, glucose 70 mg/dL, protein 30 mg/dL
✅ Correct Answer: B. WBC 500/µL, glucose 20 mg/dL, protein 200 mg/dL
Rationale: Bacterial meningitis typically presents with elevated WBC (mostly
neutrophils), low glucose, and elevated protein.
6. A 10‑kg child in septic shock is unresponsive to a 20 mL/kg fluid bolus. The
next appropriate fluid bolus should be:
A) 5 mL/kg
B) 10 mL/kg
C) 20 mL/kg
D) 40 mL/kg
✅ Correct Answer: C. Another 20 mL/kg bolus
Rationale: In septic shock, up to 60 mL/kg of fluid may be given in the first
hour in 20 mL/kg aliquots.
7. A 5‑year‑old child is intubated for respiratory failure. The ventilator is set
to pressure control. The child desaturates to 85%, and breath sounds are absent
on the left. The most likely cause is:
3|Page
, A) Pneumothorax
B) Mucous plug
C) Endotracheal tube in the right main bronchus
D) Pulmonary edema
✅ Correct Answer: C. Endotracheal tube in the right main bronchus
Rationale: Absent breath sounds on the left after intubation suggests mainstem
intubation (tube advanced too far). The tube should be withdrawn.
8. A 2‑month‑old infant with bronchiolitis is on high‑flow nasal cannula (HFNC).
The respiratory rate increases from 40 to 70 breaths/min, and the infant is
now grunting. The most appropriate next step is:
A) Increase HFNC flow
B) Start heliox
C) Non‑invasive ventilation (NIV)
D) Intubation and mechanical ventilation
✅ Correct Answer: D. Intubation and mechanical ventilation
Rationale: Grunting indicates impending respiratory failure; HFNC failure
warrants escalation to intubation.
9. Which of the following is a contraindication to non‑invasive ventilation (NIV)
in a child?
A) Obstructive sleep apnea
B) Altered mental status with inability to protect airway
C) Status asthmaticus
4|Page
