PALS COMPREHENSIVE EXAM
2026/2027 QUESTIONS AND ANSWERS
1. A 4-year-old child presents with a barking cough and stridor at rest. After administering
nebulized epinephrine, which of the following is the most appropriate next step in
management?
A. Immediate endotracheal intubation
B. Perform a needle cricothyrotomy
C. Discharge home if stridor improves for 20 minutes
D. Administration of oral or IM dexamethasone
Answer: D
Conceptual Explanation: For moderate to severe croup, dexamethasone is indicated to
reduce airway inflammation. Patients receiving nebulized epinephrine must be observed
for at least 2 hours to ensure no rebound effect occurs.
2. You are treating a 10kg infant in cardiac arrest. What is the initial energy dose for the first
manual defibrillation?
A. 40 Joules
,B. 20 Joules
C. 2 Joules
D. 10 Joules
Answer: B
Conceptual Explanation: The initial dose for defibrillation in pediatric cardiac arrest is 2
J/kg. For a 10kg infant, 10 x 2 = 20 Joules.
3. During the management of a child with septic shock, which clinical finding most indicates
the transition from compensated to hypotensive shock?
A. Delayed capillary refill
B. Altered mental status
C. Tachycardia disproportionate to fever
D. Systolic blood pressure below the 5th percentile for age
Answer: D
Conceptual Explanation: Compensated shock is defined by the body’s ability to maintain
blood pressure through tachycardia and vasoconstriction; once blood pressure falls below
age-adjusted limits, it is classified as hypotensive shock.
, 4. An 8-year-old is brought to the ED with a heart rate of 190 bpm, narrow QRS complexes,
and absent P-waves. The child is hemodynamically stable. What is the first recommended
intervention?
A. Synchronized cardioversion at 0.5 J/kg
B. Adenosine 0.1 mg/kg rapid IV push
C. Vagal maneuvers
D. Amiodarone 5 mg/kg infusion
Answer: C
Conceptual Explanation: In stable Supraventricular Tachycardia (SVT), vagal maneuvers
should be attempted first while preparing for pharmacological intervention.
5. What is the correct compression-to-ventilation ratio for two-provider pediatric CPR when
an advanced airway is NOT in place?
A. 15:2
B. 30:2
C. 15:1
D. 3:1
Answer: A
Conceptual Explanation: The PALS guidelines specify a 15:2 ratio for two-provider CPR in
infants and children to optimize ventilation.
2026/2027 QUESTIONS AND ANSWERS
1. A 4-year-old child presents with a barking cough and stridor at rest. After administering
nebulized epinephrine, which of the following is the most appropriate next step in
management?
A. Immediate endotracheal intubation
B. Perform a needle cricothyrotomy
C. Discharge home if stridor improves for 20 minutes
D. Administration of oral or IM dexamethasone
Answer: D
Conceptual Explanation: For moderate to severe croup, dexamethasone is indicated to
reduce airway inflammation. Patients receiving nebulized epinephrine must be observed
for at least 2 hours to ensure no rebound effect occurs.
2. You are treating a 10kg infant in cardiac arrest. What is the initial energy dose for the first
manual defibrillation?
A. 40 Joules
,B. 20 Joules
C. 2 Joules
D. 10 Joules
Answer: B
Conceptual Explanation: The initial dose for defibrillation in pediatric cardiac arrest is 2
J/kg. For a 10kg infant, 10 x 2 = 20 Joules.
3. During the management of a child with septic shock, which clinical finding most indicates
the transition from compensated to hypotensive shock?
A. Delayed capillary refill
B. Altered mental status
C. Tachycardia disproportionate to fever
D. Systolic blood pressure below the 5th percentile for age
Answer: D
Conceptual Explanation: Compensated shock is defined by the body’s ability to maintain
blood pressure through tachycardia and vasoconstriction; once blood pressure falls below
age-adjusted limits, it is classified as hypotensive shock.
, 4. An 8-year-old is brought to the ED with a heart rate of 190 bpm, narrow QRS complexes,
and absent P-waves. The child is hemodynamically stable. What is the first recommended
intervention?
A. Synchronized cardioversion at 0.5 J/kg
B. Adenosine 0.1 mg/kg rapid IV push
C. Vagal maneuvers
D. Amiodarone 5 mg/kg infusion
Answer: C
Conceptual Explanation: In stable Supraventricular Tachycardia (SVT), vagal maneuvers
should be attempted first while preparing for pharmacological intervention.
5. What is the correct compression-to-ventilation ratio for two-provider pediatric CPR when
an advanced airway is NOT in place?
A. 15:2
B. 30:2
C. 15:1
D. 3:1
Answer: A
Conceptual Explanation: The PALS guidelines specify a 15:2 ratio for two-provider CPR in
infants and children to optimize ventilation.
