PEPP – Pediatric Education for Prehospital Professionals |
PEPP – PEDIATRIC EDUCATION FOR PREHOSPITAL PROFESSIONALS |
EXAM QUESTIONS AND CORRECT ANSWERS | LATEST VERSION
2026/2027
PEDIATRIC EDUCATION FOR PREHOSPITAL PROFESSIONALS
(PEPP)
1. The three components of the Pediatric Assessment Triangle (PAT) are:
A. Appearance, work of breathing, and circulation to skin
B. Appearance, heart rate, and capillary refill
C. Airway, breathing, and circulation
D. Level of consciousness, pulse rate, and blood pressure
ANSWER : A. Appearance, work of breathing, and circulation to skin
The PAT is a hands-off, observational tool built on appearance, work of
breathing, and circulation to the skin.
2. The main purpose of the Pediatric Assessment Triangle is to:
A. Form a rapid general impression of the child's physiologic status without
touching the child
B. Replace the hands-on primary assessment
C. Calculate medication doses for the child
D. Determine the exact underlying diagnosis
ANSWER : A. Form a rapid general impression of the child's physiologic
status without touching the child
The PAT is done from across the room in seconds to identify how sick the
child is and the category of the problem, not a specific diagnosis.
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, PEPP – Pediatric Education for Prehospital Professionals |
3. In the TICLS mnemonic used to evaluate appearance, the letters stand for:
A. Tone, Inspection, Capillary refill, Level of consciousness, Skin
B. Tone, Interactiveness, Consolability, Look/gaze, Speech/cry
C. Tachycardia, Injury, Consciousness, Lethargy, Shock
D. Temperature, Irritability, Color, Lungs, Skin
ANSWER : B. Tone, Interactiveness, Consolability, Look/gaze,
Speech/cry
TICLS breaks appearance into tone, interactiveness, consolability, look or
gaze, and speech or cry.
4. A 2-year-old has abnormal appearance and increased work of breathing,
but circulation to the skin is normal. The PAT indicates:
A. Compensated shock
B. Respiratory failure
C. Primary brain dysfunction
D. Respiratory distress
ANSWER : B. Respiratory failure
When increased work of breathing is accompanied by abnormal appearance,
the child is no longer compensating and is in respiratory failure.
5. A 5-year-old is alert and interactive with nasal flaring and intercostal
retractions. Skin color is normal. The PAT suggests:
A. Cardiopulmonary failure
B. Respiratory failure
C. Respiratory distress
D. Decompensated shock
ANSWER : C. Respiratory distress
Isolated increased work of breathing with normal appearance indicates
respiratory distress, a compensated state.
6. An infant has normal appearance and normal work of breathing but pale,
mottled skin. This PAT pattern is most consistent with:
A. Cardiopulmonary failure
B. Compensated shock
C. Decompensated shock
D. Respiratory distress
ANSWER : B. Compensated shock
Abnormal circulation to skin with a normal appearance means perfusion to the
brain is still preserved, which defines compensated shock.
Page 2 of 55
, PEPP – Pediatric Education for Prehospital Professionals |
7. A toddler is listless and poorly responsive with mottled skin, while work of
breathing is normal. The PAT indicates:
A. Respiratory distress
B. Compensated shock
C. Decompensated shock
D. Respiratory failure
ANSWER : C. Decompensated shock
Abnormal appearance plus abnormal circulation signals that brain perfusion is
now inadequate, consistent with decompensated shock.
8. A child has abnormal appearance with normal work of breathing and
normal skin circulation. The most likely category of problem is:
A. Primary brain dysfunction or a systemic problem such as toxic ingestion or
hypoglycemia
B. Respiratory distress
C. Compensated shock
D. Upper airway obstruction
ANSWER : A. Primary brain dysfunction or a systemic problem such as
toxic ingestion or hypoglycemia
An isolated abnormal appearance points to CNS injury, seizure, intoxication,
metabolic disturbance, or another systemic process.
9. When all three components of the PAT are abnormal, the child should be
considered to be in:
A. Respiratory distress
B. Cardiopulmonary failure
C. Compensated shock
D. Primary brain dysfunction
ANSWER : B. Cardiopulmonary failure
Abnormal appearance, breathing, and circulation together indicate
cardiopulmonary failure and the need for immediate resuscitation.
Page 3 of 55
, PEPP – Pediatric Education for Prehospital Professionals |
10. Which PAT component best reflects the adequacy of oxygenation,
ventilation, and brain perfusion?
A. Respiratory rate
B. Work of breathing
C. Appearance
D. Circulation to skin
ANSWER : C. Appearance
Appearance is the most important part of the PAT because the brain is
sensitive to hypoxia and poor perfusion.
11. Which group of findings reflects abnormal circulation to the skin?
A. Pallor, mottling, and cyanosis
B. Grunting, flaring, and retractions
C. Stridor, wheezing, and drooling
D. Poor tone, weak cry, and vacant gaze
ANSWER : A. Pallor, mottling, and cyanosis
Pallor, mottling, and cyanosis show the body shunting blood away from the
skin to protect vital organs.
12. Grunting in an infant with respiratory difficulty most often indicates:
A. Bronchospasm of the small airways only
B. Partial obstruction of the upper airway
C. An attempt to keep the alveoli open in lower airway or alveolar disease
D. Normal respiratory effort during feeding
ANSWER : C. An attempt to keep the alveoli open in lower airway or
alveolar disease
Grunting is exhalation against a partially closed glottis that creates back
pressure to keep small airways and alveoli open.
13. High-pitched inspiratory stridor most commonly indicates:
A. Fluid within the alveoli
B. Upper airway obstruction
C. Pneumothorax
D. Lower airway bronchospasm
ANSWER : B. Upper airway obstruction
Stridor arises from turbulent airflow through a narrowed upper airway, as seen
in croup, foreign body, or epiglottitis.
Page 4 of 55
PEPP – PEDIATRIC EDUCATION FOR PREHOSPITAL PROFESSIONALS |
EXAM QUESTIONS AND CORRECT ANSWERS | LATEST VERSION
2026/2027
PEDIATRIC EDUCATION FOR PREHOSPITAL PROFESSIONALS
(PEPP)
1. The three components of the Pediatric Assessment Triangle (PAT) are:
A. Appearance, work of breathing, and circulation to skin
B. Appearance, heart rate, and capillary refill
C. Airway, breathing, and circulation
D. Level of consciousness, pulse rate, and blood pressure
ANSWER : A. Appearance, work of breathing, and circulation to skin
The PAT is a hands-off, observational tool built on appearance, work of
breathing, and circulation to the skin.
2. The main purpose of the Pediatric Assessment Triangle is to:
A. Form a rapid general impression of the child's physiologic status without
touching the child
B. Replace the hands-on primary assessment
C. Calculate medication doses for the child
D. Determine the exact underlying diagnosis
ANSWER : A. Form a rapid general impression of the child's physiologic
status without touching the child
The PAT is done from across the room in seconds to identify how sick the
child is and the category of the problem, not a specific diagnosis.
Page 1 of 55
, PEPP – Pediatric Education for Prehospital Professionals |
3. In the TICLS mnemonic used to evaluate appearance, the letters stand for:
A. Tone, Inspection, Capillary refill, Level of consciousness, Skin
B. Tone, Interactiveness, Consolability, Look/gaze, Speech/cry
C. Tachycardia, Injury, Consciousness, Lethargy, Shock
D. Temperature, Irritability, Color, Lungs, Skin
ANSWER : B. Tone, Interactiveness, Consolability, Look/gaze,
Speech/cry
TICLS breaks appearance into tone, interactiveness, consolability, look or
gaze, and speech or cry.
4. A 2-year-old has abnormal appearance and increased work of breathing,
but circulation to the skin is normal. The PAT indicates:
A. Compensated shock
B. Respiratory failure
C. Primary brain dysfunction
D. Respiratory distress
ANSWER : B. Respiratory failure
When increased work of breathing is accompanied by abnormal appearance,
the child is no longer compensating and is in respiratory failure.
5. A 5-year-old is alert and interactive with nasal flaring and intercostal
retractions. Skin color is normal. The PAT suggests:
A. Cardiopulmonary failure
B. Respiratory failure
C. Respiratory distress
D. Decompensated shock
ANSWER : C. Respiratory distress
Isolated increased work of breathing with normal appearance indicates
respiratory distress, a compensated state.
6. An infant has normal appearance and normal work of breathing but pale,
mottled skin. This PAT pattern is most consistent with:
A. Cardiopulmonary failure
B. Compensated shock
C. Decompensated shock
D. Respiratory distress
ANSWER : B. Compensated shock
Abnormal circulation to skin with a normal appearance means perfusion to the
brain is still preserved, which defines compensated shock.
Page 2 of 55
, PEPP – Pediatric Education for Prehospital Professionals |
7. A toddler is listless and poorly responsive with mottled skin, while work of
breathing is normal. The PAT indicates:
A. Respiratory distress
B. Compensated shock
C. Decompensated shock
D. Respiratory failure
ANSWER : C. Decompensated shock
Abnormal appearance plus abnormal circulation signals that brain perfusion is
now inadequate, consistent with decompensated shock.
8. A child has abnormal appearance with normal work of breathing and
normal skin circulation. The most likely category of problem is:
A. Primary brain dysfunction or a systemic problem such as toxic ingestion or
hypoglycemia
B. Respiratory distress
C. Compensated shock
D. Upper airway obstruction
ANSWER : A. Primary brain dysfunction or a systemic problem such as
toxic ingestion or hypoglycemia
An isolated abnormal appearance points to CNS injury, seizure, intoxication,
metabolic disturbance, or another systemic process.
9. When all three components of the PAT are abnormal, the child should be
considered to be in:
A. Respiratory distress
B. Cardiopulmonary failure
C. Compensated shock
D. Primary brain dysfunction
ANSWER : B. Cardiopulmonary failure
Abnormal appearance, breathing, and circulation together indicate
cardiopulmonary failure and the need for immediate resuscitation.
Page 3 of 55
, PEPP – Pediatric Education for Prehospital Professionals |
10. Which PAT component best reflects the adequacy of oxygenation,
ventilation, and brain perfusion?
A. Respiratory rate
B. Work of breathing
C. Appearance
D. Circulation to skin
ANSWER : C. Appearance
Appearance is the most important part of the PAT because the brain is
sensitive to hypoxia and poor perfusion.
11. Which group of findings reflects abnormal circulation to the skin?
A. Pallor, mottling, and cyanosis
B. Grunting, flaring, and retractions
C. Stridor, wheezing, and drooling
D. Poor tone, weak cry, and vacant gaze
ANSWER : A. Pallor, mottling, and cyanosis
Pallor, mottling, and cyanosis show the body shunting blood away from the
skin to protect vital organs.
12. Grunting in an infant with respiratory difficulty most often indicates:
A. Bronchospasm of the small airways only
B. Partial obstruction of the upper airway
C. An attempt to keep the alveoli open in lower airway or alveolar disease
D. Normal respiratory effort during feeding
ANSWER : C. An attempt to keep the alveoli open in lower airway or
alveolar disease
Grunting is exhalation against a partially closed glottis that creates back
pressure to keep small airways and alveoli open.
13. High-pitched inspiratory stridor most commonly indicates:
A. Fluid within the alveoli
B. Upper airway obstruction
C. Pneumothorax
D. Lower airway bronchospasm
ANSWER : B. Upper airway obstruction
Stridor arises from turbulent airflow through a narrowed upper airway, as seen
in croup, foreign body, or epiglottitis.
Page 4 of 55
