PALS PEDIATRIC EXAM SCRIPT 2025/2026 QUESTIONS
WITH SOLUTIONS RATED A+
✔✔Initial Therapeutic Endpoints of Initial Resuscitation - ✔✔- Capillary refill ≤2 seconds
- Normal blood pressure for age
- Normal pulses with no differen0al between peripheral and central pulses
- Warm extremi0es - UOP > 1mL/kg/hr - Normal mental status
✔✔Isotonic Crystalloids are used to replace - ✔✔interstitial fluid volume
✔✔If patients receive boluses of normal saline and will not resuscitate, what options are
left - ✔✔Inotropes (if hepatomegaly or rales exist)
vasopressors
vasodilators
✔✔Inotrope Administration Pearls - ✔✔given when patient is hepatomegaly
and when patient is not responsive to fluid resuscitation with isotonic crystalloids
**may be given peripherally until central access is attained
✔✔Inotropes Purpose - ✔✔increase contractility of the heart
✔✔Name Inotropes - ✔✔dobutamine
dopamine
epinephrine
phosphodiesteraste inhibirors
levosimendan
✔✔Vasopressin MOA - ✔✔direct constriction of vascular smooth muscle
not really proven in peds
✔✔Vasodilators are for patients with - ✔✔normotensive, low CO, elevated SVR
✔✔When should antibiotics be administered in septic shock patients - ✔✔within 1 hour
of presentation
✔✔Pediatrics are more susceptible to toxins so in septic patients we want to provide -
✔✔clindamycin (antitoxin)
✔✔C. diff in sepsis patients should be treated with - ✔✔enteral antibiotics
vanco
✔✔When are corticosteroids considered in sepsis patients? - ✔✔severe sepsis
fluid refractory
catecholamine resistant (vasodilator)
, adrenal insufficiency ( purpura)
✔✔ECMO definition - ✔✔externalization of lungs
✔✔ECMO Medication Considerations - ✔✔-monitor drug levels when available and
therapeutic outcomes
risk of drug sequestration in tubing and altered medication clearance
✔✔Adult VS Pediatric Sepsis Guidelines Differences - ✔✔Peds: deep vein thrombosis
and stress ulcer prophylaxis are not recommended as they are in adults
✔✔First Hour upon arrival with sepsis - ✔✔initial resuscitation (isotonic saline or colloid,
correcting hypoglycemia, hypoCa)
inotropes for refractory
antibiotics administered
✔✔Factors causing Asthma Exacerbation - ✔✔• Recent viral illness
• Potent allergen or irritant exposure
• Exposure to cold air
• Underuse of an0-inflammatory maintenance therapy
✔✔Modified Pulmonary Index Score - ✔✔monitor severity of exacerbation
positively correlated with ICU admission, continuous SABA therapy, etc. (>score =
worse)
✔✔Therapy for Status Asthmaticus - ✔✔1. SABA
2. Ipratropium FOR OUTPATIENT USE
3. systemic corticosteroids (mostly IV)
if fails
Continuous albuterol
IV magnesium
✔✔IV Mg is 2nd line in status asthmaticus but still considered in initial management
why? - ✔✔initial mgmt approach includes it since benefit of Mg is better early in disease
process rather than later in disease process
✔✔Albuterol Administration in Status Asthmaticus - ✔✔TAPERING to intermittent
✔✔Albuterol Admin Side Effects when given continuously - ✔✔hypoK <2yo
inc risk tachycardia
✔✔Steroid Taper - ✔✔if short duration <7days the taper is to EFFECT and respiratory
tolerance NOT FOR TOXICITY
WITH SOLUTIONS RATED A+
✔✔Initial Therapeutic Endpoints of Initial Resuscitation - ✔✔- Capillary refill ≤2 seconds
- Normal blood pressure for age
- Normal pulses with no differen0al between peripheral and central pulses
- Warm extremi0es - UOP > 1mL/kg/hr - Normal mental status
✔✔Isotonic Crystalloids are used to replace - ✔✔interstitial fluid volume
✔✔If patients receive boluses of normal saline and will not resuscitate, what options are
left - ✔✔Inotropes (if hepatomegaly or rales exist)
vasopressors
vasodilators
✔✔Inotrope Administration Pearls - ✔✔given when patient is hepatomegaly
and when patient is not responsive to fluid resuscitation with isotonic crystalloids
**may be given peripherally until central access is attained
✔✔Inotropes Purpose - ✔✔increase contractility of the heart
✔✔Name Inotropes - ✔✔dobutamine
dopamine
epinephrine
phosphodiesteraste inhibirors
levosimendan
✔✔Vasopressin MOA - ✔✔direct constriction of vascular smooth muscle
not really proven in peds
✔✔Vasodilators are for patients with - ✔✔normotensive, low CO, elevated SVR
✔✔When should antibiotics be administered in septic shock patients - ✔✔within 1 hour
of presentation
✔✔Pediatrics are more susceptible to toxins so in septic patients we want to provide -
✔✔clindamycin (antitoxin)
✔✔C. diff in sepsis patients should be treated with - ✔✔enteral antibiotics
vanco
✔✔When are corticosteroids considered in sepsis patients? - ✔✔severe sepsis
fluid refractory
catecholamine resistant (vasodilator)
, adrenal insufficiency ( purpura)
✔✔ECMO definition - ✔✔externalization of lungs
✔✔ECMO Medication Considerations - ✔✔-monitor drug levels when available and
therapeutic outcomes
risk of drug sequestration in tubing and altered medication clearance
✔✔Adult VS Pediatric Sepsis Guidelines Differences - ✔✔Peds: deep vein thrombosis
and stress ulcer prophylaxis are not recommended as they are in adults
✔✔First Hour upon arrival with sepsis - ✔✔initial resuscitation (isotonic saline or colloid,
correcting hypoglycemia, hypoCa)
inotropes for refractory
antibiotics administered
✔✔Factors causing Asthma Exacerbation - ✔✔• Recent viral illness
• Potent allergen or irritant exposure
• Exposure to cold air
• Underuse of an0-inflammatory maintenance therapy
✔✔Modified Pulmonary Index Score - ✔✔monitor severity of exacerbation
positively correlated with ICU admission, continuous SABA therapy, etc. (>score =
worse)
✔✔Therapy for Status Asthmaticus - ✔✔1. SABA
2. Ipratropium FOR OUTPATIENT USE
3. systemic corticosteroids (mostly IV)
if fails
Continuous albuterol
IV magnesium
✔✔IV Mg is 2nd line in status asthmaticus but still considered in initial management
why? - ✔✔initial mgmt approach includes it since benefit of Mg is better early in disease
process rather than later in disease process
✔✔Albuterol Administration in Status Asthmaticus - ✔✔TAPERING to intermittent
✔✔Albuterol Admin Side Effects when given continuously - ✔✔hypoK <2yo
inc risk tachycardia
✔✔Steroid Taper - ✔✔if short duration <7days the taper is to EFFECT and respiratory
tolerance NOT FOR TOXICITY
