PALS EXAM: NEW ORIGINAL PALS EXAM
QUESTIONS, 2026/2027 WITH
CORRECT/ACCURATE ANSWERS
ADVANCED PALS
Questions 1–200 (safe, original content inspired by PALS).
PALS exam QUESTION SET
1. A 3-year-old presents with inspiratory stridor and retractions.
What is the most likely cause?
A. Asthma
B. Bronchiolitis
C. Upper airway obstruction
D. Pneumonia
Rationale: Stridor = obstruction at or above the glottis.
2. A 6-year-old with asthma suddenly becomes silent after severe
wheezing. What does this indicate?
A. Clinical improvement
B. Impending respiratory failure
C. Pneumonia
D. Anxiety
Rationale: Loss of wheeze + silent chest = critical loss of airflow.
3. Which oxygen saturation reading indicates the need for
immediate intervention?
,A. 96% on room air
B. 93% on nasal cannula
C. 90% on simple mask
D. 88% on oxygen therapy
Rationale: SpO₂ < 90% on supplemental O₂ = acute deterioration.
4. A 10-month-old’s RR drops from 60/min to 25/min and becomes
lethargic. What does this suggest?
A. Condition improving
B. Mild respiratory distress
C. Impending respiratory failure
D. Fever-related fatigue
Rationale: Falling respiratory rate + lethargy = fatigue → failure.
5. A febrile 5-year-old in septic shock has prolonged CRT and cool
extremities. What is the FIRST intervention?
A. Start antibiotics
B. Give 20 mL/kg isotonic crystalloid bolus
C. Obtain chest X-ray
D. Apply nasal cannula oxygen
Rationale: First step in septic shock = rapid isotonic fluid bolus.
6. Cardiac monitor shows organized rhythm with no pulse. What is
it?
A. Asystole
B. PEA
C. SVT
D. VF
Rationale: Organized electrical rhythm without pulses = PEA.
7. Maximum time to check breathing + pulse in an unresponsive
infant?
,A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 30 seconds
Rationale: PALS allows max 10 seconds.
8. A child with slow irregular breathing after seizure most likely has
which problem?
A. Upper airway obstruction
B. Shock
C. Disordered brainstem regulation
D. Pneumonia
Rationale: Postictal brain dysfunction affects respiratory drive.
9. A 7-year-old with lethargy and deep rapid breathing likely needs
which test FIRST?
A. CBC
B. Chest X-ray
C. Blood glucose
D. ABG
Rationale: Kussmaul breathing = possible diabetic ketoacidosis.
10. Child with shallow respirations and snoring airway after
benzodiazepine. Best first intervention?
A. Narcan
B. Open airway + adjunct
C. IV fluids
D. MRI
Rationale: Obstructed upper airway → reposition + OPA/NPA.
, ADVANCED PALS EXAM QUESTIONS (1–100)
Questions 1–20 are below.
ADVANCED PALS EXAM QUESTIONS 1–20
1. A 10-year-old intubated for status asthmaticus suddenly shows a
sharp rise in peak inspiratory pressure and hypotension. What is
the MOST likely cause?
A. Aspiration
B. Tube obstruction from secretions
C. Tension pneumothorax
D. Displaced endotracheal tube
Rationale: In ventilated asthma patients, sudden ↑ PIP + hypotension strongly suggests air-trapping →
tension pneumothorax.
2. A 6-year-old with sepsis remains hypotensive despite 60 mL/kg of
crystalloid. Pulses are bounding, extremities warm, and cap refill is
brisk. What medication should be started next?
A. Norepinephrine
B. Epinephrine infusion
C. Dopamine
D. Amiodarone
Rationale: Warm (“hyperdynamic”) septic shock → low SVR → epinephrine is first-line vasoactive.
3. During CPR of a 2-year-old, ETCO₂ abruptly increases from 10
mmHg to 38 mmHg. What does this MOST likely indicate?
A. ET tube obstruction
B. Hyperventilation
C. Worsening ventilation-perfusion mismatch
QUESTIONS, 2026/2027 WITH
CORRECT/ACCURATE ANSWERS
ADVANCED PALS
Questions 1–200 (safe, original content inspired by PALS).
PALS exam QUESTION SET
1. A 3-year-old presents with inspiratory stridor and retractions.
What is the most likely cause?
A. Asthma
B. Bronchiolitis
C. Upper airway obstruction
D. Pneumonia
Rationale: Stridor = obstruction at or above the glottis.
2. A 6-year-old with asthma suddenly becomes silent after severe
wheezing. What does this indicate?
A. Clinical improvement
B. Impending respiratory failure
C. Pneumonia
D. Anxiety
Rationale: Loss of wheeze + silent chest = critical loss of airflow.
3. Which oxygen saturation reading indicates the need for
immediate intervention?
,A. 96% on room air
B. 93% on nasal cannula
C. 90% on simple mask
D. 88% on oxygen therapy
Rationale: SpO₂ < 90% on supplemental O₂ = acute deterioration.
4. A 10-month-old’s RR drops from 60/min to 25/min and becomes
lethargic. What does this suggest?
A. Condition improving
B. Mild respiratory distress
C. Impending respiratory failure
D. Fever-related fatigue
Rationale: Falling respiratory rate + lethargy = fatigue → failure.
5. A febrile 5-year-old in septic shock has prolonged CRT and cool
extremities. What is the FIRST intervention?
A. Start antibiotics
B. Give 20 mL/kg isotonic crystalloid bolus
C. Obtain chest X-ray
D. Apply nasal cannula oxygen
Rationale: First step in septic shock = rapid isotonic fluid bolus.
6. Cardiac monitor shows organized rhythm with no pulse. What is
it?
A. Asystole
B. PEA
C. SVT
D. VF
Rationale: Organized electrical rhythm without pulses = PEA.
7. Maximum time to check breathing + pulse in an unresponsive
infant?
,A. 5 seconds
B. 10 seconds
C. 15 seconds
D. 30 seconds
Rationale: PALS allows max 10 seconds.
8. A child with slow irregular breathing after seizure most likely has
which problem?
A. Upper airway obstruction
B. Shock
C. Disordered brainstem regulation
D. Pneumonia
Rationale: Postictal brain dysfunction affects respiratory drive.
9. A 7-year-old with lethargy and deep rapid breathing likely needs
which test FIRST?
A. CBC
B. Chest X-ray
C. Blood glucose
D. ABG
Rationale: Kussmaul breathing = possible diabetic ketoacidosis.
10. Child with shallow respirations and snoring airway after
benzodiazepine. Best first intervention?
A. Narcan
B. Open airway + adjunct
C. IV fluids
D. MRI
Rationale: Obstructed upper airway → reposition + OPA/NPA.
, ADVANCED PALS EXAM QUESTIONS (1–100)
Questions 1–20 are below.
ADVANCED PALS EXAM QUESTIONS 1–20
1. A 10-year-old intubated for status asthmaticus suddenly shows a
sharp rise in peak inspiratory pressure and hypotension. What is
the MOST likely cause?
A. Aspiration
B. Tube obstruction from secretions
C. Tension pneumothorax
D. Displaced endotracheal tube
Rationale: In ventilated asthma patients, sudden ↑ PIP + hypotension strongly suggests air-trapping →
tension pneumothorax.
2. A 6-year-old with sepsis remains hypotensive despite 60 mL/kg of
crystalloid. Pulses are bounding, extremities warm, and cap refill is
brisk. What medication should be started next?
A. Norepinephrine
B. Epinephrine infusion
C. Dopamine
D. Amiodarone
Rationale: Warm (“hyperdynamic”) septic shock → low SVR → epinephrine is first-line vasoactive.
3. During CPR of a 2-year-old, ETCO₂ abruptly increases from 10
mmHg to 38 mmHg. What does this MOST likely indicate?
A. ET tube obstruction
B. Hyperventilation
C. Worsening ventilation-perfusion mismatch
