1. A 6-year-old collapses in the gym. He is unresponsive, not breathing, and has no pulse.
What is your first action?
A. Check for a femoral pulse for 30 seconds
B. Attach the AED and analyze
C. Begin CPR with a 15:2 ratio
D. Start high-quality CPR, 30:2 for one rescuer*
Single rescuer uses 30:2 for all ages until advanced airway; immediate CPR first.
2. During resuscitation of a 4-year-old, you see a wide complex tachycardia on the monitor.
The child is pulseless. This rhythm is best described as:
A. Supraventricular tachycardia
B. Ventricular tachycardia
C. Atrial flutter
D. Sinus tachycardia
Pulseless wide complex is ventricular tachycardia until proven otherwise; treat as
VF/pulseless VT.
3. A 2-year-old with respiratory distress has stridor, barking cough, and low oxygen
saturation. Your most appropriate initial intervention is:
A. Racemic epinephrine neb
B. Blow-by oxygen and airway support
C. Intubation
D. Chest physiotherapy
Croup presents with stridor, cough; oxygen first, then consider racemic epinephrine if
severe.
4. A 7-year-old is in shock. BP is low, heart rate 180, and liver is enlarged. Which type of
shock is most likely?
A. Hypovolemic
, B. Distributive
C. Cardiogenic
D. Obstructive
Enlarged liver + tachycardia + low BP suggests pump failure; cardiogenic shock.
5. A 5-year-old has supraventricular tachycardia, heart rate 240, BP 80/50, and is lethargic.
Next intervention:
A. Vagal maneuvers
B. *Adenosine 0.1 mg/kg rapid IV push*
C. Synchronized cardioversion 0.5 J/kg
D. Amiodarone 5 mg/kg
Stable but lethargic – adenosine first; unstable (poor perfusion) would need synchronized
cardioversion.
6. During CPR on a 3-year-old, you see an organized rhythm on the monitor but no pulse.
What is this?
A. Return of spontaneous circulation
B. Pulseless electrical activity (PEA)
C. Sinus bradycardia
D. Ventricular fibrillation
Organized electric activity without palpable pulse = PEA; treat with epinephrine and
search for cause.
7. A 1-year-old in respiratory failure has a heart rate of 50 with poor perfusion. Next step:
A. Atropine 0.02 mg/kg
B. Start CPR
C. Transcutaneous pacing
D. Epinephrine 0.01 mg/kg IV
*Heart rate <60 with poor perfusion in infant/child = CPR immediately.*
8. A 9-year-old after submersion injury has VF on monitor. First defibrillation dose:
A. *2 J/kg*
B. 4 J/kg
C. 1 J/kg
, D. 10 J/kg
*AHA guidelines: initial defibrillation for VF/pVT is 2 J/kg, then 4 J/kg.*
9. A 12-year-old with asthma has increasing respiratory distress, silent chest, and
exhaustion. Next best action:
A. Nebulized albuterol and ipratropium
B. Magnesium sulfate IV
C. Prepare for intubation
D. Heliox therapy
Silent chest + exhaustion = impending respiratory failure; prepare for advanced airway.
10. A 3-year-old trauma victim has weak distal pulses, cold extremities, and narrow pulse
pressure. Most likely shock type:
A. Distributive
B. Hypovolemic
C. Cardiogenic
D. Obstructive
Trauma + weak pulses + narrow pulse pressure = hypovolemic from blood loss.
11. A 4-month-old with bronchiolitis has grunting, nasal flaring, and SpO2 82% on room air.
First intervention:
A. Intubate immediately
B. Supplemental oxygen via nasal cannula
C. Chest physiotherapy
D. Nebulized epinephrine
Hypoxia first – give oxygen; bronchiolitis supportive care unless severe apnea.
12. A 6-year-old in PICU has sudden hypotension, muffled heart tones, and distended neck
veins. Most likely cause:
A. Tension pneumothorax
B. Cardiac tamponade
C. Pulmonary embolism
D. Severe hypovolemia
Muffled tones, distended veins, hypotension = Beck’s triad = tamponade.
, 13. A 2-year-old with septic shock has a fluid-refractory hypotension. Next vasoactive agent
of choice:
A. Norepinephrine
B. Dopamine
C. Vasopressin
D. Dobutamine
Fluid-refractory septic shock: norepinephrine first-line for hypotension.
14. A 5-year-old with SVT and poor perfusion is about to receive synchronized
cardioversion. Initial energy dose:
A. *0.5 to 1 J/kg*
B. 2 J/kg
C. 4 J/kg
D. 1 to 2 J/kg
*Unstable SVT: synchronized cardioversion 0.5-1 J/kg, increase to 2 J/kg if fails.*
15. A 9-month-old has bradycardia 52 bpm, poor perfusion, and no response to oxygen and
ventilation. Next drug:
A. Atropine 0.02 mg/kg
B. *Epinephrine 0.01 mg/kg IV*
C. Adenosine
D. Amiodarone
Bradycardia with poor perfusion after oxygenation/ventilation → epinephrine; atropine
for vagal excess.
16. A 7-year-old arrested due to anaphylaxis. CPR is ongoing. Which medication is
prioritized?
A. Diphenhydramine
B. *Epinephrine 0.01 mg/kg IV*
C. Methylprednisolone
D. Albuterol
Anaphylaxis cardiac arrest: epinephrine is life-saving; anti-histamines and steroids are
adjuncts.
What is your first action?
A. Check for a femoral pulse for 30 seconds
B. Attach the AED and analyze
C. Begin CPR with a 15:2 ratio
D. Start high-quality CPR, 30:2 for one rescuer*
Single rescuer uses 30:2 for all ages until advanced airway; immediate CPR first.
2. During resuscitation of a 4-year-old, you see a wide complex tachycardia on the monitor.
The child is pulseless. This rhythm is best described as:
A. Supraventricular tachycardia
B. Ventricular tachycardia
C. Atrial flutter
D. Sinus tachycardia
Pulseless wide complex is ventricular tachycardia until proven otherwise; treat as
VF/pulseless VT.
3. A 2-year-old with respiratory distress has stridor, barking cough, and low oxygen
saturation. Your most appropriate initial intervention is:
A. Racemic epinephrine neb
B. Blow-by oxygen and airway support
C. Intubation
D. Chest physiotherapy
Croup presents with stridor, cough; oxygen first, then consider racemic epinephrine if
severe.
4. A 7-year-old is in shock. BP is low, heart rate 180, and liver is enlarged. Which type of
shock is most likely?
A. Hypovolemic
, B. Distributive
C. Cardiogenic
D. Obstructive
Enlarged liver + tachycardia + low BP suggests pump failure; cardiogenic shock.
5. A 5-year-old has supraventricular tachycardia, heart rate 240, BP 80/50, and is lethargic.
Next intervention:
A. Vagal maneuvers
B. *Adenosine 0.1 mg/kg rapid IV push*
C. Synchronized cardioversion 0.5 J/kg
D. Amiodarone 5 mg/kg
Stable but lethargic – adenosine first; unstable (poor perfusion) would need synchronized
cardioversion.
6. During CPR on a 3-year-old, you see an organized rhythm on the monitor but no pulse.
What is this?
A. Return of spontaneous circulation
B. Pulseless electrical activity (PEA)
C. Sinus bradycardia
D. Ventricular fibrillation
Organized electric activity without palpable pulse = PEA; treat with epinephrine and
search for cause.
7. A 1-year-old in respiratory failure has a heart rate of 50 with poor perfusion. Next step:
A. Atropine 0.02 mg/kg
B. Start CPR
C. Transcutaneous pacing
D. Epinephrine 0.01 mg/kg IV
*Heart rate <60 with poor perfusion in infant/child = CPR immediately.*
8. A 9-year-old after submersion injury has VF on monitor. First defibrillation dose:
A. *2 J/kg*
B. 4 J/kg
C. 1 J/kg
, D. 10 J/kg
*AHA guidelines: initial defibrillation for VF/pVT is 2 J/kg, then 4 J/kg.*
9. A 12-year-old with asthma has increasing respiratory distress, silent chest, and
exhaustion. Next best action:
A. Nebulized albuterol and ipratropium
B. Magnesium sulfate IV
C. Prepare for intubation
D. Heliox therapy
Silent chest + exhaustion = impending respiratory failure; prepare for advanced airway.
10. A 3-year-old trauma victim has weak distal pulses, cold extremities, and narrow pulse
pressure. Most likely shock type:
A. Distributive
B. Hypovolemic
C. Cardiogenic
D. Obstructive
Trauma + weak pulses + narrow pulse pressure = hypovolemic from blood loss.
11. A 4-month-old with bronchiolitis has grunting, nasal flaring, and SpO2 82% on room air.
First intervention:
A. Intubate immediately
B. Supplemental oxygen via nasal cannula
C. Chest physiotherapy
D. Nebulized epinephrine
Hypoxia first – give oxygen; bronchiolitis supportive care unless severe apnea.
12. A 6-year-old in PICU has sudden hypotension, muffled heart tones, and distended neck
veins. Most likely cause:
A. Tension pneumothorax
B. Cardiac tamponade
C. Pulmonary embolism
D. Severe hypovolemia
Muffled tones, distended veins, hypotension = Beck’s triad = tamponade.
, 13. A 2-year-old with septic shock has a fluid-refractory hypotension. Next vasoactive agent
of choice:
A. Norepinephrine
B. Dopamine
C. Vasopressin
D. Dobutamine
Fluid-refractory septic shock: norepinephrine first-line for hypotension.
14. A 5-year-old with SVT and poor perfusion is about to receive synchronized
cardioversion. Initial energy dose:
A. *0.5 to 1 J/kg*
B. 2 J/kg
C. 4 J/kg
D. 1 to 2 J/kg
*Unstable SVT: synchronized cardioversion 0.5-1 J/kg, increase to 2 J/kg if fails.*
15. A 9-month-old has bradycardia 52 bpm, poor perfusion, and no response to oxygen and
ventilation. Next drug:
A. Atropine 0.02 mg/kg
B. *Epinephrine 0.01 mg/kg IV*
C. Adenosine
D. Amiodarone
Bradycardia with poor perfusion after oxygenation/ventilation → epinephrine; atropine
for vagal excess.
16. A 7-year-old arrested due to anaphylaxis. CPR is ongoing. Which medication is
prioritized?
A. Diphenhydramine
B. *Epinephrine 0.01 mg/kg IV*
C. Methylprednisolone
D. Albuterol
Anaphylaxis cardiac arrest: epinephrine is life-saving; anti-histamines and steroids are
adjuncts.
