PEDIATRIC ADVANCED LIFE SUPPORT
(PALS) FINAL EXAM QUESTIONS AND
ANSWERS
1. A 4-year-old child presents with a sudden onset of respiratory distress, audible stridor, and
a barking cough. Which of the following is the most likely diagnosis and initial management?
A. Asthma; administer albuterol and ipratropium bromide
B. Epiglottitis; immediately visualize the airway with a tongue depressor
C. Croup; administer nebulized epinephrine and corticosteroids
D. Foreign body aspiration; perform abdominal thrusts immediately
Answer: C
Conceptual Explanation: Croup is characterized by stridor and a barking cough. Initial
treatment for severe croup involves nebulized epinephrine to reduce airway edema and
corticosteroids.
2. What is the correct initial energy dose for unsynchronized cardioversion (defibrillation) in a
pediatric patient with ventricular fibrillation?
A. 1 J/kg
,B. 4 J/kg
C. 2 J/kg
D. 10 J/kg
Answer: C
Conceptual Explanation: PALS guidelines recommend an initial defibrillation dose of 2
J/kg, followed by 4 J/kg for subsequent shocks.
3. A 6-month-old infant has a heart rate of 210 bpm, absent P waves, and a narrow QRS
complex. The infant is lethargic with a capillary refill time of 4 seconds. What is the most
appropriate first intervention?
A. Immediate synchronized cardioversion at 0.5 to 1 J/kg
B. Administer IV Adenosine 0.1 mg/kg
C. Perform vagal maneuvers (e.g., ice to the face)
D. Start chest compressions immediately
Answer: A
Conceptual Explanation: In an unstable patient with Supraventricular Tachycardia (SVT),
synchronized cardioversion is the priority if vascular access is not immediately available or
if the patient is severely compromised.
, 4. Which of the following is a reliable clinical indicator of successful endotracheal tube
placement in a child?
A. Exhaled CO2 detection (Capnography)
B. Improvement in skin color
C. Bilateral breath sounds and chest rise
D. Condensation in the tube
Answer: A
Conceptual Explanation: Quantitative waveform capnography or colorimetric CO2
detection is the most reliable method to confirm tracheal placement of an ETT.
5. During the management of a 10-year-old in septic shock, you have already administered 60
mL/kg of isotonic crystalloid. The patient remains hypotensive. What is the next step?
A. Administer another 20 mL/kg fluid bolus
B. Administer IV Atropine
C. Start a vasoactive infusion (e.g., Epinephrine or Norepinephrine)
D. Administer 25% Albumin
Answer: C
Conceptual Explanation: Fluid-refractory shock in pediatrics requires the initiation of
vasoactive support (inotropes/vasopressors) after 40-60 mL/kg of fluid.
(PALS) FINAL EXAM QUESTIONS AND
ANSWERS
1. A 4-year-old child presents with a sudden onset of respiratory distress, audible stridor, and
a barking cough. Which of the following is the most likely diagnosis and initial management?
A. Asthma; administer albuterol and ipratropium bromide
B. Epiglottitis; immediately visualize the airway with a tongue depressor
C. Croup; administer nebulized epinephrine and corticosteroids
D. Foreign body aspiration; perform abdominal thrusts immediately
Answer: C
Conceptual Explanation: Croup is characterized by stridor and a barking cough. Initial
treatment for severe croup involves nebulized epinephrine to reduce airway edema and
corticosteroids.
2. What is the correct initial energy dose for unsynchronized cardioversion (defibrillation) in a
pediatric patient with ventricular fibrillation?
A. 1 J/kg
,B. 4 J/kg
C. 2 J/kg
D. 10 J/kg
Answer: C
Conceptual Explanation: PALS guidelines recommend an initial defibrillation dose of 2
J/kg, followed by 4 J/kg for subsequent shocks.
3. A 6-month-old infant has a heart rate of 210 bpm, absent P waves, and a narrow QRS
complex. The infant is lethargic with a capillary refill time of 4 seconds. What is the most
appropriate first intervention?
A. Immediate synchronized cardioversion at 0.5 to 1 J/kg
B. Administer IV Adenosine 0.1 mg/kg
C. Perform vagal maneuvers (e.g., ice to the face)
D. Start chest compressions immediately
Answer: A
Conceptual Explanation: In an unstable patient with Supraventricular Tachycardia (SVT),
synchronized cardioversion is the priority if vascular access is not immediately available or
if the patient is severely compromised.
, 4. Which of the following is a reliable clinical indicator of successful endotracheal tube
placement in a child?
A. Exhaled CO2 detection (Capnography)
B. Improvement in skin color
C. Bilateral breath sounds and chest rise
D. Condensation in the tube
Answer: A
Conceptual Explanation: Quantitative waveform capnography or colorimetric CO2
detection is the most reliable method to confirm tracheal placement of an ETT.
5. During the management of a 10-year-old in septic shock, you have already administered 60
mL/kg of isotonic crystalloid. The patient remains hypotensive. What is the next step?
A. Administer another 20 mL/kg fluid bolus
B. Administer IV Atropine
C. Start a vasoactive infusion (e.g., Epinephrine or Norepinephrine)
D. Administer 25% Albumin
Answer: C
Conceptual Explanation: Fluid-refractory shock in pediatrics requires the initiation of
vasoactive support (inotropes/vasopressors) after 40-60 mL/kg of fluid.
