, Question 1
Which of the following best describes the primary physiologic difference in the
pediatric respiratory system that predisposes infants to rapid respiratory failure
compared to adults?
A. Higher functional residual capacity
B. More compliant chest wall and lower airway cartilage
C. Increased number of type II pneumocytes
D. Greater alveolar surface area per kilogram
Correct Answer: B - More compliant chest wall and lower airway
cartilage
RATIONALE
Infants have a highly compliant chest wall and poorly developed
airway cartilage, leading to increased chest wall retractions and airway
collapse. This results in rapid fatigue and respiratory failure. The other
options are not characteristic of infants and would actually protect
against respiratory failure.
Question 2
In the management of pediatric septic shock, which of the following best
explains why early epinephrine infusion is preferred over dopamine in cold
shock with myocardial dysfunction?
A. Epinephrine has greater alpha-adrenergic selectivity
B. Dopamine increases pulmonary vascular resistance more than
epinephrine
C. Epinephrine provides more potent beta-adrenergic inotropy and
chronotropy
D. Dopamine is associated with higher risk of tachyarrhythmias
Correct Answer: C - Epinephrine provides more potent
beta-adrenergic inotropy and chronotropy
Page 2
, RATIONALE
Epinephrine's strong beta-adrenergic effects improve myocardial
contractility and heart rate, which are crucial in cold shock with
cardiac dysfunction. While dopamine also has beta effects,
epinephrine is more potent and is preferred in this scenario per 2026
PALS guidelines. The other options are either incorrect or less
relevant.
Question 3
A 6-month-old infant with a history of congenital heart disease presents with
severe bradycardia and poor perfusion. After ensuring adequate oxygenation
and ventilation, which of the following is the most appropriate initial
pharmacologic intervention?
A. Atropine 0.02 mg/kg IV
B. Epinephrine 0.01 mg/kg IV
C. Adenosine 0.1 mg/kg IV
D. Amiodarone 5 mg/kg IV
Correct Answer: B - Epinephrine 0.01 mg/kg IV
RATIONALE
In pediatric bradycardia with poor perfusion that is not due to vagal
stimulation or primary AV block, epinephrine is the first-line drug
after oxygenation and ventilation. Atropine is less effective in infants
and may cause paradoxical bradycardia. Adenosine and amiodarone
are for tachyarrhythmias.
Question 4
Which of the following is the most reliable indicator of effective chest
compressions during pediatric CPR?
A. Palpable femoral pulse
B. End-tidal CO2 > 10 mmHg
C. Pupillary constriction
Page 3
, D. Increase in heart rate on monitor
Correct Answer: B - End-tidal CO2 > 10 mmHg
RATIONALE
End-tidal CO2 (ETCO2) reflects pulmonary blood flow and is a
reliable indicator of compression effectiveness. A value >10 mmHg
suggests adequate compressions. Palpable pulses are often unreliable,
and pupillary changes are not immediate indicators.
Question 5
A child with a ventricular assist device (VAD) presents in cardiac arrest. Which
of the following is the most appropriate action regarding defibrillation?
A. Defibrillate as usual; VADs are not affected by defibrillation.
B. Avoid defibrillation; it may damage the VAD.
C. Defibrillate only after disconnecting the VAD.
D. Use lower energy settings to protect the VAD.
Correct Answer: A - Defibrillate as usual; VADs are not affected
by defibrillation.
RATIONALE
Defibrillation is safe and should be performed as usual in patients with
VADs; the device is designed to withstand defibrillation.
Disconnecting the VAD is unnecessary and may harm the patient.
Lower energy is not recommended as it may be ineffective.
Question 6
In a pediatric patient with suspected tension pneumothorax, which of the
following findings is most specific for immediate needle decompression?
A. Tracheal deviation to the affected side
B. Hyperresonance to percussion on the affected side
C. Absent breath sounds with hemodynamic instability
D. Subcutaneous emphysema
Page 4
Which of the following best describes the primary physiologic difference in the
pediatric respiratory system that predisposes infants to rapid respiratory failure
compared to adults?
A. Higher functional residual capacity
B. More compliant chest wall and lower airway cartilage
C. Increased number of type II pneumocytes
D. Greater alveolar surface area per kilogram
Correct Answer: B - More compliant chest wall and lower airway
cartilage
RATIONALE
Infants have a highly compliant chest wall and poorly developed
airway cartilage, leading to increased chest wall retractions and airway
collapse. This results in rapid fatigue and respiratory failure. The other
options are not characteristic of infants and would actually protect
against respiratory failure.
Question 2
In the management of pediatric septic shock, which of the following best
explains why early epinephrine infusion is preferred over dopamine in cold
shock with myocardial dysfunction?
A. Epinephrine has greater alpha-adrenergic selectivity
B. Dopamine increases pulmonary vascular resistance more than
epinephrine
C. Epinephrine provides more potent beta-adrenergic inotropy and
chronotropy
D. Dopamine is associated with higher risk of tachyarrhythmias
Correct Answer: C - Epinephrine provides more potent
beta-adrenergic inotropy and chronotropy
Page 2
, RATIONALE
Epinephrine's strong beta-adrenergic effects improve myocardial
contractility and heart rate, which are crucial in cold shock with
cardiac dysfunction. While dopamine also has beta effects,
epinephrine is more potent and is preferred in this scenario per 2026
PALS guidelines. The other options are either incorrect or less
relevant.
Question 3
A 6-month-old infant with a history of congenital heart disease presents with
severe bradycardia and poor perfusion. After ensuring adequate oxygenation
and ventilation, which of the following is the most appropriate initial
pharmacologic intervention?
A. Atropine 0.02 mg/kg IV
B. Epinephrine 0.01 mg/kg IV
C. Adenosine 0.1 mg/kg IV
D. Amiodarone 5 mg/kg IV
Correct Answer: B - Epinephrine 0.01 mg/kg IV
RATIONALE
In pediatric bradycardia with poor perfusion that is not due to vagal
stimulation or primary AV block, epinephrine is the first-line drug
after oxygenation and ventilation. Atropine is less effective in infants
and may cause paradoxical bradycardia. Adenosine and amiodarone
are for tachyarrhythmias.
Question 4
Which of the following is the most reliable indicator of effective chest
compressions during pediatric CPR?
A. Palpable femoral pulse
B. End-tidal CO2 > 10 mmHg
C. Pupillary constriction
Page 3
, D. Increase in heart rate on monitor
Correct Answer: B - End-tidal CO2 > 10 mmHg
RATIONALE
End-tidal CO2 (ETCO2) reflects pulmonary blood flow and is a
reliable indicator of compression effectiveness. A value >10 mmHg
suggests adequate compressions. Palpable pulses are often unreliable,
and pupillary changes are not immediate indicators.
Question 5
A child with a ventricular assist device (VAD) presents in cardiac arrest. Which
of the following is the most appropriate action regarding defibrillation?
A. Defibrillate as usual; VADs are not affected by defibrillation.
B. Avoid defibrillation; it may damage the VAD.
C. Defibrillate only after disconnecting the VAD.
D. Use lower energy settings to protect the VAD.
Correct Answer: A - Defibrillate as usual; VADs are not affected
by defibrillation.
RATIONALE
Defibrillation is safe and should be performed as usual in patients with
VADs; the device is designed to withstand defibrillation.
Disconnecting the VAD is unnecessary and may harm the patient.
Lower energy is not recommended as it may be ineffective.
Question 6
In a pediatric patient with suspected tension pneumothorax, which of the
following findings is most specific for immediate needle decompression?
A. Tracheal deviation to the affected side
B. Hyperresonance to percussion on the affected side
C. Absent breath sounds with hemodynamic instability
D. Subcutaneous emphysema
Page 4
