AHA PALS Certification Exam (PDF) | Updated
PALS Practice Questions | Pediatric Life Support
1. A 4-year-old presents with stridor, barking cough, and
respiratory distress. Which is the most likely diagnosis?
A) Asthma
B) Bronchiolitis
C) Croup
D) Foreign body aspiration
Answer: C) Croup
Rationale: Stridor, barking cough, and respiratory distress
are classic for croup (laryngotracheobronchitis). Asthma
causes wheezing, bronchiolitis causes crackles/wheezing
in infants, and foreign body aspiration presents with
sudden onset.
2. Which medication is first-line for moderate to severe
croup?
A) Albuterol
B) Racemic epinephrine
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,C) Dexamethasone
D) Ipratropium bromide
Answer: C) Dexamethasone
Rationale: Corticosteroids (dexamethasone) reduce
airway inflammation and are first-line for croup. Racemic
epinephrine is used for severe croup with impending
respiratory failure.
3. A 2-year-old has increased work of breathing, nasal
flaring, and oxygen saturation 88% on room air. Initial
intervention?
A) Intubate immediately
B) Apply high-flow oxygen
C) Chest physiotherapy
D) Nebulized albuterol
Answer: B) Apply high-flow oxygen
Rationale: Hypoxia (SpO2 <90%) requires oxygen
supplementation first. Assess response before invasive
steps.
2
,4. Which finding indicates impending respiratory failure
in a child?
A) Tachypnea without retractions
B) Cyanosis despite supplemental oxygen
C) Intermittent barking cough
D) Mild grunting
Answer: B) Cyanosis despite supplemental oxygen
Rationale: Cyanosis on oxygen is a late sign of
inadequate gas exchange, signaling respiratory failure.
5. A 6-month-old has wheezing, tachypnea, and nasal
flaring. Most likely cause?
A) Croup
B) Bronchiolitis
C) Epiglottitis
D) Anaphylaxis
Answer: B) Bronchiolitis
Rationale: Bronchiolitis (typically RSV) causes wheezing,
tachypnea, and retractions in infants <12 months.
3
, 6. What is the first step in managing a child with severe
asthma exacerbation?
A) Oral corticosteroids
B) Oxygen and inhaled short-acting beta-agonist
C) IV magnesium sulfate
D) Intubation
Answer: B) Oxygen and inhaled short-acting beta-agonist
Rationale: Initial therapy is high-flow oxygen and
albuterol (SABA) via nebulizer or MDI with spacer.
7. In respiratory failure, which blood gas finding is most
concerning?
A) pH 7.35, PaCO2 45, PaO2 80
B) pH 7.28, PaCO2 60, PaO2 55
C) pH 7.40, PaCO2 40, PaO2 90
D) pH 7.32, PaCO2 50, PaO2 70
Answer: B) pH 7.28, PaCO2 60, PaO2 55
Rationale: Respiratory acidosis (low pH, high PaCO2)
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PALS Practice Questions | Pediatric Life Support
1. A 4-year-old presents with stridor, barking cough, and
respiratory distress. Which is the most likely diagnosis?
A) Asthma
B) Bronchiolitis
C) Croup
D) Foreign body aspiration
Answer: C) Croup
Rationale: Stridor, barking cough, and respiratory distress
are classic for croup (laryngotracheobronchitis). Asthma
causes wheezing, bronchiolitis causes crackles/wheezing
in infants, and foreign body aspiration presents with
sudden onset.
2. Which medication is first-line for moderate to severe
croup?
A) Albuterol
B) Racemic epinephrine
1
,C) Dexamethasone
D) Ipratropium bromide
Answer: C) Dexamethasone
Rationale: Corticosteroids (dexamethasone) reduce
airway inflammation and are first-line for croup. Racemic
epinephrine is used for severe croup with impending
respiratory failure.
3. A 2-year-old has increased work of breathing, nasal
flaring, and oxygen saturation 88% on room air. Initial
intervention?
A) Intubate immediately
B) Apply high-flow oxygen
C) Chest physiotherapy
D) Nebulized albuterol
Answer: B) Apply high-flow oxygen
Rationale: Hypoxia (SpO2 <90%) requires oxygen
supplementation first. Assess response before invasive
steps.
2
,4. Which finding indicates impending respiratory failure
in a child?
A) Tachypnea without retractions
B) Cyanosis despite supplemental oxygen
C) Intermittent barking cough
D) Mild grunting
Answer: B) Cyanosis despite supplemental oxygen
Rationale: Cyanosis on oxygen is a late sign of
inadequate gas exchange, signaling respiratory failure.
5. A 6-month-old has wheezing, tachypnea, and nasal
flaring. Most likely cause?
A) Croup
B) Bronchiolitis
C) Epiglottitis
D) Anaphylaxis
Answer: B) Bronchiolitis
Rationale: Bronchiolitis (typically RSV) causes wheezing,
tachypnea, and retractions in infants <12 months.
3
, 6. What is the first step in managing a child with severe
asthma exacerbation?
A) Oral corticosteroids
B) Oxygen and inhaled short-acting beta-agonist
C) IV magnesium sulfate
D) Intubation
Answer: B) Oxygen and inhaled short-acting beta-agonist
Rationale: Initial therapy is high-flow oxygen and
albuterol (SABA) via nebulizer or MDI with spacer.
7. In respiratory failure, which blood gas finding is most
concerning?
A) pH 7.35, PaCO2 45, PaO2 80
B) pH 7.28, PaCO2 60, PaO2 55
C) pH 7.40, PaCO2 40, PaO2 90
D) pH 7.32, PaCO2 50, PaO2 70
Answer: B) pH 7.28, PaCO2 60, PaO2 55
Rationale: Respiratory acidosis (low pH, high PaCO2)
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