PALS Exam Questions & Answers 2026 (1–10)

Question 1

A 3-year-old is brought in by a parent who reports the child has been 'breathing fast' since this morning. You observe the child sitting upright, looking at you, with audible stridor and mild intercostal retractions. His skin is pink and warm. Using the Pediatric Assessment Triangle (PAT), which component is primarily abnormal?

TheoryPractice · Accepted Answer

Work of breathing only. The PAT assesses Appearance, Work of Breathing, and Circulation to skin; stridor and intercostal retractions indicate abnormal work of breathing, while the child's alertness and pink skin indicate normal appearance and circulation.

Question 2

In the PALS systematic approach, after you perform the initial PAT and find an abnormality, your next step is to:

TheoryPractice · Accepted Answer

Perform a primary assessment (ABCDE) and identify the problem. The PALS evaluate-identify-intervene loop directs the provider to follow the initial PAT with a hands-on primary (ABCDE) assessment to identify the type and severity of physiologic derangement before choosing an intervention.

Question 3

A 7-year-old presents with rapid breathing, oxygen saturation of 91% on room air, nasal flaring, and subcostal retractions, but responds normally to her name and maintains her airway independently. Blood pressure is 98/62 mmHg. This clinical picture BEST represents:

TheoryPractice · Accepted Answer

Respiratory distress. Respiratory distress is characterized by increased work of breathing (flaring, retractions), mild hypoxia, and preserved mental status and airway control; respiratory failure requires signs of inadequate gas exchange such as markedly altered mentation, apnea, or severe hypoxia that exceeds the child's compensatory effort.

Question 4

A 5-year-old with a history of asthma is found barely responsive, with agonal breathing at 4 breaths/min, oxygen saturation unmeasurable by pulse oximetry, and cyanotic lips. Which category of respiratory dysfunction does this child demonstrate?

TheoryPractice · Accepted Answer

Respiratory failure. Respiratory failure is identified when the child's breathing effort is insufficient to maintain adequate oxygenation and ventilation, evidenced here by near-apneic rate, unmeasurable SpO2, cyanosis, and markedly decreased level of consciousness.

Question 5

An 18-month-old is tachycardic at 178 beats/min, has cool mottled extremities with a capillary refill of 4 seconds, and is irritable but responsive to voice. Blood pressure is 86/54 mmHg, which is within the lower-normal range for age. This presentation BEST fits:

TheoryPractice · Accepted Answer

Compensated shock. Compensated shock describes a state in which compensatory mechanisms (tachycardia, vasoconstriction) maintain blood pressure within an acceptable range despite signs of poor peripheral perfusion such as cool extremities, prolonged capillary refill, and tachycardia.

Question 6

A 4-year-old involved in a motor vehicle crash arrives with tachycardia of 160 beats/min, blood pressure of 62/40 mmHg, mottled and pale skin, capillary refill of 5 seconds, and a Glasgow Coma Scale score of 10. Which best describes this child's condition?

TheoryPractice · Accepted Answer

Decompensated shock. Decompensated shock is present when compensatory mechanisms fail and blood pressure falls below the fifth percentile for age, accompanied by signs of severely impaired perfusion; a systolic BP of 62 mmHg is clearly hypotensive for a 4-year-old (normal lower limit approximately 70 + 2× age = 78 mmHg).

Question 7

A 6-year-old presents with a heart rate of 170 beats/min and a blood pressure of 84/50 mmHg. He is lethargic but arousable. Capillary refill is 3 seconds centrally. His skin is warm and flushed with bounding peripheral pulses. Lungs are clear. Which type of shock MOST likely explains his findings?

TheoryPractice · Accepted Answer

Distributive (septic/vasodilatory) shock — warm and vasodilated. Distributive shock (early septic shock is the classic pediatric example) produces warm, flushed skin with bounding pulses and widened pulse pressure due to pathologic vasodilation, distinguishing it from the cold, clamped extremities seen in hypovolemic or cardiogenic shock.

Question 8

During the PAT of a 2-year-old, you note she has a weak cry but keeps her eyes fixed on her mother and does not explore her environment. Breathing is quiet with no abnormal sounds. Skin appears pale at the nail beds but pink centrally. How would you classify the PAT findings?

TheoryPractice · Accepted Answer

Appearance and circulation to skin abnormal; work of breathing normal. A weak cry and failure to interact with the environment indicate abnormal appearance (tone/interactivity), and peripheral pallor reflects abnormal circulation to skin; absent increased work of breathing means that component is normal, pointing toward a circulatory or neurological rather than respiratory etiology.

Question 9

Which mnemonic is used in PALS to quickly evaluate the five domains of pediatric appearance during the PAT?

TheoryPractice · Accepted Answer

TICLS. TICLS (Tone, Interactivity, Consolability, Look/gaze, Speech/cry) is the AHA-endorsed mnemonic for assessing the Appearance component of the Pediatric Assessment Triangle.

Question 10

A 10-year-old with known congenital heart disease presents with severe respiratory distress, oxygen saturation of 84% despite 15 L/min non-rebreather mask, frothy pink sputum, and diffuse crackles bilaterally. His heart rate is 140 beats/min and blood pressure is 80/60 mmHg. Which PAT pattern does this child display?

TheoryPractice · Accepted Answer

Abnormal work of breathing and circulation to skin — likely cardiopulmonary failure. The simultaneous presence of severe increased work of breathing (frothy sputum, crackles, refractory hypoxia) and signs of poor perfusion (low BP, pale or mottled skin) indicates abnormality in both work of breathing and circulation to skin, reflecting combined cardiopulmonary failure — a finding that mandates the most aggressive intervention.

PALS Exam Questions & Answers 2026 (1–10)

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