PALS Systematic Assessment 4 — Questions and Answers
Question 1: A 5-year-old is unresponsive with absent breathing and no pulse. In the PALS systematic approach, what is the correct categorization of this presentation?
- Respiratory failure
- Compensated shock
- Cardiopulmonary arrest (Correct answer)
- Decompensated shock
Correct answer: Cardiopulmonary arrest
Unresponsiveness with absent breathing and no pulse meets criteria for cardiopulmonary arrest, requiring immediate CPR.
Question 2: Which auscultatory finding during the primary assessment indicates air trapping and lower airway obstruction in a pediatric patient?
- Inspiratory stridor
- Expiratory wheezing (Correct answer)
- Inspiratory crackles
- Absence of breath sounds unilaterally
Correct answer: Expiratory wheezing
Expiratory wheezing indicates lower airway obstruction with air trapping, as in bronchospasm or asthma.
Question 3: During systematic assessment of a 4-year-old with suspected increased intracranial pressure, which pupillary finding is most concerning?
- Equal and reactive pupils bilaterally
- Sluggish bilateral pupil response
- Unilateral fixed and dilated pupil (Correct answer)
- Pinpoint pupils bilaterally
Correct answer: Unilateral fixed and dilated pupil
A unilateral fixed and dilated pupil (blown pupil) suggests uncal herniation from unilateral mass effect or severe ICP elevation.
Question 4: In the PALS assessment framework, the term 'identify and treat' means providers should:
- Complete all assessment steps before initiating any treatment
- Identify and treat life threats as they are discovered during assessment (Correct answer)
- Only treat after the secondary assessment is complete
- Treat based on PAT findings alone before any primary assessment
Correct answer: Identify and treat life threats as they are discovered during assessment
PALS uses an 'identify and treat' approach, meaning life-threatening conditions are managed immediately as found rather than waiting for a complete assessment.
Question 5: A 9-year-old has a blood pressure of 70/40 mmHg, tachycardia, and altered mental status after a motor vehicle collision. Which type of shock is most likely?
- Distributive
- Cardiogenic
- Hypovolemic (Correct answer)
- Obstructive
Correct answer: Hypovolemic
Trauma with hypotension and tachycardia most commonly indicates hypovolemic shock from hemorrhage.
Question 6: When assessing the 'Appearance' component of the PAT in an infant, which finding is most consistent with abnormal tone?
- Crying vigorously
- Flexed extremities at rest
- Limp body with no movement (Correct answer)
- Normal startle response
Correct answer: Limp body with no movement
A limp, hypotonic infant indicates abnormal tone and is a significant PAT appearance abnormality suggesting serious illness.
Question 7: Which finding during the primary assessment 'C' (Circulation) step specifically differentiates distributive shock from hypovolemic shock?
- Tachycardia
- Delayed capillary refill
- Warm, flushed skin with bounding pulses (Correct answer)
- Hypotension
Correct answer: Warm, flushed skin with bounding pulses
Warm, flushed skin with bounding pulses (hyperdynamic circulation) is characteristic of distributive (septic/anaphylactic) shock due to pathologic vasodilation.
PALS Systematic Assessment 4
A 5-year-old is unresponsive with absent breathing and no pulse.
In the PALS systematic approach, what is the correct categorization of this presentation?