PALS Systematic Assessment 5 — Questions and Answers
Question 1: A 6-year-old has decreased breath sounds on the left, tracheal deviation to the right, and hypotension. Which diagnosis does this assessment suggest?
- Hemothorax
- Pneumonia
- Tension pneumothorax (Correct answer)
- Pleural effusion
Correct answer: Tension pneumothorax
Absent unilateral breath sounds, tracheal deviation away from the affected side, and hemodynamic compromise indicate tension pneumothorax requiring immediate needle decompression.
Question 2: In the PALS systematic approach, what is the primary purpose of the tertiary assessment?
- To replace the primary assessment when the patient is stable
- To obtain advanced diagnostics and identify underlying etiology (Correct answer)
- To perform a head-to-toe physical examination
- To reassess response to initial interventions
Correct answer: To obtain advanced diagnostics and identify underlying etiology
The tertiary assessment uses advanced diagnostics (labs, imaging, ECG) to identify the underlying cause of the child's illness or injury.
Question 3: Which respiratory rate range is considered normal for a 1-year-old child?
- 10–20 breaths/min
- 20–30 breaths/min
- 30–53 breaths/min (Correct answer)
- 40–60 breaths/min
Correct answer: 30–53 breaths/min
Normal respiratory rate for a 1-year-old is approximately 24–40 breaths/min; the range 30–53 breaths/min is within expected variation for infants and toddlers.
Question 4: A toddler is brought in after ingesting an unknown substance. She has miosis, bradycardia, excessive secretions, and bronchospasm. Which toxidrome does this systematic assessment suggest?
- Sympathomimetic
- Anticholinergic
- Cholinergic (organophosphate) (Correct answer)
- Opioid
Correct answer: Cholinergic (organophosphate)
SLUDGE/DUMBELS signs (salivation, lacrimation, urination, defecation, GI distress, emesis, bradycardia, bronchospasm, miosis) indicate cholinergic toxidrome from organophosphate or similar agents.
Question 5: During reassessment after an intervention, which change in the PAT most clearly indicates clinical improvement in a child who had compensated shock?
- Respiratory rate increases slightly
- Skin color normalizes and mental status improves (Correct answer)
- Heart rate remains unchanged
- Blood pressure decreases slightly
Correct answer: Skin color normalizes and mental status improves
Normalization of circulation to skin (color, capillary refill) and improved appearance (mental status) on the PAT indicates effective treatment of shock.
Question 6: When evaluating a pediatric patient's blood pressure, which formula approximates the lower limit of normal systolic BP for children aged 1–10 years?
- 70 + (age in years × 2) mmHg (Correct answer)
- 80 + (age in years × 2) mmHg
- 70 + (age in years × 3) mmHg
- 60 + (age in years × 2) mmHg
Correct answer: 70 + (age in years × 2) mmHg
The PALS formula for the lower limit of normal systolic BP is 70 + (2 × age in years) mmHg for children aged 1–10 years.
Question 7: A 4-year-old with severe anaphylaxis has stridor, urticaria, and hypotension. Which PAT category best describes this presentation?
- Respiratory distress only
- Shock only
- Respiratory failure with shock
- Respiratory distress with shock (Correct answer)
Correct answer: Respiratory distress with shock
Stridor indicates increased work of breathing (respiratory distress), while hypotension signals shock — both PAT circulation and work of breathing components are abnormal without failure criteria.
PALS Systematic Assessment 5
A 6-year-old has decreased breath sounds on the left, tracheal deviation to the right, and hypotension.
Which diagnosis does this assessment suggest?