PEARS Emergency Recognition 2 — Questions and Answers
Question 1: A 3-year-old presents with stridor at rest, drooling, and refuses to move her neck. Which emergency does this presentation most suggest?
- Croup
- Epiglottitis (Correct answer)
- Bronchiolitis
- Asthma exacerbation
Correct answer: Epiglottitis
Drooling, refusal to swallow, stridor at rest, and a toxic appearance in a child are classic signs of epiglottitis, a life-threatening upper airway emergency.
Question 2: Which finding best distinguishes compensated shock from uncompensated (decompensated) shock in a pediatric patient?
- Tachycardia
- Hypotension (Correct answer)
- Cool extremities
- Prolonged capillary refill
Correct answer: Hypotension
Hypotension is the hallmark of decompensated shock; in compensated shock, blood pressure is maintained despite other signs of poor perfusion.
Question 3: A 6-month-old has a respiratory rate of 70 breaths/min, nasal flaring, and subcostal retractions. How should this infant's respiratory status be categorized?
- Normal respiratory effort
- Respiratory distress (Correct answer)
- Respiratory failure
- Respiratory arrest
Correct answer: Respiratory distress
Tachypnea with accessory muscle use (nasal flaring and retractions) indicates respiratory distress, signaling increased work of breathing.
Question 4: In PEARS, which of the following is the FIRST step in the systematic approach to a critically ill child?
- Obtain IV access
- Perform the primary assessment
- Administer high-flow oxygen (Correct answer)
- Attach a cardiac monitor
Correct answer: Administer high-flow oxygen
In PEARS, administering high-flow oxygen is prioritized immediately upon recognition of respiratory distress or potential cardiopulmonary compromise.
Question 5: A child with septic shock will most likely present with which combination of findings?
- Bradycardia, hypertension, and bounding pulses
- Tachycardia, fever, and altered mental status (Correct answer)
- Normal heart rate, hypothermia, and strong pulses
- Bradycardia, hypotension, and fever
Correct answer: Tachycardia, fever, and altered mental status
Septic shock typically presents with tachycardia, signs of infection such as fever, and altered mental status due to decreased cerebral perfusion.
Question 6: Which respiratory rate would be considered tachypneic for a 2-year-old child?
- 22 breaths/min
- 28 breaths/min
- 34 breaths/min
- 40 breaths/min (Correct answer)
Correct answer: 40 breaths/min
A respiratory rate above 40 breaths/min is considered tachypneic for a toddler (1–3 years), whose normal range is approximately 24–40 breaths/min.
Question 7: A child has diminished breath sounds on the left side, tracheal deviation to the right, and hypotension. What is the most likely diagnosis?
- Left-sided pneumonia
- Tension pneumothorax (Correct answer)
- Cardiac tamponade
- Pulmonary embolism
Correct answer: Tension pneumothorax
Unilateral absent breath sounds, tracheal deviation away from the affected side, and hemodynamic instability are the classic triad of tension pneumothorax.
PEARS Emergency Recognition 2
A 3-year-old presents with stridor at rest, drooling, and refuses to move her neck.
Which emergency does this presentation most suggest?