PEARS Pediatric Assessment Triangle 3 — Questions and Answers
Question 1: A child has a normal PAT but deteriorates during the primary assessment. What is the MOST appropriate action?
- Repeat the PAT to confirm deterioration
- Proceed directly to the secondary survey
- Reassess and immediately address any life threats found (Correct answer)
- Document the PAT findings and continue the examination
Correct answer: Reassess and immediately address any life threats found
The PAT is dynamic; if the child deteriorates, the clinician must stop, reassess, and treat life-threatening problems as they are identified.
Question 2: A 4-year-old presents with labored breathing but appears alert, interactive, and pink. Which PAT pattern does this represent?
- Respiratory distress — abnormal work of breathing only (Correct answer)
- Respiratory failure — two abnormal PAT components
- Compensated shock — abnormal circulation only
- Cardiopulmonary failure — all three components abnormal
Correct answer: Respiratory distress — abnormal work of breathing only
Abnormal work of breathing with normal appearance and circulation indicates respiratory distress, which is compensated and requires prompt but not emergent intervention.
Question 3: Nasal flaring in an infant is classified under which PAT component?
- Appearance
- Circulation to Skin
- Work of Breathing (Correct answer)
- It is not part of the PAT
Correct answer: Work of Breathing
Nasal flaring is a sign of increased respiratory effort and is assessed under Work of Breathing in the PAT.
Question 4: Which combination of PAT findings is MOST consistent with decompensated shock?
- Abnormal appearance only
- Abnormal work of breathing and abnormal circulation
- Abnormal appearance and abnormal circulation, normal work of breathing (Correct answer)
- All three PAT components normal
Correct answer: Abnormal appearance and abnormal circulation, normal work of breathing
Decompensated shock typically presents with altered mental status (abnormal appearance) and poor perfusion (abnormal circulation) without primary respiratory pathology.
Question 5: A 7-year-old has intercostal and supraclavicular retractions with absent breath sounds on the left. Which TWO PAT components are abnormal?
- Appearance and Circulation
- Work of Breathing and Circulation (Correct answer)
- Appearance and Work of Breathing
- Work of Breathing only
Correct answer: Work of Breathing and Circulation
Significant retractions indicate increased work of breathing, and absent breath sounds with likely tension pneumothorax impairs circulation, making both components abnormal.
Question 6: The 'C' (Consolability) in TICLS refers to:
- Whether the child is cooperative with examination
- Whether crying stops when a caregiver provides comfort (Correct answer)
- Whether the child can communicate pain level
- Whether the child responds to verbal stimuli
Correct answer: Whether crying stops when a caregiver provides comfort
Consolability assesses whether the child's distress is soothed by caregiver interaction, which reflects normal social and neurologic responsiveness.
Question 7: A 10-month-old is limp, pale, and making no sounds. How many PAT components are abnormal?
- One — only appearance is abnormal
- Two — appearance and circulation (Correct answer)
- Three — all components are abnormal
- None — this requires hands-on assessment first
Correct answer: Two — appearance and circulation
Limpness and silence indicate abnormal appearance, while pallor signals abnormal circulation to skin — two components, consistent with possible cardiopulmonary failure risk.
PEARS Pediatric Assessment Triangle 3
A child has a normal PAT but deteriorates during the primary assessment.
What is the MOST appropriate action?