PEARS Pediatric Evaluation 3 — Questions and Answers
Question 1: In the PEARS systematic approach, after forming a general impression using the PAT, the next step is to assess:
- Disability and blood glucose
- Airway, breathing, and circulation (primary assessment) (Correct answer)
- Detailed head-to-toe exam
- Obtain a 12-lead ECG
Correct answer: Airway, breathing, and circulation (primary assessment)
Following the PAT general impression, the primary assessment evaluates Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) in a structured sequence.
Question 2: A 2-year-old is unresponsive after a suspected submersion injury. Respirations are absent. What ventilation device is preferred if bag-mask ventilation is effective?
- Nasopharyngeal airway only
- Bag-mask ventilation with 100% oxygen (Correct answer)
- Immediate endotracheal intubation
- Simple face mask at 6 L/min
Correct answer: Bag-mask ventilation with 100% oxygen
Effective bag-mask ventilation with 100% oxygen is the preferred initial airway management in pediatric arrest and should be optimized before considering advanced airway placement.
Question 3: Which pediatric patient presentation is consistent with respiratory distress rather than respiratory failure?
- Absent breath sounds bilaterally
- Bradycardia with cyanosis
- Tachypnea with nasal flaring but SpO2 of 94% (Correct answer)
- Apnea with limpness
Correct answer: Tachypnea with nasal flaring but SpO2 of 94%
Respiratory distress involves increased work of breathing with maintained oxygenation, while respiratory failure is characterized by inadequate ventilation/oxygenation despite compensatory effort.
Question 4: During assessment of a febrile 18-month-old, you note a capillary refill time of 4 seconds in a warm environment. This finding indicates:
- Normal perfusion
- Mild dehydration only
- Poor peripheral perfusion requiring further evaluation (Correct answer)
- An artifact of cold ambient temperature
Correct answer: Poor peripheral perfusion requiring further evaluation
Normal capillary refill is less than 2 seconds; a CRT of 4 seconds in a warm environment indicates poor peripheral perfusion and potential circulatory compromise.
Question 5: A 10-year-old with a known peanut allergy develops urticaria, stridor, and hypotension after eating at a restaurant. What is the FIRST-LINE treatment?
- IV diphenhydramine 25 mg
- Nebulized albuterol
- Epinephrine 0.01 mg/kg IM to lateral thigh (Correct answer)
- IV methylprednisolone
Correct answer: Epinephrine 0.01 mg/kg IM to lateral thigh
Epinephrine IM to the anterolateral thigh is the first-line and most critical treatment for anaphylaxis because it reverses bronchospasm, vasodilation, and laryngeal edema.
Question 6: What is the primary reason children are more susceptible to respiratory failure than adults?
- Larger tidal volumes relative to body weight
- Higher respiratory reserve and accessory muscle strength
- Higher oxygen consumption and smaller functional residual capacity (Correct answer)
- Slower respiratory rate leading to CO2 retention
Correct answer: Higher oxygen consumption and smaller functional residual capacity
Children have higher metabolic rates and oxygen consumption but smaller functional residual capacity, making them desaturate faster and have less respiratory reserve than adults.
Question 7: When performing a pediatric neurological assessment, the AVPU scale grades 'P' as:
- Patient is fully alert and oriented
- Patient responds only to painful stimuli (Correct answer)
- Patient responds to verbal stimuli
- Patient is completely unresponsive
Correct answer: Patient responds only to painful stimuli
In the AVPU scale: Alert, responds to Voice, responds to Pain, Unresponsive — 'P' indicates the child responds only when a painful stimulus is applied.
PEARS Pediatric Evaluation 3
In the PEARS systematic approach, after forming a general impression using the PAT, the next step is to assess: