Q1. A 3-year-old presents with sudden onset of stridor, drooling, and sits in a tripod
position. Temperature is 39.5°C. What is the most likely diagnosis?
A. Croup (laryngotracheobronchitis)
B. Epiglottitis
C. Bacterial tracheitis
D. Foreign body aspiration
✓ Answer: B. Epiglottitis
Explanation: Epiglottitis presents with the classic triad of drooling, dysphagia, and
distress (3 D's), along with tripod positioning and high fever. It requires immediate
airway management.
Q2. A child with croup has a seal-bark cough and mild stridor at rest. SpO2 is 96%. What
is the first-line treatment?
A. Heliox
B. Intubation
C. Nebulized racemic epinephrine
D. Dexamethasone 0.6 mg/kg PO/IM
✓ Answer: D. Dexamethasone 0.6 mg/kg PO/IM
Explanation: Dexamethasone is the first-line treatment for croup. It reduces airway
edema. Nebulized epinephrine is reserved for moderate-to-severe cases.
Q3. According to PALS, which of the following is a sign of severe respiratory distress in
a child?
A. Respiratory rate of 30/min in a 2-year-old
B. Nasal flaring
C. Head bobbing
D. Mild intercostal retractions
✓ Answer: C. Head bobbing
, Explanation: Head bobbing (using neck muscles to assist breathing) is a sign of
severe respiratory distress. It indicates increased work of breathing and imminent
respiratory failure.
Q4. A 6-month-old presents with wheezing, increased work of breathing, and SpO2 of
88% on room air. Lungs are hyperinflated on exam. What is the most likely diagnosis?
A. Asthma
B. Bronchiolitis
C. Pneumonia
D. Cardiac failure
✓ Answer: B. Bronchiolitis
Explanation: Bronchiolitis most commonly occurs in infants < 2 years, caused by
RSV. It presents with wheezing, hyperinflation, and increased work of breathing.
Q5. What is the initial oxygen delivery method of choice in a child with respiratory
distress and SpO2 of 90%?
A. Nasal cannula at 1 L/min
B. Non-rebreather mask at 10-15 L/min
C. Simple face mask at 6 L/min
D. Bag-mask ventilation
✓ Answer: B. Non-rebreather mask at 10-15 L/min
Explanation: A non-rebreather mask delivers the highest concentration of oxygen (up
to 95%) and is indicated for significant hypoxemia (SpO2 < 94%) with spontaneous
breathing.
Q6. A child presents with asthma exacerbation with severe wheeze, SpO2 88%, and poor
air entry. She has received two doses of salbutamol. What is the next best step?
A. IV magnesium sulfate
B. Oral prednisolone
C. Theophylline infusion
D. Chest physiotherapy
✓ Answer: A. IV magnesium sulfate
Explanation: IV magnesium sulfate (25-75 mg/kg, max 2g) is indicated for severe
asthma not responding to initial bronchodilator therapy. It works as a bronchodilator
via calcium channel blockade.
Q7. Which of the following findings indicates impending respiratory failure in a child?
A. Respiratory rate 40/min
B. Mild intercostal retractions
C. Decreased level of consciousness
, D. Mild tachycardia
✓ Answer: C. Decreased level of consciousness
Explanation: Altered mental status or decreased level of consciousness in the context
of respiratory distress indicates impending respiratory failure and requires immediate
intervention.
Q8. The appropriate tidal volume for bag-mask ventilation in a child is:
A. 3-5 mL/kg
B. 6-8 mL/kg
C. 10-12 mL/kg
D. 15-20 mL/kg
✓ Answer: B. 6-8 mL/kg
Explanation: PALS recommends tidal volumes of 6-8 mL/kg for bag-mask
ventilation. Excessive tidal volumes increase risk of barotrauma and reduce cardiac
output.
Q9. A 5-year-old is intubated for respiratory failure. The recommended endotracheal tube
(ETT) size for an uncuffed tube is:
A. 3.0 mm
B. 4.0 mm
C. 5.0 mm
D. 6.0 mm
✓ Answer: C. 5.0 mm
Explanation: For uncuffed ETT: (age/4) + 4 = (5/4) + 4 = 5.25, rounded to 5.0 mm.
For cuffed: (age/4) + 3.5.
Q10. Which of the following is a sign of upper airway obstruction?
A. Expiratory wheeze
B. Inspiratory stridor
C. Fine crackles
D. Prolonged expiration
✓ Answer: B. Inspiratory stridor
Explanation: Inspiratory stridor indicates upper airway (extrathoracic) obstruction.
Expiratory wheeze suggests lower airway (intrathoracic) obstruction.
Q11. In a child with suspected foreign body aspiration causing complete airway
obstruction, what is the recommended intervention for a child > 1 year?
A. Back blows only
B. Blind finger sweeps
, C. Abdominal thrusts (Heimlich maneuver)
D. Chest compressions only
✓ Answer: C. Abdominal thrusts (Heimlich maneuver)
Explanation: For complete airway obstruction in children > 1 year, abdominal thrusts
are recommended. For infants < 1 year, use 5 back blows and 5 chest thrusts.
Q12. What is the most reliable method to confirm correct ETT placement?
A. Chest X-ray
B. Bilateral breath sounds auscultation
C. Continuous waveform capnography (ETCO2)
D. Improvement in SpO2
✓ Answer: C. Continuous waveform capnography (ETCO2)
Explanation: Continuous waveform capnography is the most reliable method to
confirm and continuously monitor ETT placement. It detects esophageal intubation
and inadvertent extubation.
Q13. A neonate presents with respiratory distress immediately after birth. Which of the
following is NOT a cause of neonatal respiratory distress?
A. Transient tachypnea of the newborn
B. Respiratory distress syndrome
C. Meconium aspiration syndrome
D. Pyloric stenosis
✓ Answer: D. Pyloric stenosis
Explanation: Pyloric stenosis causes vomiting and metabolic alkalosis, not acute
respiratory distress. The other three are common causes of neonatal respiratory
distress.
Q14. A 2-year-old has stridor at rest, moderate retractions, and SpO2 95%. Nebulized
epinephrine is given. Improvement occurs. How long should the child be observed after
epinephrine?
A. 30 minutes
B. 2 hours
C. 4 hours
D. 6 hours
✓ Answer: B. 2 hours
Explanation: Due to the risk of rebound stridor, children treated with nebulized
epinephrine should be observed for at least 2-4 hours. Rebound can occur as the
epinephrine wears off.
position. Temperature is 39.5°C. What is the most likely diagnosis?
A. Croup (laryngotracheobronchitis)
B. Epiglottitis
C. Bacterial tracheitis
D. Foreign body aspiration
✓ Answer: B. Epiglottitis
Explanation: Epiglottitis presents with the classic triad of drooling, dysphagia, and
distress (3 D's), along with tripod positioning and high fever. It requires immediate
airway management.
Q2. A child with croup has a seal-bark cough and mild stridor at rest. SpO2 is 96%. What
is the first-line treatment?
A. Heliox
B. Intubation
C. Nebulized racemic epinephrine
D. Dexamethasone 0.6 mg/kg PO/IM
✓ Answer: D. Dexamethasone 0.6 mg/kg PO/IM
Explanation: Dexamethasone is the first-line treatment for croup. It reduces airway
edema. Nebulized epinephrine is reserved for moderate-to-severe cases.
Q3. According to PALS, which of the following is a sign of severe respiratory distress in
a child?
A. Respiratory rate of 30/min in a 2-year-old
B. Nasal flaring
C. Head bobbing
D. Mild intercostal retractions
✓ Answer: C. Head bobbing
, Explanation: Head bobbing (using neck muscles to assist breathing) is a sign of
severe respiratory distress. It indicates increased work of breathing and imminent
respiratory failure.
Q4. A 6-month-old presents with wheezing, increased work of breathing, and SpO2 of
88% on room air. Lungs are hyperinflated on exam. What is the most likely diagnosis?
A. Asthma
B. Bronchiolitis
C. Pneumonia
D. Cardiac failure
✓ Answer: B. Bronchiolitis
Explanation: Bronchiolitis most commonly occurs in infants < 2 years, caused by
RSV. It presents with wheezing, hyperinflation, and increased work of breathing.
Q5. What is the initial oxygen delivery method of choice in a child with respiratory
distress and SpO2 of 90%?
A. Nasal cannula at 1 L/min
B. Non-rebreather mask at 10-15 L/min
C. Simple face mask at 6 L/min
D. Bag-mask ventilation
✓ Answer: B. Non-rebreather mask at 10-15 L/min
Explanation: A non-rebreather mask delivers the highest concentration of oxygen (up
to 95%) and is indicated for significant hypoxemia (SpO2 < 94%) with spontaneous
breathing.
Q6. A child presents with asthma exacerbation with severe wheeze, SpO2 88%, and poor
air entry. She has received two doses of salbutamol. What is the next best step?
A. IV magnesium sulfate
B. Oral prednisolone
C. Theophylline infusion
D. Chest physiotherapy
✓ Answer: A. IV magnesium sulfate
Explanation: IV magnesium sulfate (25-75 mg/kg, max 2g) is indicated for severe
asthma not responding to initial bronchodilator therapy. It works as a bronchodilator
via calcium channel blockade.
Q7. Which of the following findings indicates impending respiratory failure in a child?
A. Respiratory rate 40/min
B. Mild intercostal retractions
C. Decreased level of consciousness
, D. Mild tachycardia
✓ Answer: C. Decreased level of consciousness
Explanation: Altered mental status or decreased level of consciousness in the context
of respiratory distress indicates impending respiratory failure and requires immediate
intervention.
Q8. The appropriate tidal volume for bag-mask ventilation in a child is:
A. 3-5 mL/kg
B. 6-8 mL/kg
C. 10-12 mL/kg
D. 15-20 mL/kg
✓ Answer: B. 6-8 mL/kg
Explanation: PALS recommends tidal volumes of 6-8 mL/kg for bag-mask
ventilation. Excessive tidal volumes increase risk of barotrauma and reduce cardiac
output.
Q9. A 5-year-old is intubated for respiratory failure. The recommended endotracheal tube
(ETT) size for an uncuffed tube is:
A. 3.0 mm
B. 4.0 mm
C. 5.0 mm
D. 6.0 mm
✓ Answer: C. 5.0 mm
Explanation: For uncuffed ETT: (age/4) + 4 = (5/4) + 4 = 5.25, rounded to 5.0 mm.
For cuffed: (age/4) + 3.5.
Q10. Which of the following is a sign of upper airway obstruction?
A. Expiratory wheeze
B. Inspiratory stridor
C. Fine crackles
D. Prolonged expiration
✓ Answer: B. Inspiratory stridor
Explanation: Inspiratory stridor indicates upper airway (extrathoracic) obstruction.
Expiratory wheeze suggests lower airway (intrathoracic) obstruction.
Q11. In a child with suspected foreign body aspiration causing complete airway
obstruction, what is the recommended intervention for a child > 1 year?
A. Back blows only
B. Blind finger sweeps
, C. Abdominal thrusts (Heimlich maneuver)
D. Chest compressions only
✓ Answer: C. Abdominal thrusts (Heimlich maneuver)
Explanation: For complete airway obstruction in children > 1 year, abdominal thrusts
are recommended. For infants < 1 year, use 5 back blows and 5 chest thrusts.
Q12. What is the most reliable method to confirm correct ETT placement?
A. Chest X-ray
B. Bilateral breath sounds auscultation
C. Continuous waveform capnography (ETCO2)
D. Improvement in SpO2
✓ Answer: C. Continuous waveform capnography (ETCO2)
Explanation: Continuous waveform capnography is the most reliable method to
confirm and continuously monitor ETT placement. It detects esophageal intubation
and inadvertent extubation.
Q13. A neonate presents with respiratory distress immediately after birth. Which of the
following is NOT a cause of neonatal respiratory distress?
A. Transient tachypnea of the newborn
B. Respiratory distress syndrome
C. Meconium aspiration syndrome
D. Pyloric stenosis
✓ Answer: D. Pyloric stenosis
Explanation: Pyloric stenosis causes vomiting and metabolic alkalosis, not acute
respiratory distress. The other three are common causes of neonatal respiratory
distress.
Q14. A 2-year-old has stridor at rest, moderate retractions, and SpO2 95%. Nebulized
epinephrine is given. Improvement occurs. How long should the child be observed after
epinephrine?
A. 30 minutes
B. 2 hours
C. 4 hours
D. 6 hours
✓ Answer: B. 2 hours
Explanation: Due to the risk of rebound stridor, children treated with nebulized
epinephrine should be observed for at least 2-4 hours. Rebound can occur as the
epinephrine wears off.
