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EPALS Practice Exam VERSION WITH ALL 250
QUESTIONS AND CORRECT DETAILED SOLUTIONS
WITH RATIONALES JUST RELEASED THIS YEAR
EPALS Practice Exam
Summarized Exam Coverage
The EPALS (European Paediatric Advanced Life Support) exam is a high-stakes
multiple-choice.The primary content domains include: Recognition of the deteriorating
child (ABCDE approach, respiratory distress vs. failure, compensated vs. decompensated
shock), Airway and Breathing (anatomical differences, foreign body obstruction, laryngospasm,
bronchiolitis, asthma, upper vs. lower airway noises), Circulation (shock classification, fluid
resuscitation, vascular access, rhythm recognition, reversible causes), Cardiac Arrest
Management (BLS algorithm, CPR quality, defibrillation,
epinephrine/amiodarone), Post-Resuscitation Care (targeted temperature management,
ventilation targets), Pharmacology (dosing, routes, indications), and Team Dynamics &
Non-technical Skills (leadership, closed-loop communication, crisis resource management). The
following questions reflect the current 2025 European Resuscitation Council (ERC) /
Resuscitation Council UK guidelines.
100 Scenario-Based MCQs with Italicized Rationales
1. You are assessing a 3-year-old child with stridor and drooling. The child is sitting upright,
refusing to lie down, and is becoming agitated. What is the most appropriate next action?
A) Perform a lateral neck X-ray
B) Attempt direct laryngoscopy in the emergency department
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C) Administer nebulized adrenaline
D) Prepare for immediate anaesthetic induction and intubation in a controlled setting
Answer: D
Drooling, stridor, and the tripod position with agitation are classic signs of epiglottitis. Direct
airway manipulation outside the operating theatre can cause complete airway obstruction.
Immediate senior anaesthetic/ENT support for controlled intubation is essential.
2. A 6-month-old infant is brought in with wheeze, subcostal and intercostal recessions, and a
respiratory rate of 65 breaths/min. SpO₂ is 91% on room air. What is the initial treatment of
choice?
A) Oral dexamethasone and salbutamol via metered-dose inhaler with spacer
B) Nebulized adrenaline
C) High-flow nasal cannula oxygen
D) Intravenous fluids and antibiotics
Answer: A
The infant is likely having an acute viral-induced wheeze (e.g., bronchiolitis or asthma). Inhaled
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bronchodilators (salbutamol) and systemic steroids (dexamethasone) are the first-line treatment
for asthma/wheeze. Nebulized adrenaline is reserved for moderate-severe croup.
3. In a child with respiratory failure, which blood gas parameter indicates a failure of ventilation
rather than just oxygenation?
A) PaO₂ < 60 mmHg on 40% oxygen
B) A normal pH with a PaCO₂ of 55 mmHg
C) A rising PaCO₂ with a falling pH
D) An elevated base deficit
Answer: C
Ventilatory failure is defined by hypercapnia (PaCO₂ > 45 mmHg) and respiratory acidosis (pH <
7.35). Progressive hypercapnia with acidosis signals impending respiratory arrest and the need
for assisted ventilation.
4. You are called to a child with a reduced level of consciousness after a prolonged seizure. The
child has a palpable pulse of 150/min but is not breathing adequately. What should be the first
priority?
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A) Intravenous lorazepam
B) High-flow oxygen via non-rebreather mask
C) Bag-valve-mask ventilation with 100% oxygen
D) Immediate blood glucose measurement
Answer: C
After a seizure, the priority is airway and breathing. The child has a pulse but inadequate
breathing; therefore, positive-pressure ventilation with a bag-valve-mask and
high-concentration oxygen is the initial life-saving intervention.
5. A 2-year-old child is in cardiac arrest. The cardiac rhythm shows pulseless electrical activity
(PEA). What is the most likely aetiology in a child of this age?
A) Primary cardiac arrhythmia (e.g., long QT)
B) Hypoxia secondary to respiratory failure
C) Electrolyte disturbance
D) Pulmonary embolism
Answer: B
In infants and children, cardiac arrest is rarely due to a primary cardiac event. The vast majority
4
SUCCESS!
EPALS Practice Exam VERSION WITH ALL 250
QUESTIONS AND CORRECT DETAILED SOLUTIONS
WITH RATIONALES JUST RELEASED THIS YEAR
EPALS Practice Exam
Summarized Exam Coverage
The EPALS (European Paediatric Advanced Life Support) exam is a high-stakes
multiple-choice.The primary content domains include: Recognition of the deteriorating
child (ABCDE approach, respiratory distress vs. failure, compensated vs. decompensated
shock), Airway and Breathing (anatomical differences, foreign body obstruction, laryngospasm,
bronchiolitis, asthma, upper vs. lower airway noises), Circulation (shock classification, fluid
resuscitation, vascular access, rhythm recognition, reversible causes), Cardiac Arrest
Management (BLS algorithm, CPR quality, defibrillation,
epinephrine/amiodarone), Post-Resuscitation Care (targeted temperature management,
ventilation targets), Pharmacology (dosing, routes, indications), and Team Dynamics &
Non-technical Skills (leadership, closed-loop communication, crisis resource management). The
following questions reflect the current 2025 European Resuscitation Council (ERC) /
Resuscitation Council UK guidelines.
100 Scenario-Based MCQs with Italicized Rationales
1. You are assessing a 3-year-old child with stridor and drooling. The child is sitting upright,
refusing to lie down, and is becoming agitated. What is the most appropriate next action?
A) Perform a lateral neck X-ray
B) Attempt direct laryngoscopy in the emergency department
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C) Administer nebulized adrenaline
D) Prepare for immediate anaesthetic induction and intubation in a controlled setting
Answer: D
Drooling, stridor, and the tripod position with agitation are classic signs of epiglottitis. Direct
airway manipulation outside the operating theatre can cause complete airway obstruction.
Immediate senior anaesthetic/ENT support for controlled intubation is essential.
2. A 6-month-old infant is brought in with wheeze, subcostal and intercostal recessions, and a
respiratory rate of 65 breaths/min. SpO₂ is 91% on room air. What is the initial treatment of
choice?
A) Oral dexamethasone and salbutamol via metered-dose inhaler with spacer
B) Nebulized adrenaline
C) High-flow nasal cannula oxygen
D) Intravenous fluids and antibiotics
Answer: A
The infant is likely having an acute viral-induced wheeze (e.g., bronchiolitis or asthma). Inhaled
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bronchodilators (salbutamol) and systemic steroids (dexamethasone) are the first-line treatment
for asthma/wheeze. Nebulized adrenaline is reserved for moderate-severe croup.
3. In a child with respiratory failure, which blood gas parameter indicates a failure of ventilation
rather than just oxygenation?
A) PaO₂ < 60 mmHg on 40% oxygen
B) A normal pH with a PaCO₂ of 55 mmHg
C) A rising PaCO₂ with a falling pH
D) An elevated base deficit
Answer: C
Ventilatory failure is defined by hypercapnia (PaCO₂ > 45 mmHg) and respiratory acidosis (pH <
7.35). Progressive hypercapnia with acidosis signals impending respiratory arrest and the need
for assisted ventilation.
4. You are called to a child with a reduced level of consciousness after a prolonged seizure. The
child has a palpable pulse of 150/min but is not breathing adequately. What should be the first
priority?
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A) Intravenous lorazepam
B) High-flow oxygen via non-rebreather mask
C) Bag-valve-mask ventilation with 100% oxygen
D) Immediate blood glucose measurement
Answer: C
After a seizure, the priority is airway and breathing. The child has a pulse but inadequate
breathing; therefore, positive-pressure ventilation with a bag-valve-mask and
high-concentration oxygen is the initial life-saving intervention.
5. A 2-year-old child is in cardiac arrest. The cardiac rhythm shows pulseless electrical activity
(PEA). What is the most likely aetiology in a child of this age?
A) Primary cardiac arrhythmia (e.g., long QT)
B) Hypoxia secondary to respiratory failure
C) Electrolyte disturbance
D) Pulmonary embolism
Answer: B
In infants and children, cardiac arrest is rarely due to a primary cardiac event. The vast majority
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