Pediatric Education for Prehospital Professionals (PEPP) Final Exam —
2025/2026 Edition | Verified Questions and Correct Answers
with Rationales
The revision material is structured into 5 main sections, covering all major pediatric emergency
concepts taught in the PEPP (Pediatric Education for Prehospital Professionals) course. Each
section contains 40 multiple-choice questions, for a total of 200 questions. All questions
include fully elaborated rationales to enhance understanding and retention. It is designed for
EMS personnel, nurses, and other healthcare providers who respond to or manage pediatric
patients
Exam Structure
Section Content Focus Weight
I. Pediatric Assessment & Initial PAT (Pediatric Assessment Triangle), ABCDEs,
15%
Impression identifying distress vs failure
II. Airway & Breathing Airway anatomy, obstruction, respiratory
20%
Emergencies distress/failure, oxygen delivery
Hypovolemic, distributive, cardiogenic shock,
III. Circulation & Shock 15%
perfusion assessment
Head, spine, thoracic, abdominal trauma, burns,
IV. Pediatric Trauma 15%
MCI
V. Medical & Environmental Seizures, poisoning, allergic reactions,
20%
Emergencies hypoglycemia, drowning, hypothermia
VI. Neonatal & Special Newborn care, congenital issues, child abuse,
10%
Populations children with special needs
Pediatric equipment, triage, documentation,
VII. Transport & Operations 5%
communication
Section I – Pediatric Assessment & Initial Impression (40
Questions)
1. The Pediatric Assessment Triangle (PAT) is used to:
,A. Determine the need for IV access
B. Form a rapid, hands-off impression of the child’s condition (CORRECT)
C. Decide which medications to administer
D. Calculate fluid replacement
Rationale: The PAT quickly assesses appearance, work of breathing, and circulation before
physical contact.
2. The three components of the PAT are:
A. Airway, Breathing, Circulation
B. Appearance, Work of Breathing, Circulation to Skin (CORRECT)
C. Level of Consciousness, Heart Rate, Respiratory Rate
D. Tone, Reflexes, Cry
Rationale: PAT focuses on general impression — not vitals.
3. Which component of PAT reflects brain perfusion and oxygenation?
A. Work of breathing
B. Appearance (CORRECT)
C. Circulation to skin
D. Capillary refill
Rationale: The “appearance” element indicates central nervous system function and perfusion.
4. A 5-year-old is lethargic, cyanotic, and minimally responsive. This finding
indicates:
A. Respiratory distress
B. Respiratory failure (CORRECT)
C. Shock
D. Seizure activity
Rationale: Decreased responsiveness with cyanosis signifies respiratory failure.
5. A 3-year-old child with grunting respirations and nasal flaring is likely
experiencing:
A. Respiratory distress (CORRECT)
B. Cardiogenic shock
,C. Normal variation
D. CNS depression
Rationale: These are compensatory signs of respiratory effort.
6. In the pediatric patient, the most reliable indicator of adequate perfusion is:
A. Heart rate
B. Skin color and capillary refill (CORRECT)
C. Respiratory rate
D. Pupil reaction
Rationale: These quickly show tissue perfusion status.
7. During the initial assessment, if the child is unresponsive and not breathing
normally, you should:
A. Begin oxygen by nasal cannula
B. Check pulse for 10 seconds (CORRECT)
C. Perform a full head-to-toe exam
D. Obtain SAMPLE history
Rationale: Assess circulation after confirming unresponsiveness and apnea.
8. The “A” in the ABCDE approach stands for:
A. Airway (CORRECT)
B. Appearance
C. Alertness
D. Access
Rationale: ABCDE = Airway, Breathing, Circulation, Disability, Exposure.
9. The most common cause of cardiac arrest in children is:
A. Ventricular fibrillation
B. Myocardial infarction
C. Hypoxia secondary to respiratory failure (CORRECT)
D. Electrocution
Rationale: Arrest typically results from progressive respiratory compromise.
, 10. When assessing a child’s airway, grunting indicates:
A. Obstructed nasal passages
B. Attempt to maintain positive end-expiratory pressure (CORRECT)
C. Pain response
D. CNS depression
Rationale: Grunting helps keep alveoli open — a sign of distress.
11. The first step when approaching a sick child is:
A. Apply oxygen
B. Check temperature
C. Ensure scene safety and general impression (CORRECT)
D. Attach monitor
Rationale: Scene safety and rapid impression come before intervention.
12. A strong cry and good tone in an infant suggest:
A. Adequate oxygenation and perfusion (CORRECT)
B. Cardiac decompensation
C. Cyanosis
D. Seizure activity
Rationale: Indicates normal CNS and respiratory function.
13. Tripod positioning in a child usually signifies:
A. Severe respiratory distress (CORRECT)
B. Seizure
C. Spinal cord injury
D. Normal posture
Rationale: The child leans forward to optimize airway diameter.
14. The work of breathing portion of the PAT includes observing:
2025/2026 Edition | Verified Questions and Correct Answers
with Rationales
The revision material is structured into 5 main sections, covering all major pediatric emergency
concepts taught in the PEPP (Pediatric Education for Prehospital Professionals) course. Each
section contains 40 multiple-choice questions, for a total of 200 questions. All questions
include fully elaborated rationales to enhance understanding and retention. It is designed for
EMS personnel, nurses, and other healthcare providers who respond to or manage pediatric
patients
Exam Structure
Section Content Focus Weight
I. Pediatric Assessment & Initial PAT (Pediatric Assessment Triangle), ABCDEs,
15%
Impression identifying distress vs failure
II. Airway & Breathing Airway anatomy, obstruction, respiratory
20%
Emergencies distress/failure, oxygen delivery
Hypovolemic, distributive, cardiogenic shock,
III. Circulation & Shock 15%
perfusion assessment
Head, spine, thoracic, abdominal trauma, burns,
IV. Pediatric Trauma 15%
MCI
V. Medical & Environmental Seizures, poisoning, allergic reactions,
20%
Emergencies hypoglycemia, drowning, hypothermia
VI. Neonatal & Special Newborn care, congenital issues, child abuse,
10%
Populations children with special needs
Pediatric equipment, triage, documentation,
VII. Transport & Operations 5%
communication
Section I – Pediatric Assessment & Initial Impression (40
Questions)
1. The Pediatric Assessment Triangle (PAT) is used to:
,A. Determine the need for IV access
B. Form a rapid, hands-off impression of the child’s condition (CORRECT)
C. Decide which medications to administer
D. Calculate fluid replacement
Rationale: The PAT quickly assesses appearance, work of breathing, and circulation before
physical contact.
2. The three components of the PAT are:
A. Airway, Breathing, Circulation
B. Appearance, Work of Breathing, Circulation to Skin (CORRECT)
C. Level of Consciousness, Heart Rate, Respiratory Rate
D. Tone, Reflexes, Cry
Rationale: PAT focuses on general impression — not vitals.
3. Which component of PAT reflects brain perfusion and oxygenation?
A. Work of breathing
B. Appearance (CORRECT)
C. Circulation to skin
D. Capillary refill
Rationale: The “appearance” element indicates central nervous system function and perfusion.
4. A 5-year-old is lethargic, cyanotic, and minimally responsive. This finding
indicates:
A. Respiratory distress
B. Respiratory failure (CORRECT)
C. Shock
D. Seizure activity
Rationale: Decreased responsiveness with cyanosis signifies respiratory failure.
5. A 3-year-old child with grunting respirations and nasal flaring is likely
experiencing:
A. Respiratory distress (CORRECT)
B. Cardiogenic shock
,C. Normal variation
D. CNS depression
Rationale: These are compensatory signs of respiratory effort.
6. In the pediatric patient, the most reliable indicator of adequate perfusion is:
A. Heart rate
B. Skin color and capillary refill (CORRECT)
C. Respiratory rate
D. Pupil reaction
Rationale: These quickly show tissue perfusion status.
7. During the initial assessment, if the child is unresponsive and not breathing
normally, you should:
A. Begin oxygen by nasal cannula
B. Check pulse for 10 seconds (CORRECT)
C. Perform a full head-to-toe exam
D. Obtain SAMPLE history
Rationale: Assess circulation after confirming unresponsiveness and apnea.
8. The “A” in the ABCDE approach stands for:
A. Airway (CORRECT)
B. Appearance
C. Alertness
D. Access
Rationale: ABCDE = Airway, Breathing, Circulation, Disability, Exposure.
9. The most common cause of cardiac arrest in children is:
A. Ventricular fibrillation
B. Myocardial infarction
C. Hypoxia secondary to respiratory failure (CORRECT)
D. Electrocution
Rationale: Arrest typically results from progressive respiratory compromise.
, 10. When assessing a child’s airway, grunting indicates:
A. Obstructed nasal passages
B. Attempt to maintain positive end-expiratory pressure (CORRECT)
C. Pain response
D. CNS depression
Rationale: Grunting helps keep alveoli open — a sign of distress.
11. The first step when approaching a sick child is:
A. Apply oxygen
B. Check temperature
C. Ensure scene safety and general impression (CORRECT)
D. Attach monitor
Rationale: Scene safety and rapid impression come before intervention.
12. A strong cry and good tone in an infant suggest:
A. Adequate oxygenation and perfusion (CORRECT)
B. Cardiac decompensation
C. Cyanosis
D. Seizure activity
Rationale: Indicates normal CNS and respiratory function.
13. Tripod positioning in a child usually signifies:
A. Severe respiratory distress (CORRECT)
B. Seizure
C. Spinal cord injury
D. Normal posture
Rationale: The child leans forward to optimize airway diameter.
14. The work of breathing portion of the PAT includes observing:
