Senior, please come!
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Wait… I’ve seen this before
The toddler ate WHAT?
100
An 8-year old known asthmatic now presents with severe respiratory distress after worsening wheeze despite repeated salbutamol at home. On examination, the child is agitated, tachycardic, using accessory muscles, and has markedly reduced air entry bilaterally with minimal wheeze. What is the most concerning finding?
Silent chest= impending respiratory failure in status asthmaticus
100
A 4-month old infant is brought to the ED for excessive crying. Parents report “baby rolled off the couch”. On examination, the infant has bruising over the ears and neck. The infant appears irritable and poorly interactive. What would you suspect?
Non-accidental Trauma
(Those who don’t cruise rarely bruise)
100
A 1-month old female infant presents to your office for a well-child visit. On physical exam she has an erythematous lesion as shown in the picture. The rest of her physical exam is unremarkable and she is growing appropriately. What is your Dx? 
Infantile Hemangioma
100
A 2-year old boy is rushed to the ED by his grandparents with lethargy and seizures. His blood sugar is 2.6 mmol/l, BP 60/40 mmhg and HR 40bpm.
Beta-Blocker Toxicity 
200
A 10-month old infant admitted 2 days prior with acute bronchiolitis and incidental murmur on exam. During your on call he suddenly becomes cyanotic and irritable while crying. The child appears limp and develops rapid breathing and murmur becomes noticeably quieter. His SpO2 drops to 60% and only slightly improves with O2 support. What is the most likely Dx?
Tetralogy of Fallot. Tet Spell
200
A 10-year old boy is brought to the ED with a one week hx of vomiting. In the ED he became lethargic and difficult to arouse. Upon assessment he is dehydrated, tachycardic and breathing deeply and rapidly. As part of your primary assessment what is the most important lab investigation to request?
Point of care glucose
200
A toxic-looking 3-year old child presents with high fever, drooling, neck pain and muffled hot potato voice. He has strider and is sitting with his neck extended. 
Retropharyngeal Abscess
300
A 4-year old child with SMA and tracheostomy suddenly desats to 68% during night shift. Nurse says there is increased work of breathing and the monitor is alarming. You enter the room and the child looks cyanotic. How would you troubleshoot?
“DOPE“
D: displacement
O: obstruction
P: pneumothorax
E: Equipment failure
300
A premature neonate admitted for vomiting suddenly develops abdominal distention, lethargy and bloody stools while on oral feeds.
Necrotising Enterocolitis (NEC).
300
A 4-month old boy presents with an erythematous rash in the neck folds with satellite pustules and maceration. 
Candidal intertrigo