SET 1: Q: 1  A term male becomes tachypneic 30 minutes after birth. Preductal SpO₂ is 96% and postductal is 86%. No murmur. Which physiologic change most directly explains the gradient? What is the single best explanation for the differential saturation? A. Decreased endogenous prostaglandin production causing PFO closure B. Increased pulmonary venous return promoting … Read more

Acute Fulminant Myocarditis Presenting as Cardiogenic Shock in a Previously Healthy Child A previously healthy 4-year-old male presented to the emergency department with 24 hours of fever (38.5°C), vomiting, and progressive lethargy. Vital signs showed tachycardia at 165 bpm, hypotension (78/42 mmHg), tachypnea (36 breaths/min), and oxygen saturation 94% on room air. Physical examination revealed … Read more

When Cough Won’t Stop: Understanding Your Child’s Persistent Cough Constipation is one of the most common reasons parents bring their child to a pediatrician. It can cause significant discomfort, anxiety, and even behavior changes in children, yet it is often misunderstood. Many parents think constipation means “not passing stool every day.” In reality, constipation is … Read more

A 2-month-old infant is 8 hours post–VSD patch closure and PDA ligation. Temperature is 38.3°C, lactate is rising, and CVP is elevated. Temporary atrial and ventricular epicardial pacing wires are in place. The surface ECG (Lead II) and atrial electrogram (AEG) from pacing wires are shown above. Quiz QuestionWhat is the most likely rhythm diagnosis, … Read more

A 3-year-old boy with repaired tetralogy of Fallot (RVOT patch + transannular patch) is admitted to the cardiac ICU with worsening fatigue and presyncope. He is postoperative day 5 following pulmonary valve replacement. He suddenly develops a regular wide-complex tachycardia at 220/min, with MAP decreasing to 45 mmHg despite fluid bolus. Near-infrared spectroscopy demonstrates declining … Read more

A 6-year-old child on postoperative day 2 after atrial septal defect repair develops sudden tachycardia with a heart rate of 160–170/min. Blood pressure is stable but trending downward. The monitor shows a regular narrow-complex tachycardia. The child is irritable with mild hepatomegaly and rising lactate. Adenosine transiently slows the ventricular rate, but the tachycardia immediately … Read more

A 4-year-old child with severe pneumonia is mechanically ventilated for hypoxemic respiratory failure. On day 3, oxygen requirement increases (FiO₂ 0.75), PEEP is 8 cmH₂O, and plateau pressures are rising. The child develops tachycardia, increasing ventilator asynchrony, and decreased right-sided breath sounds. Bedside lung ultrasound is performed. The image above is obtained from the right … Read more