A 3-month-old presents with high fever (39.8 degrees C), inconsolable irritability, a bulging fontanelle, and a brief seizure. Which diagnosis must be ruled out emergently?

A 7-year-old presents with DKA: pH 7.05, glucose 720 mg/dL, bicarbonate 4 mEq/L, and serum potassium 3.0 mEq/L. Which initial management step is most critical?

A 3-year-old with thermal burns covering 30% total body surface area (TBSA) presents to the emergency department. Which fluid resuscitation regimen is most appropriate for the first 24 hours?

A 12-year-old presents with severe right lower quadrant pain, nausea, fever, and voluntary guarding. Which combination of physical exam findings best supports a diagnosis of acute appendicitis?

A 6-month-old with a ventriculoperitoneal (VP) shunt presents with irritability, vomiting, and a bulging fontanelle. Which physical exam finding is most concerning for shunt malfunction with raised intracranial pressure?

A PNP-AC notices that a recent Cochrane systematic review contradicts the current unit protocol for post-operative pain management in children. Which action best demonstrates the integration of evidence-based practice into clinical care?

A 1-day-old neonate presents with bilious vomiting and abdominal distension. An upper gastrointestinal series reveals a “double bubble sign.” Which diagnosis is most likely?

A 7-year-old with epilepsy continues to have breakthrough seizures despite being on the maximum recommended dose of levetiracetam monotherapy. Which next step is most appropriate?

A 7-year-old presents with recurring moderate-to-severe unilateral throbbing headaches preceded by a visual aura, accompanied by nausea, photophobia, and phonophobia, lasting 2-4 hours and relieved by sleep. Which diagnosis best fits this presentation?

A 12-year-old requires a lumbar puncture for suspected meningitis. Which set of CSF results is most consistent with viral (aseptic) meningitis?