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PediaBuzz Q

The Buzz Method — 100 board questions, cracked.
1. Spot the buzz2. Narrow with the timeline3. Decide with the vitals

Most question books tell you the answer. This one shows you how the examiner hid it — and how to find it in under 30 seconds, under time pressure.

Finished PediaBuzz? Now beat the question.

You've learned the buzzwords. PediaBuzz Q turns that recall into exam points — every vignette solved by the same three-step method you can repeat on test day.

100
Vignettes
24
Systems · ABP
45
Analysis-level
3
Steps / answer
The method · used on every question
1

Spot the buzz

Find the phrase the examiner couldn't leave out, and translate it into its PediaBuzz rule.

2

Narrow the timeline

Use age, onset and the "previously well" clue to cut the differential down to two.

3

Decide with the vitals

Unstable child means treat; stable child means investigate. Then kill each distractor in one line.

Try 3 questions · exactly as they appear in the book
Solved: 0 / 3 — pick an answer to reveal the method.
001 · Neonatology
Buzz to spot: bilious vomiting in a neonate

A 6-day-old boy, born at term by uncomplicated delivery, is brought in with 8 hours of vomiting. He fed well and passed meconium within 12 hours of birth. The vomitus was initially milk, but the last three episodes have been dark green. He has had one small blood-streaked stool. Pulse 172/min, respirations 48/min, blood pressure 54/30 mm Hg, capillary refill 4 seconds. The abdomen is mildly distended and diffusely tender, without a mass. An isotonic saline bolus is running.

Most appropriate next step in management?

Answer A · Upper GI contrast study
1 · Spot the buzz. Dark-green emesis is bilious vomiting → malrotation with midgut volvulus until proven otherwise. Bile places the obstruction distal to the ampulla, excluding pyloric stenosis and reflux.
2 · Narrow. He passed meconium on day 1 and fed for five days, so a present-from-birth obstruction (atresia, meconium ileus, Hirschsprung) is unlikely. A previously well neonate with sudden bilious vomiting is the classic volvulus story.
3 · Decide. Tachycardia, slow capillary refill, hypotension and bloody stool mean the bowel is already ischaemic. The next step confirms the diagnosis and leads to surgery: emergent upper GI series (corkscrew duodenum), then a Ladd procedure. Fluids are already running — the examiner removed resuscitation so the surgical decision is what's tested.
Why the distractors failC — pyloric stenosis is non-bilious and projectile. D — a contrast enema is slower and delays surgery. E — an air enema treats intussusception and harms a volvulus. B — sweat chloride is a chronic test with no place in an emergency.
Board pearl. Non-bilious + projectile + olive = pyloric stenosis. Bilious + previously well neonate = volvulus → upper GI → Ladd. Bilious + double-bubble from day 1 = duodenal atresia.
047 · Cardiology
Buzz to spot: cyanosis with a boot-shaped heart

A 6-month-old boy has episodes in which he becomes deeply cyanotic and breathes rapidly while crying, then goes limp. He has had mild cyanosis since 2 months of age. A harsh systolic ejection murmur is heard at the left upper sternal border, and it becomes softer during the spells. Chest radiograph shows a boot-shaped heart with decreased pulmonary vascular markings.

Most appropriate immediate management of a spell?

Answer B · Knee-chest position and oxygen
1 · Spot the buzz. Hypercyanotic spells + boot-shaped heart + decreased pulmonary markings + a murmur that softens during the spell = tetralogy of Fallot with tet spells. The softening murmur is the tell: infundibular spasm cuts flow across the pulmonary outflow.
2 · Narrow. Spells come from increased right-to-left shunting across the VSD; anything that raises systemic vascular resistance or eases the infundibular spasm helps.
3 · Decide. Knee-chest position (raises SVR), oxygen, calm the child, then morphine, IV fluids, and a beta-blocker or phenylephrine if refractory. Definitive treatment is surgical repair.
Why the distractors failC — diuretics drop preload and worsen the spell. D — digoxin increases contractility and worsens the infundibular obstruction. E — epinephrine's beta effect increases spasm; phenylephrine (pure alpha) is the pressor of choice. A — PGE1 is for duct-dependent neonates, not a 6-month-old with spells.
Board pearl. TOF = PROVe (Pulmonary stenosis, RVH, Overriding aorta, VSD). Spell: knee-chest, O₂, morphine, fluids, propranolol, phenylephrine. Softer murmur during a spell = more obstruction.
094 · ENT, Eyes & Teeth
Buzz to spot: unilateral foul-smelling nasal discharge

A 3-year-old girl has had 10 days of purulent, foul-smelling discharge from the left nostril with occasional blood-streaking; the right nostril is clear. She is afebrile and otherwise well and did not improve with amoxicillin. Nasal speculum examination shows a smooth, disc-shaped metallic object lodged in the left nasal cavity with surrounding blackened, ulcerated mucosa.

Most appropriate next step in management?

Answer D · Immediate removal in the ED
1 · Spot the buzz. Unilateral foul-smelling nasal discharge in a toddler = nasal foreign body. The second buzz — a disc-shaped metallic object with blackened mucosa — identifies a button battery.
2 · Narrow. A button battery generates hydroxide at its negative pole and causes liquefactive necrosis within hours; septal perforation and saddle-nose can follow in a day. Time, not the object, is the enemy.
3 · Decide. Remove immediately — in the ED by a skilled clinician, or urgently by ENT — then irrigate and inspect for septal injury. No decongestant trial, no antibiotics first, no elective scheduling.
Why the distractors failE — waiting allows ongoing necrosis. A — antibiotics treat secondary infection but don't stop the electrochemical injury. B — elective removal is fine for an inert bead, never a battery. C — irrigation can push it deeper or into the airway.
Board pearl. Unilateral foul nasal discharge = foreign body. Button battery anywhere (nose, ear, oesophagus) = emergency removal; injury within hours. Inert objects can wait for ENT.
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