COMAT Pediatrics Exam V1 | COMAT Pediatrics
Exam V1 | COMAT Pediatrics Exam V1
1. A 3-year-old male is brought to the emergency department with a 2-day history of high
fever, barking cough, and inspiratory stridor that worsens when he is agitated. The mother
notes the symptoms are worse at night. Physical examination reveals subcostal retractions.
What is the most appropriate initial treatment for this patient?
A. Oral amoxicillin
B. Inhaled albuterol
C. Intravenous ceftriaxone
D. Dexamethasone and nebulized epinephrine
Correct Answer: D
Explanation: This patient presents with classic symptoms of Croup
(laryngotracheobronchitis), characterized by a barky cough and stridor due to subglottic
narrowing. Management of moderate-to-severe croup involves corticosteroids
(dexamethasone) to reduce airway edema and nebulized racemic epinephrine for rapid
symptom relief. Observation is critical as the effects of epinephrine are transient and
rebound symptoms may occur.
,2. A 2-week-old infant is brought to the clinic for projectile, non-bilious vomiting after every
feed. On physical exam, the infant appears mildly dehydrated and a small, firm, olive-shaped
mass is palpable in the right upper quadrant. Which of the following electrolyte abnormalities
is most likely to be found?
A. Hyperkalemic metabolic acidosis
B. Hyponatremic metabolic acidosis
C. Hypochloremic, hypokalemic metabolic alkalosis
D. Hyperchloremic metabolic alkalosis
Correct Answer: C
Explanation: Hypertrophic pyloric stenosis leads to persistent vomiting of gastric
contents, which are rich in hydrochloric acid. The loss of hydrogen and chloride ions results
in a metabolic alkalosis, and the kidneys subsequently excrete potassium to conserve
hydrogen ions, leading to hypokalemia. Correction of these electrolyte imbalances and
dehydration is mandatory before surgical pyloromyotomy.
3. A 6-month-old infant is brought to the pediatrician for a well-child visit. The mother is
concerned that the infant is not yet sitting up. On examination, the infant can roll from prone
to supine, reaches for objects with a raking grasp, and babbles. At what age do infants
typically sit without support?
A. 4 months
B. 12 months
,C. 9 months
D. 6 months
Correct Answer: D
Explanation: Sitting without support is a major gross motor milestone typically achieved
by 6 months of age. While there is a range of normal development, failure to achieve this by
9 months warrants further investigation. This infant is meeting other appropriate
milestones such as rolling and raking grasp, suggesting normal development for age.
4. A 10-year-old girl presents with a 5-day history of high fever, a beefy red tongue, and a
generalized maculopapular rash that began on her trunk and spread to her extremities. She
also has bilateral conjunctival injection without exudate and edema of her hands. What is the
most important initial management to prevent long-term complications?
A. Intramuscular penicillin G
B. Oral prednisolone and watchful waiting
C. High-dose aspirin and intravenous immunoglobulin
D. Intravenous acyclovir
Correct Answer: C
Explanation: This presentation is highly suggestive of Kawasaki Disease, an acute systemic
vasculitis. The primary risk is the development of coronary artery aneurysms, which occurs
in about 25% of untreated children. Prompt treatment with IVIG and high-dose aspirin
significantly reduces this risk and should be initiated within the first 10 days of fever onset.
, 5. A 5-year-old boy with a history of sickle cell disease presents to the emergency department
with sudden onset of severe pallor, fatigue, and tachycardia. His hemoglobin is 4 g/dL
(baseline 8 g/dL), and his reticulocyte count is 0.1%. What is the most likely cause of this
acute crisis?
A. Splenic sequestration
B. Vaso-occlusive crisis
C. Hemolytic crisis
D. Parvovirus B19 infection
Correct Answer: D
Explanation: An aplastic crisis in a sickle cell patient is characterized by a sudden drop in
hemoglobin accompanied by an inappropriately low reticulocyte count, indicating bone
marrow failure. Parvovirus B19 is the most common trigger as it infects erythroid
progenitor cells. In contrast, splenic sequestration would typically show an increased
reticulocyte count and an enlarging spleen.
6. A newborn male is noted to have a scaphoid abdomen and immediate respiratory distress
in the delivery room. Breath sounds are absent on the left side, and heart sounds are
displaced to the right. What is the most appropriate next step in management?
A. Bag-valve-mask ventilation
B. Needle thoracostomy
C. Endotracheal intubation
Exam V1 | COMAT Pediatrics Exam V1
1. A 3-year-old male is brought to the emergency department with a 2-day history of high
fever, barking cough, and inspiratory stridor that worsens when he is agitated. The mother
notes the symptoms are worse at night. Physical examination reveals subcostal retractions.
What is the most appropriate initial treatment for this patient?
A. Oral amoxicillin
B. Inhaled albuterol
C. Intravenous ceftriaxone
D. Dexamethasone and nebulized epinephrine
Correct Answer: D
Explanation: This patient presents with classic symptoms of Croup
(laryngotracheobronchitis), characterized by a barky cough and stridor due to subglottic
narrowing. Management of moderate-to-severe croup involves corticosteroids
(dexamethasone) to reduce airway edema and nebulized racemic epinephrine for rapid
symptom relief. Observation is critical as the effects of epinephrine are transient and
rebound symptoms may occur.
,2. A 2-week-old infant is brought to the clinic for projectile, non-bilious vomiting after every
feed. On physical exam, the infant appears mildly dehydrated and a small, firm, olive-shaped
mass is palpable in the right upper quadrant. Which of the following electrolyte abnormalities
is most likely to be found?
A. Hyperkalemic metabolic acidosis
B. Hyponatremic metabolic acidosis
C. Hypochloremic, hypokalemic metabolic alkalosis
D. Hyperchloremic metabolic alkalosis
Correct Answer: C
Explanation: Hypertrophic pyloric stenosis leads to persistent vomiting of gastric
contents, which are rich in hydrochloric acid. The loss of hydrogen and chloride ions results
in a metabolic alkalosis, and the kidneys subsequently excrete potassium to conserve
hydrogen ions, leading to hypokalemia. Correction of these electrolyte imbalances and
dehydration is mandatory before surgical pyloromyotomy.
3. A 6-month-old infant is brought to the pediatrician for a well-child visit. The mother is
concerned that the infant is not yet sitting up. On examination, the infant can roll from prone
to supine, reaches for objects with a raking grasp, and babbles. At what age do infants
typically sit without support?
A. 4 months
B. 12 months
,C. 9 months
D. 6 months
Correct Answer: D
Explanation: Sitting without support is a major gross motor milestone typically achieved
by 6 months of age. While there is a range of normal development, failure to achieve this by
9 months warrants further investigation. This infant is meeting other appropriate
milestones such as rolling and raking grasp, suggesting normal development for age.
4. A 10-year-old girl presents with a 5-day history of high fever, a beefy red tongue, and a
generalized maculopapular rash that began on her trunk and spread to her extremities. She
also has bilateral conjunctival injection without exudate and edema of her hands. What is the
most important initial management to prevent long-term complications?
A. Intramuscular penicillin G
B. Oral prednisolone and watchful waiting
C. High-dose aspirin and intravenous immunoglobulin
D. Intravenous acyclovir
Correct Answer: C
Explanation: This presentation is highly suggestive of Kawasaki Disease, an acute systemic
vasculitis. The primary risk is the development of coronary artery aneurysms, which occurs
in about 25% of untreated children. Prompt treatment with IVIG and high-dose aspirin
significantly reduces this risk and should be initiated within the first 10 days of fever onset.
, 5. A 5-year-old boy with a history of sickle cell disease presents to the emergency department
with sudden onset of severe pallor, fatigue, and tachycardia. His hemoglobin is 4 g/dL
(baseline 8 g/dL), and his reticulocyte count is 0.1%. What is the most likely cause of this
acute crisis?
A. Splenic sequestration
B. Vaso-occlusive crisis
C. Hemolytic crisis
D. Parvovirus B19 infection
Correct Answer: D
Explanation: An aplastic crisis in a sickle cell patient is characterized by a sudden drop in
hemoglobin accompanied by an inappropriately low reticulocyte count, indicating bone
marrow failure. Parvovirus B19 is the most common trigger as it infects erythroid
progenitor cells. In contrast, splenic sequestration would typically show an increased
reticulocyte count and an enlarging spleen.
6. A newborn male is noted to have a scaphoid abdomen and immediate respiratory distress
in the delivery room. Breath sounds are absent on the left side, and heart sounds are
displaced to the right. What is the most appropriate next step in management?
A. Bag-valve-mask ventilation
B. Needle thoracostomy
C. Endotracheal intubation
