COMLEX 3 PEDIATRICS QUESTIONS
AND ANSWERS WITH SOLUTIONS 2024
Oppositional Defiant disorder - ANSWER ODD - hostile behaviors towards authority figures. ADHD is a
common co-morbidity- trouble paying attention, easily distracted, difficulty following instructions.
Marfan Syndrome Presentation and FollowUp - ANSWER Manfanoid habitus, hyphoscoliosis, dislocated
lens (upward). Risk for aortic root dilation and aortic aneurysms.
Mumps Presentation - ANSWER Unimmunized pediatric patient: Fever, Malaise, Arthralgia, Pancreatitis
(self-resolving), Parotitis, Unilateral Orchitis.
2 months old baby expect - ANSWER lift head from chest while in prone position, track past midline,
alert to sounds, coo, recognize parents, exhibit social smile
6 months old baby mile stone - ANSWER sit unassisted, transfer objects, babble, exhibit stranger anxiety,
able to roll
10 month old mile stone - ANSWER crawl, pull themselves up to stand, use immature pincer grasp, wave
bye-bye
8 month old having recurrent pneumoniae, otitis mediaa long with skin abscess, sensitive to sun light,
and "silvery sheen" hair - ANSWER Chediak-Higashi Syndrome CHS - autosomal recessive disorder,
affecting hypopigmentation of skin, eyes, hair, prolonged bleeding times/easy bruisability, recurrent
infection, abnormal natural killer cell function, peripheral neuropathy.
Chronic Granulomatous Disease - ANSWER Bacterial and fungal infections early in life, granulomas on the
skin. 1/3 also has granulomas in GI tract. Test by Nitroblue Tetrazolium Test.
Botulism Presentation - ANSWER Neurotoxin that blocks the release acetylcholine resulting in weakness
and flaccid paralysis. Classic presentation "floppy baby' after exposure to honey.
Children Body Surface Area breakdown - ANSWER 18% Head, UE 9% each, Torso 36%, LE 14% each.
,Cryptoorchidism Presentation, Complication - ANSWER Absence of one or both testes from the scrotum,
most common birth defect regarding male genitalia. 80% cryptoorchid testes descend by the first year of
life. The incidence of testicular cancer is 40x higher. Of testicular cancers, seminoma is the most
common.
Female gymnast presents with R knee pain, yesterday heard a loud "pop" in her routine, unable to
continue 2/2 to pain and swelling that occurred. What do you suspect? - ANSWER Anterior Cruciate
Ligament ACL injury -- Female gymnasts sustain the highest rate of injury.
Basketball player presents with pain in medial knee after playing last week. He also complains of
popping, locking (unable to fully extend knee), catching or "giving out". What injury do you suspect? -
ANSWER Medial Meniscal tear - most commonly from a twisting injury witht he foot planted.
Why doesn't the medial menisci heal as well as the lateral one? - ANSWER Blood supply to inner portions
of the menisci are limited!
Whats the most sensitive and specific physical exam maneuver for ACUTE ACL injury? - ANSWER
Lachman Test -- placing knee in approx. 30 degrees flexion with one hand stabilizing distal femur, while
other pulls proximal tibia anteriorly attempting to produce anterior translation of tibia on the femur.
Intact ACL limits anterior translation and will provide distinct endpoint, compared to other side. ACUTE
injury: 85% sensitive, 94% specific. VS Anterior drawer sensitivity 92%, specificity 91% in CHRONIC
conditions.
Young teenage boy presents with joint pain, also had sore throat and fever 3 weeks ago that wasn't
treated yet. Sudden movements of hands and feet are noted. What's the diagnosis and treatment? How
do you diagnose it? - ANSWER Rheumatic Fever: Group A Streptococcus, recent pharyngitis. 2 Major
Criteria = JONES Criteria: Migratory Polyarthritis, Carditis, Subcutaneous Nodules, Erythema
Marginatum, Chorea. + 1 Minor Criteria. Treatment Penicillin.
What personality disorder is Attention Deficit and Hyperactivity Disorder associated to? - ANSWER
Antisocial Personality Disorder
Teenage boy presents with mother complaining of breasts. He's struggling to get along with people at
school, IQ test normal. He's very tall and slender. Dx. - ANSWER Klinefelter Syndrome XXY -- infertility,
hypogonadism, psychosocial problems, tall stature w/ long extremities, gynecomastia. Female
, distribution of pubic hair and gynecomastia are due to high levels of estradiol and increased estradiol-to-
testosterone ratio.
Most common substance cause of congenital abnormality - ANSWER Fetal Alcohol Syndrome -
craniofacial and cardiac abnormality.
Meconium Aspiration Syndrome. Presentation, Tx - ANSWER Meconium-stained amniotic fluid,
respiratory distress. Tx suction and Abx
1.5 years old. Presents with bilious emesis, lying crouching in fetal position. Exam shows sausage-shaped
abdominal mass. - ANSWER Intussusception, most common cause of bowel obstruction in first two years
of life. Currant jelly stool, telescoping for intestines. Abd US, air contrast or water soluble diagnostic and
therapeutic.
Teenage was running across the field with suddenly sharp pain right across front hip, Dx - ANSWER
Avulsion of Rectus Femoris which originates from AIIS ad inserts at tibial tiberosity
1 year old baby girl has "grape-like" protrusions from her vagina. Dx, Workup. - ANSWER Sarcoma
botryoides, most common malignant genitourinary tumor in young female, subtype of embryonal
rhabdomyosarcoma. Should work up with Pelvic US first, and CT to assess the vaginal involvement
What's the best way to monitor bronchodilator treatment response? - ANSWER Peak flow
measurements
Infant presents with a red rash, begins in buttocks and hands, spreading all over now. Temp 102F, feeding
less. Nikolsky sign positive. Dx. Pathophysiology. Tx. - ANSWER Staphylococcal Scalded Skin Syndrome
(SSSS) caused by exofoliative toxins produced by Staph Aureus that are proteases. Management is
supportive care with anti-staphylococcal antibiotics parenterally.
Circumcising a baby boy, wound continues to bleed. what do you do? - ANSWER Order PT/PTT to
evaluate clotting ability and guide further laboratory testing.
Turner syndrome Presentation - ANSWER Short stature, shield like chest, wide-spaced nipples and
ovarian failure. labs no estrogen ad elevated FSH because ovaries are nonfunctional.
AND ANSWERS WITH SOLUTIONS 2024
Oppositional Defiant disorder - ANSWER ODD - hostile behaviors towards authority figures. ADHD is a
common co-morbidity- trouble paying attention, easily distracted, difficulty following instructions.
Marfan Syndrome Presentation and FollowUp - ANSWER Manfanoid habitus, hyphoscoliosis, dislocated
lens (upward). Risk for aortic root dilation and aortic aneurysms.
Mumps Presentation - ANSWER Unimmunized pediatric patient: Fever, Malaise, Arthralgia, Pancreatitis
(self-resolving), Parotitis, Unilateral Orchitis.
2 months old baby expect - ANSWER lift head from chest while in prone position, track past midline,
alert to sounds, coo, recognize parents, exhibit social smile
6 months old baby mile stone - ANSWER sit unassisted, transfer objects, babble, exhibit stranger anxiety,
able to roll
10 month old mile stone - ANSWER crawl, pull themselves up to stand, use immature pincer grasp, wave
bye-bye
8 month old having recurrent pneumoniae, otitis mediaa long with skin abscess, sensitive to sun light,
and "silvery sheen" hair - ANSWER Chediak-Higashi Syndrome CHS - autosomal recessive disorder,
affecting hypopigmentation of skin, eyes, hair, prolonged bleeding times/easy bruisability, recurrent
infection, abnormal natural killer cell function, peripheral neuropathy.
Chronic Granulomatous Disease - ANSWER Bacterial and fungal infections early in life, granulomas on the
skin. 1/3 also has granulomas in GI tract. Test by Nitroblue Tetrazolium Test.
Botulism Presentation - ANSWER Neurotoxin that blocks the release acetylcholine resulting in weakness
and flaccid paralysis. Classic presentation "floppy baby' after exposure to honey.
Children Body Surface Area breakdown - ANSWER 18% Head, UE 9% each, Torso 36%, LE 14% each.
,Cryptoorchidism Presentation, Complication - ANSWER Absence of one or both testes from the scrotum,
most common birth defect regarding male genitalia. 80% cryptoorchid testes descend by the first year of
life. The incidence of testicular cancer is 40x higher. Of testicular cancers, seminoma is the most
common.
Female gymnast presents with R knee pain, yesterday heard a loud "pop" in her routine, unable to
continue 2/2 to pain and swelling that occurred. What do you suspect? - ANSWER Anterior Cruciate
Ligament ACL injury -- Female gymnasts sustain the highest rate of injury.
Basketball player presents with pain in medial knee after playing last week. He also complains of
popping, locking (unable to fully extend knee), catching or "giving out". What injury do you suspect? -
ANSWER Medial Meniscal tear - most commonly from a twisting injury witht he foot planted.
Why doesn't the medial menisci heal as well as the lateral one? - ANSWER Blood supply to inner portions
of the menisci are limited!
Whats the most sensitive and specific physical exam maneuver for ACUTE ACL injury? - ANSWER
Lachman Test -- placing knee in approx. 30 degrees flexion with one hand stabilizing distal femur, while
other pulls proximal tibia anteriorly attempting to produce anterior translation of tibia on the femur.
Intact ACL limits anterior translation and will provide distinct endpoint, compared to other side. ACUTE
injury: 85% sensitive, 94% specific. VS Anterior drawer sensitivity 92%, specificity 91% in CHRONIC
conditions.
Young teenage boy presents with joint pain, also had sore throat and fever 3 weeks ago that wasn't
treated yet. Sudden movements of hands and feet are noted. What's the diagnosis and treatment? How
do you diagnose it? - ANSWER Rheumatic Fever: Group A Streptococcus, recent pharyngitis. 2 Major
Criteria = JONES Criteria: Migratory Polyarthritis, Carditis, Subcutaneous Nodules, Erythema
Marginatum, Chorea. + 1 Minor Criteria. Treatment Penicillin.
What personality disorder is Attention Deficit and Hyperactivity Disorder associated to? - ANSWER
Antisocial Personality Disorder
Teenage boy presents with mother complaining of breasts. He's struggling to get along with people at
school, IQ test normal. He's very tall and slender. Dx. - ANSWER Klinefelter Syndrome XXY -- infertility,
hypogonadism, psychosocial problems, tall stature w/ long extremities, gynecomastia. Female
, distribution of pubic hair and gynecomastia are due to high levels of estradiol and increased estradiol-to-
testosterone ratio.
Most common substance cause of congenital abnormality - ANSWER Fetal Alcohol Syndrome -
craniofacial and cardiac abnormality.
Meconium Aspiration Syndrome. Presentation, Tx - ANSWER Meconium-stained amniotic fluid,
respiratory distress. Tx suction and Abx
1.5 years old. Presents with bilious emesis, lying crouching in fetal position. Exam shows sausage-shaped
abdominal mass. - ANSWER Intussusception, most common cause of bowel obstruction in first two years
of life. Currant jelly stool, telescoping for intestines. Abd US, air contrast or water soluble diagnostic and
therapeutic.
Teenage was running across the field with suddenly sharp pain right across front hip, Dx - ANSWER
Avulsion of Rectus Femoris which originates from AIIS ad inserts at tibial tiberosity
1 year old baby girl has "grape-like" protrusions from her vagina. Dx, Workup. - ANSWER Sarcoma
botryoides, most common malignant genitourinary tumor in young female, subtype of embryonal
rhabdomyosarcoma. Should work up with Pelvic US first, and CT to assess the vaginal involvement
What's the best way to monitor bronchodilator treatment response? - ANSWER Peak flow
measurements
Infant presents with a red rash, begins in buttocks and hands, spreading all over now. Temp 102F, feeding
less. Nikolsky sign positive. Dx. Pathophysiology. Tx. - ANSWER Staphylococcal Scalded Skin Syndrome
(SSSS) caused by exofoliative toxins produced by Staph Aureus that are proteases. Management is
supportive care with anti-staphylococcal antibiotics parenterally.
Circumcising a baby boy, wound continues to bleed. what do you do? - ANSWER Order PT/PTT to
evaluate clotting ability and guide further laboratory testing.
Turner syndrome Presentation - ANSWER Short stature, shield like chest, wide-spaced nipples and
ovarian failure. labs no estrogen ad elevated FSH because ovaries are nonfunctional.
