COMSAE ALL ACTUAL EXAM TEST PAPER FULL QUESTIONS CORRECT RESPONSES
Question:
Crigler Najjar.
Answer:
ABSENT UDP glucuronsyltransferase; early in life; die few years find: jaundice, kernicterus (in
brain) inc unconjugated bilirubin; tx: plasmapheresis and phototherapy; type II respond
phenobarbital
Question:
Dubin Johnson.
Answer:
Conjugated hyperbilirubinemia b/c defective liver excretion; grossly black liver Benign
Question:
Rotor syndrome.
Answer:
milder in presentation w/o black liver impaired hepatic uptake and excretion
Question:
wilson Disease.
Answer:
copper transporting ATPase; ATP7B on Chromosome 13 s/s: before 40 yo, liver dz, neurodisease,
psych dz, Kayser Fleischer ring, hemolytic anemia, renal dz; find: dec serum ceruloplasmin, inc
urine copper tx: chelation w/ penicillamine or Tridentine, oral zinc
,Question:
Hemochromatosis.
Answer:
recessive, HFE, chromosome 6; abnormal iron sensing, increase intestinal absorb find: inc ferritin,
inc iron, dec TIBC, inc transferrin saturation identify w/ Prussian blue stain/ liver MRI
Question:
Hemochromatosis finds.
Answer:
after age 40 >20 iron; triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy,
hypogonadism, arhtropathy; HCC is common cause death
Question:
Treatment Hemochromatosis.
Answer:
repeat phlebotomy, chelation deferasirox, deferoxamine, oral deferiprone
Question:
Wolff Parkinson White Syndrome.
Answer:
MC ventricular pre excitation syndrome abnml fast atria to ventricle (bundle of Kent); bypasses AV
node>> ventricles begin partially depolarization earlier (NOTED BY DELTA WAVE ON EKG)
widened QRS and shortened PR
Question:
Conduction pathway heart.
Answer:
,SA node> atira> AV node> bundle HIS, R and L bundle branches> purkinje fibers> ventricles L
branch anterior/posterior fascicles
Question:
Edema.
Answer:
inc capillary pressure dec plasma proteins (dec oncotic capillary pressure) inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Question:
Celiac Disease.
Answer:
setting: 14 mo kid losing weight eating lots of foods; histology: crypt abnormalities (hyperplasia);
villous atrophy, lymphocytic infiltration presents as malabsorbtion (diarrhea etc in kids) in adults=
short stature, anemia delayed puberty
Question:
Musculocutaneous nerve C5-C7.
Answer:
upper trunk compression cause injury; loss forearm flexion/supination; loss sensation over lateral
forearm
Question:
Axillary nerve C5-C6.
Answer:
flat deltoid; loss arm abduction, loss sensation over deltoid and lateral arm
Question:
, Radial C5-T1.
Answer:
mid shaft fracture humerus, compression axilla find: dec grip, loss extension (wrist drop); loss
sensation posterior arm, dorsal hand
Question:
Median C5-T1.
Answer:
supracondylar fracture humerus (proximal) CTS, wrist laceration (distal) ape hand pope's blessing
loss wrist flexion, flex of lateral fingers, thumb opposition, lumbricals 2nd and 3rd digit; loss
sensation over thenar eminence and dorsal and palmar aspects of lateral 3 1/2 fingers w/ proximal
Question:
Ulnar C8-T1.
Answer:
Fracture medial epicondyle humerus; fractured hook hamate (distal lesion) ulnar claw on extension;
radial deception wrist upon flexion (proximal lesion) loss wrist flex, flex of medial fingers,
abduction and adduction fingers; medial 2 lumbricals; loss sensation over 1 1/2 fingers including
hypothenar eminence
Question:
Recurrent branch median nerve.
Answer:
superficial laceration palm ape hand; loss thenar muscles no loss sensation
Question:
Treatment glaucoma: alpha agonists; epinephrine, brimonidine.
Answer:
Question:
Crigler Najjar.
Answer:
ABSENT UDP glucuronsyltransferase; early in life; die few years find: jaundice, kernicterus (in
brain) inc unconjugated bilirubin; tx: plasmapheresis and phototherapy; type II respond
phenobarbital
Question:
Dubin Johnson.
Answer:
Conjugated hyperbilirubinemia b/c defective liver excretion; grossly black liver Benign
Question:
Rotor syndrome.
Answer:
milder in presentation w/o black liver impaired hepatic uptake and excretion
Question:
wilson Disease.
Answer:
copper transporting ATPase; ATP7B on Chromosome 13 s/s: before 40 yo, liver dz, neurodisease,
psych dz, Kayser Fleischer ring, hemolytic anemia, renal dz; find: dec serum ceruloplasmin, inc
urine copper tx: chelation w/ penicillamine or Tridentine, oral zinc
,Question:
Hemochromatosis.
Answer:
recessive, HFE, chromosome 6; abnormal iron sensing, increase intestinal absorb find: inc ferritin,
inc iron, dec TIBC, inc transferrin saturation identify w/ Prussian blue stain/ liver MRI
Question:
Hemochromatosis finds.
Answer:
after age 40 >20 iron; triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy,
hypogonadism, arhtropathy; HCC is common cause death
Question:
Treatment Hemochromatosis.
Answer:
repeat phlebotomy, chelation deferasirox, deferoxamine, oral deferiprone
Question:
Wolff Parkinson White Syndrome.
Answer:
MC ventricular pre excitation syndrome abnml fast atria to ventricle (bundle of Kent); bypasses AV
node>> ventricles begin partially depolarization earlier (NOTED BY DELTA WAVE ON EKG)
widened QRS and shortened PR
Question:
Conduction pathway heart.
Answer:
,SA node> atira> AV node> bundle HIS, R and L bundle branches> purkinje fibers> ventricles L
branch anterior/posterior fascicles
Question:
Edema.
Answer:
inc capillary pressure dec plasma proteins (dec oncotic capillary pressure) inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Question:
Celiac Disease.
Answer:
setting: 14 mo kid losing weight eating lots of foods; histology: crypt abnormalities (hyperplasia);
villous atrophy, lymphocytic infiltration presents as malabsorbtion (diarrhea etc in kids) in adults=
short stature, anemia delayed puberty
Question:
Musculocutaneous nerve C5-C7.
Answer:
upper trunk compression cause injury; loss forearm flexion/supination; loss sensation over lateral
forearm
Question:
Axillary nerve C5-C6.
Answer:
flat deltoid; loss arm abduction, loss sensation over deltoid and lateral arm
Question:
, Radial C5-T1.
Answer:
mid shaft fracture humerus, compression axilla find: dec grip, loss extension (wrist drop); loss
sensation posterior arm, dorsal hand
Question:
Median C5-T1.
Answer:
supracondylar fracture humerus (proximal) CTS, wrist laceration (distal) ape hand pope's blessing
loss wrist flexion, flex of lateral fingers, thumb opposition, lumbricals 2nd and 3rd digit; loss
sensation over thenar eminence and dorsal and palmar aspects of lateral 3 1/2 fingers w/ proximal
Question:
Ulnar C8-T1.
Answer:
Fracture medial epicondyle humerus; fractured hook hamate (distal lesion) ulnar claw on extension;
radial deception wrist upon flexion (proximal lesion) loss wrist flex, flex of medial fingers,
abduction and adduction fingers; medial 2 lumbricals; loss sensation over 1 1/2 fingers including
hypothenar eminence
Question:
Recurrent branch median nerve.
Answer:
superficial laceration palm ape hand; loss thenar muscles no loss sensation
Question:
Treatment glaucoma: alpha agonists; epinephrine, brimonidine.
Answer:
