COMSAE ALL UPDATED Questions and
CORRECT Answers
COCAINE intoxication - CORRECT ANSWER - impaired judgement, pupil dilate,
hallucination (coke bugs) sudden cardiac death; paranoid ideations, angina
Tx: alpha blockers/ benzos
caution B block bc can cause unopposed alpha
Osteoporosis histo - CORRECT ANSWER - trabecular and cortical bone lose mass and
interconnection despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
Gilbert Syndrome - CORRECT ANSWER - mild dec UDP glucuronosyltransferase
conjugation and impaired bilirubin uptake; asymptomatic or mild jaundice>> inc unconjugated
bilirubin w/o hemolysis; w/ fasting and stress
Crigler Najjar - CORRECT 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
Dubin Johnson - CORRECT ANSWER - Conjugated hyperbilirubinemia b/c defective
liver excretion;
grossly black liver
Benign
,Rotor syndrome - CORRECT ANSWER - milder in presentation w/o black liver
impaired hepatic uptake and excretion
wilson Disease - CORRECT 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
Hemochromatosis - CORRECT 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
Hemochromatosis finds - CORRECT ANSWER - after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism, arhtropathy;
HCC is common cause death
Treatment Hemochromatosis - CORRECT ANSWER - repeat phlebotomy, chelation
deferasirox, deferoxamine, oral deferiprone
Wolff Parkinson White Syndrome - CORRECT 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
Conduction pathway heart - CORRECT ANSWER - SA node> atira> AV node> bundle
HIS, R and L bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - CORRECT ANSWER - inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Celiac Disease - CORRECT 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
Musculocutaneous nerve C5-C7 - CORRECT ANSWER - upper trunk compression cause
injury; loss forearm flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - CORRECT ANSWER - flat deltoid; loss arm abduction, loss
sensation over deltoid and lateral arm
Radial C5-T1 - CORRECT ANSWER - mid shaft fracture humerus, compression axilla
, find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
Median C5-T1 - CORRECT 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
Ulnar C8-T1 - CORRECT 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
Recurrent branch median nerve - CORRECT ANSWER - superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Treatment glaucoma: alpha agonists; epinephrine, brimonidine - CORRECT ANSWER -
dec AH synthesis> vasoconstriction; mydriasis alpha 1 (don't use in closed angle glaucoma)
blurry vision, ocular hyperemia, foreign body sensations ocular allergy, pruritis
Beta blockers: timolol, betaxolol, carteolol - CORRECT ANSWER - dec AH synthesis; no
pupil/vision changes
CORRECT Answers
COCAINE intoxication - CORRECT ANSWER - impaired judgement, pupil dilate,
hallucination (coke bugs) sudden cardiac death; paranoid ideations, angina
Tx: alpha blockers/ benzos
caution B block bc can cause unopposed alpha
Osteoporosis histo - CORRECT ANSWER - trabecular and cortical bone lose mass and
interconnection despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
Gilbert Syndrome - CORRECT ANSWER - mild dec UDP glucuronosyltransferase
conjugation and impaired bilirubin uptake; asymptomatic or mild jaundice>> inc unconjugated
bilirubin w/o hemolysis; w/ fasting and stress
Crigler Najjar - CORRECT 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
Dubin Johnson - CORRECT ANSWER - Conjugated hyperbilirubinemia b/c defective
liver excretion;
grossly black liver
Benign
,Rotor syndrome - CORRECT ANSWER - milder in presentation w/o black liver
impaired hepatic uptake and excretion
wilson Disease - CORRECT 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
Hemochromatosis - CORRECT 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
Hemochromatosis finds - CORRECT ANSWER - after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism, arhtropathy;
HCC is common cause death
Treatment Hemochromatosis - CORRECT ANSWER - repeat phlebotomy, chelation
deferasirox, deferoxamine, oral deferiprone
Wolff Parkinson White Syndrome - CORRECT 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
Conduction pathway heart - CORRECT ANSWER - SA node> atira> AV node> bundle
HIS, R and L bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - CORRECT ANSWER - inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Celiac Disease - CORRECT 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
Musculocutaneous nerve C5-C7 - CORRECT ANSWER - upper trunk compression cause
injury; loss forearm flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - CORRECT ANSWER - flat deltoid; loss arm abduction, loss
sensation over deltoid and lateral arm
Radial C5-T1 - CORRECT ANSWER - mid shaft fracture humerus, compression axilla
, find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
Median C5-T1 - CORRECT 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
Ulnar C8-T1 - CORRECT 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
Recurrent branch median nerve - CORRECT ANSWER - superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Treatment glaucoma: alpha agonists; epinephrine, brimonidine - CORRECT ANSWER -
dec AH synthesis> vasoconstriction; mydriasis alpha 1 (don't use in closed angle glaucoma)
blurry vision, ocular hyperemia, foreign body sensations ocular allergy, pruritis
Beta blockers: timolol, betaxolol, carteolol - CORRECT ANSWER - dec AH synthesis; no
pupil/vision changes
