COMSAE ALL EXAM QUESTIONS WITH
VERIFIED ANSWERS
Conduction pathway heart - ANSWER-SA node> atira> AV node> bundle HIS, R and
L bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - ANSWER-inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
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
Musculocutaneous nerve C5-C7 - ANSWER-upper trunk compression cause injury;
loss forearm flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - ANSWER-flat deltoid; loss arm abduction, loss sensation over
deltoid and lateral arm
Radial C5-T1 - ANSWER-mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
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
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
Recurrent branch median nerve - ANSWER-superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Treatment glaucoma: alpha agonists; epinephrine, brimonidine - 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 - ANSWER-dec AH synthesis; no
pupil/vision changes
Diuretics; acetazolamide - ANSWER-dec AH synthesis by inhibiting carbonic
anhydrase; no vision/pupil change
Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine,
echothiophate - ANSWER-inc outflow of AH via contraction of ciliary muscle/open
trabecular mesh; pilocarpine in ER--very effective open meshwork into Canal
schlemm,
lead to miosis--and cyclospasm
Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - ANSWER-inc outflow AH;
darken iris (brown); eyelash growth
alpha agonists should be avoided in - ANSWER-closed angle glaucoma pts
M3 agonist= pilocarpine/carbachol (direct) - ANSWER-contract the sphincter
muscles allowing passage of fluid; pilocarpine emergencies
pervasive development disorder - ANSWER-what you think of when you consider
autism spectrum: can't be touched, comforted, can't understand speech
Mifepristone/ulipristal (mifetuspleasebegone) - ANSWER-competitive inhibitor
progestins at progesterone receptors;
terminate pregnancy (mifepristone w/ misoprostol); ER contraception (ulipristal)
antiprogestins
AntiHistamines - ANSWER-Reversible inhibitor of H1 histamine receptors
1st generation antihistamines - ANSWER-diphenhydramine, dimenhydrinate,
chlorpheniramine "en/ine" or "en/ate"
use: allergy motion sick, sleep aid
AE: sedation, antimuscarinic, anti alpha adrenergic
2nd generation antihistimes - ANSWER-loratadine, fexofenadine, desloratadine,
cetgirizine "adines"
, use: allergy; far less sedation than first gen bc dec entry into CNS
Decompression disease/caisson dz) - ANSWER-Air emboli--nitrogen bubbles
precipitate in ascending divers>
tx hyperbaric O2; can be iatrogenic due to invasive procedures
Bronchiectasis - ANSWER-chronic necrotizing infection bronchi>> perm dilated
airways, purulent sputum, recurrent infecting, hemoptysis, digital clubbing;
assoc: obstruction, poor ciliary motility (Kartagener syndrome, smoking) CF, allergic
bronchopulmonary aspergillosis
Kartagener Syndrome -- primary ciliary dyskinesia - ANSWER-immotile cilia b/c dyne
arm defect; male and female infertility, inc risk ectopic pregnancy; causes
bronchiectasis, recurrent sinusitis, and situs inversus
Myasthenia gravis - ANSWER-Most C NMJ disorder;
autos to postsynaptic ACh receptor;;
clinical-ptosis diplopia weakness, worsen w/ MUSCLE USE==WORSEEE
Assoc: thymoma, thyme hyperplasia
tx: pyridostigmine, edrophonium to diagnose==AChE inhibitor
Lambert Eaton myasthenia syndrome - ANSWER-uncommon;
autoabs to presynaptic Ca+2 channel>> dec ACh release
proximal muscle weakness, autonomic sx, improve WITH MUSCLE USE= BETTER
assoc: small cell lung cancer;
AChE inhibitors don't help
Visual Field defects: Right anopia - ANSWER-Right optic nerve
2 bitemporal hemianopia - ANSWER-optic chiasm, pituitary tumor
Left homonymous hemianopia - ANSWER-right optic tract
Left upper quadratic anopia - ANSWER-right temporal lesion MCA, Meyer loop
Left Lower quadrantic anopia - ANSWER-right parietal lesion MCA--dorsal optic
radiation
Left hemianopia w/ macular sparing - ANSWER-PCA infarct
Central scotoma - ANSWER-macular degeneration
Cranial nerve III damage - ANSWER->> poss cause DM >> inc sorbitol; due dc
O2/nutrients
S/s: ptosis, down and out; diminished/absent pupillary light reflex, blown pupil
VERIFIED ANSWERS
Conduction pathway heart - ANSWER-SA node> atira> AV node> bundle HIS, R and
L bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - ANSWER-inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
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
Musculocutaneous nerve C5-C7 - ANSWER-upper trunk compression cause injury;
loss forearm flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - ANSWER-flat deltoid; loss arm abduction, loss sensation over
deltoid and lateral arm
Radial C5-T1 - ANSWER-mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
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
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
Recurrent branch median nerve - ANSWER-superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Treatment glaucoma: alpha agonists; epinephrine, brimonidine - 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 - ANSWER-dec AH synthesis; no
pupil/vision changes
Diuretics; acetazolamide - ANSWER-dec AH synthesis by inhibiting carbonic
anhydrase; no vision/pupil change
Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine,
echothiophate - ANSWER-inc outflow of AH via contraction of ciliary muscle/open
trabecular mesh; pilocarpine in ER--very effective open meshwork into Canal
schlemm,
lead to miosis--and cyclospasm
Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - ANSWER-inc outflow AH;
darken iris (brown); eyelash growth
alpha agonists should be avoided in - ANSWER-closed angle glaucoma pts
M3 agonist= pilocarpine/carbachol (direct) - ANSWER-contract the sphincter
muscles allowing passage of fluid; pilocarpine emergencies
pervasive development disorder - ANSWER-what you think of when you consider
autism spectrum: can't be touched, comforted, can't understand speech
Mifepristone/ulipristal (mifetuspleasebegone) - ANSWER-competitive inhibitor
progestins at progesterone receptors;
terminate pregnancy (mifepristone w/ misoprostol); ER contraception (ulipristal)
antiprogestins
AntiHistamines - ANSWER-Reversible inhibitor of H1 histamine receptors
1st generation antihistamines - ANSWER-diphenhydramine, dimenhydrinate,
chlorpheniramine "en/ine" or "en/ate"
use: allergy motion sick, sleep aid
AE: sedation, antimuscarinic, anti alpha adrenergic
2nd generation antihistimes - ANSWER-loratadine, fexofenadine, desloratadine,
cetgirizine "adines"
, use: allergy; far less sedation than first gen bc dec entry into CNS
Decompression disease/caisson dz) - ANSWER-Air emboli--nitrogen bubbles
precipitate in ascending divers>
tx hyperbaric O2; can be iatrogenic due to invasive procedures
Bronchiectasis - ANSWER-chronic necrotizing infection bronchi>> perm dilated
airways, purulent sputum, recurrent infecting, hemoptysis, digital clubbing;
assoc: obstruction, poor ciliary motility (Kartagener syndrome, smoking) CF, allergic
bronchopulmonary aspergillosis
Kartagener Syndrome -- primary ciliary dyskinesia - ANSWER-immotile cilia b/c dyne
arm defect; male and female infertility, inc risk ectopic pregnancy; causes
bronchiectasis, recurrent sinusitis, and situs inversus
Myasthenia gravis - ANSWER-Most C NMJ disorder;
autos to postsynaptic ACh receptor;;
clinical-ptosis diplopia weakness, worsen w/ MUSCLE USE==WORSEEE
Assoc: thymoma, thyme hyperplasia
tx: pyridostigmine, edrophonium to diagnose==AChE inhibitor
Lambert Eaton myasthenia syndrome - ANSWER-uncommon;
autoabs to presynaptic Ca+2 channel>> dec ACh release
proximal muscle weakness, autonomic sx, improve WITH MUSCLE USE= BETTER
assoc: small cell lung cancer;
AChE inhibitors don't help
Visual Field defects: Right anopia - ANSWER-Right optic nerve
2 bitemporal hemianopia - ANSWER-optic chiasm, pituitary tumor
Left homonymous hemianopia - ANSWER-right optic tract
Left upper quadratic anopia - ANSWER-right temporal lesion MCA, Meyer loop
Left Lower quadrantic anopia - ANSWER-right parietal lesion MCA--dorsal optic
radiation
Left hemianopia w/ macular sparing - ANSWER-PCA infarct
Central scotoma - ANSWER-macular degeneration
Cranial nerve III damage - ANSWER->> poss cause DM >> inc sorbitol; due dc
O2/nutrients
S/s: ptosis, down and out; diminished/absent pupillary light reflex, blown pupil
