COMLEX LEVEL 2 EXAM WITH VERIFIED
SOLUTIONS
ITP (Idiopathic thrombocytopenic purpura) - tx of choice? - Correct Answers -
Corticosteroids & IV IG
TTP (thrombotic thrombocytopenic purpura) - cause? - Correct Answers -Inhibition of
enzyme ADAMTS13, a protease that cleaves Vwf
54 y.o. multiparous female c/o 5 month hx of urinary incontinence, she admits to urinary
frequency, dribbling, and hesitancy - first step? - Correct Answers -UA (All urinary
incontinence workups should begin with UA to r/o infxn, hematuria, etc...this lady
eventually has clean UA and high postvoid residual volume via cath tx'ed by self-cath
[likely 2/2 diabetes or spinal cord trauma])
Group of physicians contract w/ an HMO for a flat fee per pt - term described? - Correct
Answers -Capitation
5 day old w/ green vomiting, no solid particles, bleed per rectum, abd series shows
double-bubble sign, upper GI series shows bird's beak - dx? - Correct Answers -Midgut
volvulus ("bird's beak" = compression/torsion... "double bubble" = duodenal
obstruction...duodenal atresia of Trisomy 21 does not have blood per rectum)
Fall on dorsiflexed hand w/ pain over dorsum of wrist at level of 3rd digit & worsened by
hand gripping - dx? - Correct Answers -Lunate fx
Hypocalcemia & hyperphosphatemia with low normal PTH - dx? - Correct Answers -
Hypoparathyroidism
Pseudohypoparathyroidism - what is it; PTH level? - Correct Answers -Kidney
unresponsiveness to PTH; high PTH
Chvostek's sign - cause; what is it? - Correct Answers -Hypocalcemia; facial nerve
tapping causes contraction of facial muscles
Trousseau's sign - cause; what is it? - Correct Answers -Hypocalcemia; blood pressure
cuff on the arm causes carpopedal spasms
Ovarian tumor causing virilization? - Correct Answers -Sertoli-Leydig cell tumor
(androgen-secreting)
,Sudden pruritic rash on palms and soles, no meds - causative organism; name of rash?
- Correct Answers -Herpes simplex virus; erythema multiforme minor
Erythema multiforme major - name of syndrome; usual cause; which bug causes;
difference between minor? - Correct Answers -Stevens-Johnson syndrome;
medications; mycoplasma pneumonia; mucous membrane ulceration w/ target lesions
Non-pruritic macules on palms and soles - most likely dx? - Correct Answers -
Secondary syphilis
[OMM] T9 ESL - setup for Muscle Energy? - Correct Answers -Flex, sidebend R, rotate
R
Labyrinthitis - tx? - Correct Answers -Corticosteroids
Meniere's dz - acute tx; chronic tx? - Correct Answers -Benzodiazepine or meclizine;
diuretic & low salt
Acute sinusitis - days after which bacterial concern > viral; supportive tx options? -
Correct Answers -10 days; antihistamine, saline spray, NSAIDS, decongestants
Rhabdomyolysis - initial tx; likely metabolic disturbance and screening test; tx to reduce
renal failure after initial step? - Correct Answers -IV hydration; hyperkalemia check
EKG; IV NaHCO3 to alkalinize urine
PCOS (polycystic ovary syndrome) - characteristic lab finding; tx? - Correct Answers -
LH:FSH ratio at least 2:1; OCPs (oral contraceptive pills) +/- spironolactone
Afebrile 25 y.o. female w/ h/o salpingitis has sausage-shaped cystic lesions inside
fallopian tube - dx? - Correct Answers -Hydrosalpinx
[OMM] Pancreatitis - chapman point? - Correct Answers -R 7th intercostal space
[OMM] Splenic dysfunction - chapman point? - Correct Answers -L 7th intercostal space
[OMM] 2nd intercostal space chapman point - possible structures involved (4 of them)?
- Correct Answers -Myocardium, thyroid gland, esophagus & bronchi
Child has a febrile seizure 2/2 AOM and presents with moderate left arm weakness -
dx? - Correct Answers -Todd's paralysis
Tourette syndrome - tx? - Correct Answers -Fluphenazine or haloperidol (typical
antipsychotic)
Tourette syndrome - comorbidities? - Correct Answers -OCD, ADHD, learning disorder,
conduct disorder
,Leg pain on flexion, absent patellar reflex - herniated disc at what level; nerve root
injured? - Correct Answers -L3-L4; L4
Barium swallow shows: - dx; tx? - Correct Answers -Diffuse esophageal spasm;
diltiazem
70 y.o. pt w/ SOB and CP w/ following EKG and clean coronary cath - dx? - Correct
Answers -Pulmonary embolism (S1Q3T3 pattern, sinus tachycardia & RBBB [S wave in
lead I, Q and T waves inverted in lead III)
A pt is placed on haloperidol and develops jitteriness and inner restlessness - side
effect name; tx? - Correct Answers -Akathisia; propranolol or benzodiazepine
Baby Ashkenazi Jew has cherry-red spot, hypotonia, mental retardation, and
hepatosplenomegaly - dx; enzyme affected; characteristic difference between similar
disorder? - Correct Answers -Niemann-Pick disease; sphingomyelinase deficiency; Tay
Sachs does NOT involved the liver (hexosaminidase deficiency)
Tall, long-armed pt with medullary thyroid CA, pheochromocytoma - what else should
be evaluated; dx; type of genetic transmission? - Correct Answers -Tumor of the
tongue; MEN IIB (MEN IIB has marfanoid body habitus and mucosal neuromas, while
MEN IIA has parathyroid tumor); autosomal dominant (all MEN II AD)
TTP (thrombotic thrombocytopenic purpura) - tx? - Correct Answers -Fresh Frozen
Plasma (urgent exchange)
45 y.o. female w/ abd pain and distension, no passage of stool or flatus, no peritoneal
signs, tympanitic abd, abd x-ray shown: - dx; tx? - Correct Answers -Sigmoid volvulus;
endoscopic decompression followed by elective sigmoid resection (50% recurrence)
27 y.o. female w/ suicidal ideation and a plan was sexually abused 16 years ago has
intrusive memories and nightmares plus hypervigilance - dx; tx? - Correct Answers -
Chronic PTSD (post-traumatic stress disorder); Inpatient admit due to suicidal behavior
(PTSD can be tx w/ SSRI and desensitization-exposure psychotherapy)
Infant w/ abdominal distension, choking upon feeding, and inability to pass NG tube -
dx; tx? - Correct Answers -Tracheoesophageal fistula (NOT choanal atresia b/c abd
distension; surgical repair)
Genetic causes of conjugated hyperbilirubinemia? - Correct Answers -Dubin-Johnson
syndrome & Rotor syndrome (DJS black liver, can't visualize gallbladder on oral
cholecystography, urine coproporphyrin I 80%...reverse is true for Rotor and 80%
coproporphyrin III)
, 2nd degree burn gives off a blue/green discharge with a fruity odor 2 weeks later - test
to identify organism? - Correct Answers -Culture and sensitivity (pseudomonas
aeruginosa)
Gastric adenocarcinoma - which 2 organisms can cause it; which blood type? - Correct
Answers -Helicobacter pylori and Epstein-Barr virus; blood type A
Drug X is being tested on several pts who have HTN - which clinical phase is it in? -
Correct Answers -Phase II (Phase II = few subjects for effectiveness, Phase III = large
scale trials, Phase IV = general surveillance after drug is released)
Most common location for compartment syndrome of the leg? - Correct Answers -
Anterior compartment (contains anterior tibial artery and deep fibular nerve)
Endometriosis and no desire to conceive - tx? - Correct Answers -OCPs & NSAIDS
(laparoscopy may be used if desires to conceive and cannot)
OCD - tx? - Correct Answers -TCA or SSRI + CBT
29 y.o. female w/ severe RUQ pain, jaundice and hepatomegaly. US shows obliteration
of hepatic vein, large collateral vessels, and ascites - dx, tx? - Correct Answers -Budd-
Chiari syndrome (thrombosis of hepatic vein or IVC 2/2 hypercoagulable state); tissue
plasminogen activator
28 y.o. male w/ unilateral headaches and "watery" eyes especially in the winter - dx;
acute tx; prophylactic tx? - Correct Answers -Cluster headache; 100% oxygen;
verapamil, prednisone, topiramte, or valproic acid
65 y.o. female with a mass in her neck that is painful while drinking alcohol, CXR shows
mediastinal lymphadenopathy, CT shows spleen involvement, bx of lymph node shows
the following image: - dx; stage; tx? - Correct Answers -Hodgkin's Lymphoma, Stage III
(Stage I = 1 lymph node, Stage II = 2 or more nodes on same side of diaphragm [above
or below], Stage III = both sides of diaphragm including one organ or area near the
lymph nodes or spleen, Stage IV = extralymphatic tissue [liver, bone, lungs]),
chemotherapy (Stage I/II = radiation, Stage III/IV = chemotherapy)
Obsessive-compulsive disorder vs. obsessive-compulsive personality disorder -
difference? - Correct Answers -OCD pt recognizes own rituals as irrational. OCPD pt
believes what they are doing is correct
Congenital Adrenal Hyperplasia - serum test for dx; high or low? - Correct Answers -17-
hydroxyprogesterone; high (21-hydroxylase is responsible for converting 17-
hydroxyprogesterone to 11-deoxycortisol)
SOLUTIONS
ITP (Idiopathic thrombocytopenic purpura) - tx of choice? - Correct Answers -
Corticosteroids & IV IG
TTP (thrombotic thrombocytopenic purpura) - cause? - Correct Answers -Inhibition of
enzyme ADAMTS13, a protease that cleaves Vwf
54 y.o. multiparous female c/o 5 month hx of urinary incontinence, she admits to urinary
frequency, dribbling, and hesitancy - first step? - Correct Answers -UA (All urinary
incontinence workups should begin with UA to r/o infxn, hematuria, etc...this lady
eventually has clean UA and high postvoid residual volume via cath tx'ed by self-cath
[likely 2/2 diabetes or spinal cord trauma])
Group of physicians contract w/ an HMO for a flat fee per pt - term described? - Correct
Answers -Capitation
5 day old w/ green vomiting, no solid particles, bleed per rectum, abd series shows
double-bubble sign, upper GI series shows bird's beak - dx? - Correct Answers -Midgut
volvulus ("bird's beak" = compression/torsion... "double bubble" = duodenal
obstruction...duodenal atresia of Trisomy 21 does not have blood per rectum)
Fall on dorsiflexed hand w/ pain over dorsum of wrist at level of 3rd digit & worsened by
hand gripping - dx? - Correct Answers -Lunate fx
Hypocalcemia & hyperphosphatemia with low normal PTH - dx? - Correct Answers -
Hypoparathyroidism
Pseudohypoparathyroidism - what is it; PTH level? - Correct Answers -Kidney
unresponsiveness to PTH; high PTH
Chvostek's sign - cause; what is it? - Correct Answers -Hypocalcemia; facial nerve
tapping causes contraction of facial muscles
Trousseau's sign - cause; what is it? - Correct Answers -Hypocalcemia; blood pressure
cuff on the arm causes carpopedal spasms
Ovarian tumor causing virilization? - Correct Answers -Sertoli-Leydig cell tumor
(androgen-secreting)
,Sudden pruritic rash on palms and soles, no meds - causative organism; name of rash?
- Correct Answers -Herpes simplex virus; erythema multiforme minor
Erythema multiforme major - name of syndrome; usual cause; which bug causes;
difference between minor? - Correct Answers -Stevens-Johnson syndrome;
medications; mycoplasma pneumonia; mucous membrane ulceration w/ target lesions
Non-pruritic macules on palms and soles - most likely dx? - Correct Answers -
Secondary syphilis
[OMM] T9 ESL - setup for Muscle Energy? - Correct Answers -Flex, sidebend R, rotate
R
Labyrinthitis - tx? - Correct Answers -Corticosteroids
Meniere's dz - acute tx; chronic tx? - Correct Answers -Benzodiazepine or meclizine;
diuretic & low salt
Acute sinusitis - days after which bacterial concern > viral; supportive tx options? -
Correct Answers -10 days; antihistamine, saline spray, NSAIDS, decongestants
Rhabdomyolysis - initial tx; likely metabolic disturbance and screening test; tx to reduce
renal failure after initial step? - Correct Answers -IV hydration; hyperkalemia check
EKG; IV NaHCO3 to alkalinize urine
PCOS (polycystic ovary syndrome) - characteristic lab finding; tx? - Correct Answers -
LH:FSH ratio at least 2:1; OCPs (oral contraceptive pills) +/- spironolactone
Afebrile 25 y.o. female w/ h/o salpingitis has sausage-shaped cystic lesions inside
fallopian tube - dx? - Correct Answers -Hydrosalpinx
[OMM] Pancreatitis - chapman point? - Correct Answers -R 7th intercostal space
[OMM] Splenic dysfunction - chapman point? - Correct Answers -L 7th intercostal space
[OMM] 2nd intercostal space chapman point - possible structures involved (4 of them)?
- Correct Answers -Myocardium, thyroid gland, esophagus & bronchi
Child has a febrile seizure 2/2 AOM and presents with moderate left arm weakness -
dx? - Correct Answers -Todd's paralysis
Tourette syndrome - tx? - Correct Answers -Fluphenazine or haloperidol (typical
antipsychotic)
Tourette syndrome - comorbidities? - Correct Answers -OCD, ADHD, learning disorder,
conduct disorder
,Leg pain on flexion, absent patellar reflex - herniated disc at what level; nerve root
injured? - Correct Answers -L3-L4; L4
Barium swallow shows: - dx; tx? - Correct Answers -Diffuse esophageal spasm;
diltiazem
70 y.o. pt w/ SOB and CP w/ following EKG and clean coronary cath - dx? - Correct
Answers -Pulmonary embolism (S1Q3T3 pattern, sinus tachycardia & RBBB [S wave in
lead I, Q and T waves inverted in lead III)
A pt is placed on haloperidol and develops jitteriness and inner restlessness - side
effect name; tx? - Correct Answers -Akathisia; propranolol or benzodiazepine
Baby Ashkenazi Jew has cherry-red spot, hypotonia, mental retardation, and
hepatosplenomegaly - dx; enzyme affected; characteristic difference between similar
disorder? - Correct Answers -Niemann-Pick disease; sphingomyelinase deficiency; Tay
Sachs does NOT involved the liver (hexosaminidase deficiency)
Tall, long-armed pt with medullary thyroid CA, pheochromocytoma - what else should
be evaluated; dx; type of genetic transmission? - Correct Answers -Tumor of the
tongue; MEN IIB (MEN IIB has marfanoid body habitus and mucosal neuromas, while
MEN IIA has parathyroid tumor); autosomal dominant (all MEN II AD)
TTP (thrombotic thrombocytopenic purpura) - tx? - Correct Answers -Fresh Frozen
Plasma (urgent exchange)
45 y.o. female w/ abd pain and distension, no passage of stool or flatus, no peritoneal
signs, tympanitic abd, abd x-ray shown: - dx; tx? - Correct Answers -Sigmoid volvulus;
endoscopic decompression followed by elective sigmoid resection (50% recurrence)
27 y.o. female w/ suicidal ideation and a plan was sexually abused 16 years ago has
intrusive memories and nightmares plus hypervigilance - dx; tx? - Correct Answers -
Chronic PTSD (post-traumatic stress disorder); Inpatient admit due to suicidal behavior
(PTSD can be tx w/ SSRI and desensitization-exposure psychotherapy)
Infant w/ abdominal distension, choking upon feeding, and inability to pass NG tube -
dx; tx? - Correct Answers -Tracheoesophageal fistula (NOT choanal atresia b/c abd
distension; surgical repair)
Genetic causes of conjugated hyperbilirubinemia? - Correct Answers -Dubin-Johnson
syndrome & Rotor syndrome (DJS black liver, can't visualize gallbladder on oral
cholecystography, urine coproporphyrin I 80%...reverse is true for Rotor and 80%
coproporphyrin III)
, 2nd degree burn gives off a blue/green discharge with a fruity odor 2 weeks later - test
to identify organism? - Correct Answers -Culture and sensitivity (pseudomonas
aeruginosa)
Gastric adenocarcinoma - which 2 organisms can cause it; which blood type? - Correct
Answers -Helicobacter pylori and Epstein-Barr virus; blood type A
Drug X is being tested on several pts who have HTN - which clinical phase is it in? -
Correct Answers -Phase II (Phase II = few subjects for effectiveness, Phase III = large
scale trials, Phase IV = general surveillance after drug is released)
Most common location for compartment syndrome of the leg? - Correct Answers -
Anterior compartment (contains anterior tibial artery and deep fibular nerve)
Endometriosis and no desire to conceive - tx? - Correct Answers -OCPs & NSAIDS
(laparoscopy may be used if desires to conceive and cannot)
OCD - tx? - Correct Answers -TCA or SSRI + CBT
29 y.o. female w/ severe RUQ pain, jaundice and hepatomegaly. US shows obliteration
of hepatic vein, large collateral vessels, and ascites - dx, tx? - Correct Answers -Budd-
Chiari syndrome (thrombosis of hepatic vein or IVC 2/2 hypercoagulable state); tissue
plasminogen activator
28 y.o. male w/ unilateral headaches and "watery" eyes especially in the winter - dx;
acute tx; prophylactic tx? - Correct Answers -Cluster headache; 100% oxygen;
verapamil, prednisone, topiramte, or valproic acid
65 y.o. female with a mass in her neck that is painful while drinking alcohol, CXR shows
mediastinal lymphadenopathy, CT shows spleen involvement, bx of lymph node shows
the following image: - dx; stage; tx? - Correct Answers -Hodgkin's Lymphoma, Stage III
(Stage I = 1 lymph node, Stage II = 2 or more nodes on same side of diaphragm [above
or below], Stage III = both sides of diaphragm including one organ or area near the
lymph nodes or spleen, Stage IV = extralymphatic tissue [liver, bone, lungs]),
chemotherapy (Stage I/II = radiation, Stage III/IV = chemotherapy)
Obsessive-compulsive disorder vs. obsessive-compulsive personality disorder -
difference? - Correct Answers -OCD pt recognizes own rituals as irrational. OCPD pt
believes what they are doing is correct
Congenital Adrenal Hyperplasia - serum test for dx; high or low? - Correct Answers -17-
hydroxyprogesterone; high (21-hydroxylase is responsible for converting 17-
hydroxyprogesterone to 11-deoxycortisol)
