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COMLEX Level 3 Questions and Verified
Answers
Vitamin C Deficiency
Ans: Everything *normal* in coag panel
Normal PT
Normal PTT
Normal Bleeding Time
Normal Platelet Count
Hemophilia A (X-linked recessive disorder)
Ans: AKA Factor VIII deficiency - i.e. intrinsic pathway will be dysfunctional. Same
effect as pts receiving heparin.
Pts. receiving receiving Warfarin will have extrisinc pathway affected - i.e.
increased PT
Normal PT
Increased PTT
Normal Bleeding Time
Normal Platelet Count
Von Willbrand Disease (VWD) (Autosomal Dominant)
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Ans: MC inherited bleeding disorder and is transmitted as AD trait. Affects platelet
binding and is also a carrier protein for factor VIII (intrinsinc, PTT)
Normal PT
Increased PTT Increased Bleeding Time
Normal Platelet Count
DIC
Ans: Increased PT
Increased PTT
Increased Bleeding Time
Low Platelet Count
BMP and UA (least costly and invasive and most readily available)
Ans: In pts with suspected BPH and urinary retention what 2 dx tests would be most
important order first
Renal US - to eval for hydronephrosis and bladder outlet obstruction
Ans: Any pt with BPH and renal insufficiency (elevated Cr) should have a ____
performed
it's only effective if given within hours after being bitten
anaphylaxis and serum sickness so it is reserved for severe cases
Ans: When is antivenin indicated
What are 2 feared complications
opthlamic flq. make sure to tx both eyes
Ans: tx for bacterial conjunctivitis
placenta previa (definition)
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Ans: condition in which the placenta implants near or covering the cervical os
placenta previa (symptoms)
Ans: *painless*, acute vaginal bleeding in the 2nd or 3rd trimester is _____ until
proven otherwise. Can be triggered by intercourse. *contractions are absent*
placenta abruption (definition)
Ans: a condition where the placenta separates from the wall of the uterus
placental abruption (symptoms)
Ans: *painful* vaginal bleeding in the 2nd or 3rd trimester and associated with
with severe tetanic uterine *contractions*
uterine rupture *definition* and when does it usually happen
Ans: a *severely painful* condition in which the uterus opens at a previous incision
site. occurs during labor or induction of labor.
uterine rupture risk factors (5)
Ans: 1. previous rupture
2. previous uterine surgery (esp transfundal)
3. use of prostaglandins or oxytocin
4. short inter-pregnancy interval
5. hydatidiform mole (a type of gestational trophoblastic disease)
vasa previa (definition)
Ans: a condition in which the fetal vessels course through the membranes, over the
cervical os and insert into the placenta close to the os.
bedside abdominal US to confirm that the placenta is overlyling the cervical os
Do this before jumping to c-section immediately
Ans: Confirm dx of suspected placenta previa with
Expectant mgmt if the pt remains stable and her bleeding subsides.
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If hemorrhage worsens or persists or there are signs of fetal distress, immediate C-section
is warranted
Ans: Tx options for placenta previa (2)
placenta accreta (definition)
Ans: severe OB complication involving an abnormally deep attachment of the
placenta through the endometrium and into the myometrium (middle layer of the
uterine wall)
placenta accreta risk factors (7)
Ans: 1. advanced maternal age
2. multiparity
3. multiple gestation
4. hx of placenta previa
5. leiomyomas
6. smoking
7. cocaine use
uterine inversion
Ans: complication of placenta accreta
MRI
Ans: gold standard in evaluation of placenta accreta
1. MRI to establish level and amount of invasion of the placenta
2. UA - hematuria can be a sign of placental invasion into the bladder
3. AFP - this is generally elevated in cases of abnormal placental implantation
Ans: Workup for placenta accreta (3)
1. children
2. fatigue, bone pain (signs of bone marrow failure d/t the replacement with immature
blast cells), pallor, fever
3.*neutropenia* with or without anemia and thrombocytopenia
COMLEX Level 3 Questions and Verified
Answers
Vitamin C Deficiency
Ans: Everything *normal* in coag panel
Normal PT
Normal PTT
Normal Bleeding Time
Normal Platelet Count
Hemophilia A (X-linked recessive disorder)
Ans: AKA Factor VIII deficiency - i.e. intrinsic pathway will be dysfunctional. Same
effect as pts receiving heparin.
Pts. receiving receiving Warfarin will have extrisinc pathway affected - i.e.
increased PT
Normal PT
Increased PTT
Normal Bleeding Time
Normal Platelet Count
Von Willbrand Disease (VWD) (Autosomal Dominant)
, Page | 2
Ans: MC inherited bleeding disorder and is transmitted as AD trait. Affects platelet
binding and is also a carrier protein for factor VIII (intrinsinc, PTT)
Normal PT
Increased PTT Increased Bleeding Time
Normal Platelet Count
DIC
Ans: Increased PT
Increased PTT
Increased Bleeding Time
Low Platelet Count
BMP and UA (least costly and invasive and most readily available)
Ans: In pts with suspected BPH and urinary retention what 2 dx tests would be most
important order first
Renal US - to eval for hydronephrosis and bladder outlet obstruction
Ans: Any pt with BPH and renal insufficiency (elevated Cr) should have a ____
performed
it's only effective if given within hours after being bitten
anaphylaxis and serum sickness so it is reserved for severe cases
Ans: When is antivenin indicated
What are 2 feared complications
opthlamic flq. make sure to tx both eyes
Ans: tx for bacterial conjunctivitis
placenta previa (definition)
, Page | 3
Ans: condition in which the placenta implants near or covering the cervical os
placenta previa (symptoms)
Ans: *painless*, acute vaginal bleeding in the 2nd or 3rd trimester is _____ until
proven otherwise. Can be triggered by intercourse. *contractions are absent*
placenta abruption (definition)
Ans: a condition where the placenta separates from the wall of the uterus
placental abruption (symptoms)
Ans: *painful* vaginal bleeding in the 2nd or 3rd trimester and associated with
with severe tetanic uterine *contractions*
uterine rupture *definition* and when does it usually happen
Ans: a *severely painful* condition in which the uterus opens at a previous incision
site. occurs during labor or induction of labor.
uterine rupture risk factors (5)
Ans: 1. previous rupture
2. previous uterine surgery (esp transfundal)
3. use of prostaglandins or oxytocin
4. short inter-pregnancy interval
5. hydatidiform mole (a type of gestational trophoblastic disease)
vasa previa (definition)
Ans: a condition in which the fetal vessels course through the membranes, over the
cervical os and insert into the placenta close to the os.
bedside abdominal US to confirm that the placenta is overlyling the cervical os
Do this before jumping to c-section immediately
Ans: Confirm dx of suspected placenta previa with
Expectant mgmt if the pt remains stable and her bleeding subsides.
, Page | 4
If hemorrhage worsens or persists or there are signs of fetal distress, immediate C-section
is warranted
Ans: Tx options for placenta previa (2)
placenta accreta (definition)
Ans: severe OB complication involving an abnormally deep attachment of the
placenta through the endometrium and into the myometrium (middle layer of the
uterine wall)
placenta accreta risk factors (7)
Ans: 1. advanced maternal age
2. multiparity
3. multiple gestation
4. hx of placenta previa
5. leiomyomas
6. smoking
7. cocaine use
uterine inversion
Ans: complication of placenta accreta
MRI
Ans: gold standard in evaluation of placenta accreta
1. MRI to establish level and amount of invasion of the placenta
2. UA - hematuria can be a sign of placental invasion into the bladder
3. AFP - this is generally elevated in cases of abnormal placental implantation
Ans: Workup for placenta accreta (3)
1. children
2. fatigue, bone pain (signs of bone marrow failure d/t the replacement with immature
blast cells), pallor, fever
3.*neutropenia* with or without anemia and thrombocytopenia
