INTERNAL MEDICINE COMAT EXAM WITH
WELL VERIFIED QUESTIONS AND ANSWERS||
GUARANTEED PASS|| LATEST VERSION 2026
What are "cannon A waves" - ANSWER-Cannon atrial waves are sometimes
seen in the jugular vein in certain arrhythmias.
When the atria & ventricles contract simultaneously, the blood will be pushed
against the AV valve and the large pressure waves runs up the vein.
*associated w/heart block...especially third degree (complete) heart block.
(it can also be seen in pulmonary HTN...and sometimes in ventricular tachy bc
of inherent AV dissociation of the arrhythmia)
Multifocal Atrial Tachycardia - ANSWER-Cardiac arrhythmia caused by
multiple sites of competing atrial activity; characterized by an irregular atrial
rate >100 beats/min.
**varrying PR interval with *3 or more morphologically distinct P waves in the
same lead***
Cannon a-waves on physical exam plus ECG showing regular P-P interval &
regular R-R interval - ANSWER-Complete (3rd degree) heart block.
*** "Varrying PR interval with 3 or more morphologically distinct P waves in
the same lead."***
,Seen in an old person with chronic lung disease in pending respiratory failure -
ANSWER-Multifocal atrial tachycardia.
Three or more consecutive beast with a QRS<120 ms at a rate of 120 beats per
minute - ANSWER-Ventricular tachycardia
Short PR interval followed by QRS <120 ms w/a slurred initial deflection
representing early ventricular activation (via bundle of Kent) - ANSWER-
Wolff-Parkinson-White syndrome.
Regular rhythm w/a atrial rate of 250-300 bpm and a ventricular rate of 125-150
bpm.
EKG has a saw-tooth appearance - ANSWER-Atrial flutter
What's a supraventricular tachycardia? - ANSWER-tachycardia that originates
at or above the AV node
Note: the patient often will experience a sudden onset of palpitations/dizziness.
What is pulsus paradoxus - ANSWER-Pulsus paradoxus= an abnormal drop in
systolic BP (>10 mm Hg) upon inspiration
In which conditions can pulsus paradoxus be seen? - ANSWER-Cardiac
tamponade
Pericarditis
Chronic sleep apnea
Croup
Obstructive lung disease (eg: asthma, COPD).
Which factor is depleted first in liver disease - ANSWER-VII (7), so PT
increases first.
,Which 2 factors aren't depleted in severe liver dz - ANSWER-VIII and vWF (bc
they're made by endothelial cells).
What looks like DIC (decreased fibrinogen, D-dimer and fibrin split products
elevated) but with normal PT and PTT - ANSWER-HUS or TTP.
Treatment of HUS/TTP - ANSWER-plasmapheresis...NO PLATELETS!!
What to consider in someone w/unprovoked thrombus - ANSWER-Cancer
Lupus Anticoagulant (increased PTT, false + VDRL, multiple spontaneous
abortions)
Protein C/S deficiency (skin necrosis after start of warfarin)
Factor V Leiden (factor 5 resistant to C)
AT III deficiency (heparin won't work)
OCPs/HRT
Nephrotic syndrome (**bc you urinate ATIII, protein C & S
preferentially)...puts pt at risk for renal vein thrombosis.
Best test for a patient that comes in w/an acute swollen, painful joint -
ANSWER-Tap it!!
>50k WBC's= septic arthritis.
Septic arthritis in a sexually active young person - ANSWER-Gonococcal.
Look for tenosynovitis & arm pustules.
*Treatment=ceftriaxone.
MC cause of septic arthritis in a "70 yr old nun" - ANSWER-Staph aureus
*treatment= nafcillin or vanco.
, Chronic treatment for gout - ANSWER-Probenecid if undersecreter.
Allopurinol if overproducer.
Antibodies in systemic sclerosis - ANSWER-anti-scl-70
anti-topoisomerase
Antibodies seen in mixed connective tissue disease - ANSWER-anti-RNP
Precursor lesion of squamous cell carcinoma - ANSWER-actinic keratosis
(*treat w/5FU or excision) or keratoacanthoma.
Types of melanoma - ANSWER-Superficial spreading (best prog, most
common)
Nodular (poor prog)
Acrolintiginous (palms, soles, mucous membranes, in darker complected races).
Lentigo maligna (head & neck; good prog)
Presentation of diabetes insipidus - ANSWER-Polyuria, polydipsia,
hypernatremia, hyperosmolarity, dilute urine.
How to differentiate central vs nephrogenic diabetes insipidus? - ANSWER-
First, do water deprivation test to see if pt has DI.
Central= urine osm still low s/p water dep; urine osm increases w/ddAVP.
Nephrogenic= urine osm still low s/p ddAVP. tx= HCTZ/amiloride (potassium-
sparing diuretic).
Treatment of hyperthyroidism - ANSWER-Propranolo + PTU/MTZ.
i131 ablation or surgery if pregnant or a child.
WELL VERIFIED QUESTIONS AND ANSWERS||
GUARANTEED PASS|| LATEST VERSION 2026
What are "cannon A waves" - ANSWER-Cannon atrial waves are sometimes
seen in the jugular vein in certain arrhythmias.
When the atria & ventricles contract simultaneously, the blood will be pushed
against the AV valve and the large pressure waves runs up the vein.
*associated w/heart block...especially third degree (complete) heart block.
(it can also be seen in pulmonary HTN...and sometimes in ventricular tachy bc
of inherent AV dissociation of the arrhythmia)
Multifocal Atrial Tachycardia - ANSWER-Cardiac arrhythmia caused by
multiple sites of competing atrial activity; characterized by an irregular atrial
rate >100 beats/min.
**varrying PR interval with *3 or more morphologically distinct P waves in the
same lead***
Cannon a-waves on physical exam plus ECG showing regular P-P interval &
regular R-R interval - ANSWER-Complete (3rd degree) heart block.
*** "Varrying PR interval with 3 or more morphologically distinct P waves in
the same lead."***
,Seen in an old person with chronic lung disease in pending respiratory failure -
ANSWER-Multifocal atrial tachycardia.
Three or more consecutive beast with a QRS<120 ms at a rate of 120 beats per
minute - ANSWER-Ventricular tachycardia
Short PR interval followed by QRS <120 ms w/a slurred initial deflection
representing early ventricular activation (via bundle of Kent) - ANSWER-
Wolff-Parkinson-White syndrome.
Regular rhythm w/a atrial rate of 250-300 bpm and a ventricular rate of 125-150
bpm.
EKG has a saw-tooth appearance - ANSWER-Atrial flutter
What's a supraventricular tachycardia? - ANSWER-tachycardia that originates
at or above the AV node
Note: the patient often will experience a sudden onset of palpitations/dizziness.
What is pulsus paradoxus - ANSWER-Pulsus paradoxus= an abnormal drop in
systolic BP (>10 mm Hg) upon inspiration
In which conditions can pulsus paradoxus be seen? - ANSWER-Cardiac
tamponade
Pericarditis
Chronic sleep apnea
Croup
Obstructive lung disease (eg: asthma, COPD).
Which factor is depleted first in liver disease - ANSWER-VII (7), so PT
increases first.
,Which 2 factors aren't depleted in severe liver dz - ANSWER-VIII and vWF (bc
they're made by endothelial cells).
What looks like DIC (decreased fibrinogen, D-dimer and fibrin split products
elevated) but with normal PT and PTT - ANSWER-HUS or TTP.
Treatment of HUS/TTP - ANSWER-plasmapheresis...NO PLATELETS!!
What to consider in someone w/unprovoked thrombus - ANSWER-Cancer
Lupus Anticoagulant (increased PTT, false + VDRL, multiple spontaneous
abortions)
Protein C/S deficiency (skin necrosis after start of warfarin)
Factor V Leiden (factor 5 resistant to C)
AT III deficiency (heparin won't work)
OCPs/HRT
Nephrotic syndrome (**bc you urinate ATIII, protein C & S
preferentially)...puts pt at risk for renal vein thrombosis.
Best test for a patient that comes in w/an acute swollen, painful joint -
ANSWER-Tap it!!
>50k WBC's= septic arthritis.
Septic arthritis in a sexually active young person - ANSWER-Gonococcal.
Look for tenosynovitis & arm pustules.
*Treatment=ceftriaxone.
MC cause of septic arthritis in a "70 yr old nun" - ANSWER-Staph aureus
*treatment= nafcillin or vanco.
, Chronic treatment for gout - ANSWER-Probenecid if undersecreter.
Allopurinol if overproducer.
Antibodies in systemic sclerosis - ANSWER-anti-scl-70
anti-topoisomerase
Antibodies seen in mixed connective tissue disease - ANSWER-anti-RNP
Precursor lesion of squamous cell carcinoma - ANSWER-actinic keratosis
(*treat w/5FU or excision) or keratoacanthoma.
Types of melanoma - ANSWER-Superficial spreading (best prog, most
common)
Nodular (poor prog)
Acrolintiginous (palms, soles, mucous membranes, in darker complected races).
Lentigo maligna (head & neck; good prog)
Presentation of diabetes insipidus - ANSWER-Polyuria, polydipsia,
hypernatremia, hyperosmolarity, dilute urine.
How to differentiate central vs nephrogenic diabetes insipidus? - ANSWER-
First, do water deprivation test to see if pt has DI.
Central= urine osm still low s/p water dep; urine osm increases w/ddAVP.
Nephrogenic= urine osm still low s/p ddAVP. tx= HCTZ/amiloride (potassium-
sparing diuretic).
Treatment of hyperthyroidism - ANSWER-Propranolo + PTU/MTZ.
i131 ablation or surgery if pregnant or a child.
