COMSAE UPDATED ACTUAL EXAM QUESTIONS CORRECT ANSWERS GRADED A PLUS
Question:
COCAINE intoxication
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
Question:
Osteoporosis histo
Answer:
trabecular and cortical bone lose mass and interconnection despite normal bone mineralization assoc
w/ Colles fracture- distal radial fracture; fracture of femoral neck
Question:
Gilbert Syndrome
Answer:
mild dec UDP glucuronosyltransferase conjugation and impaired bilirubin uptake; asymptomatic or
mild jaundice>> inc unconjugated bilirubin w/o hemolysis; w/ fasting and stress
Question:
Crigler Najjar
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
,Question:
Dubin Johnson
Answer:
Conjugated hyperbilirubinemia b/c defective liver excretion; grossly black liver Benign
Question:
Rotor syndrome
Answer:
milder in presentation w/o black liver impaired hepatic uptake and excretion
Question:
wilson Disease
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
Question:
Hemochromatosis
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
Question:
Hemochromatosis finds
Answer:
after age 40 >20 iron; triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy,
hypogonadism, arhtropathy; HCC is common cause death
,Question:
Treatment Hemochromatosis
Answer:
repeat phlebotomy, chelation deferasirox, deferoxamine, oral deferiprone
Question:
Wolff Parkinson White Syndrome
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
Question:
Conduction pathway heart
Answer:
SA node> atira> AV node> bundle HIS, R and L bundle branches> purkinje fibers> ventricles L
branch anterior/posterior fascicles
Question:
Edema
Answer:
inc capillary pressure dec plasma proteins (dec oncotic capillary pressure) inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Question:
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
Question:
Musculocutaneous nerve C5-C7
Answer:
upper trunk compression cause injury; loss forearm flexion/supination; loss sensation over lateral
forearm
Question:
Axillary nerve C5-C6
Answer:
flat deltoid; loss arm abduction, loss sensation over deltoid and lateral arm
Question:
Radial C5-T1
Answer:
mid shaft fracture humerus, compression axilla find: dec grip, loss extension (wrist drop); loss
sensation posterior arm, dorsal hand
Question:
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
Question:
COCAINE intoxication
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
Question:
Osteoporosis histo
Answer:
trabecular and cortical bone lose mass and interconnection despite normal bone mineralization assoc
w/ Colles fracture- distal radial fracture; fracture of femoral neck
Question:
Gilbert Syndrome
Answer:
mild dec UDP glucuronosyltransferase conjugation and impaired bilirubin uptake; asymptomatic or
mild jaundice>> inc unconjugated bilirubin w/o hemolysis; w/ fasting and stress
Question:
Crigler Najjar
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
,Question:
Dubin Johnson
Answer:
Conjugated hyperbilirubinemia b/c defective liver excretion; grossly black liver Benign
Question:
Rotor syndrome
Answer:
milder in presentation w/o black liver impaired hepatic uptake and excretion
Question:
wilson Disease
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
Question:
Hemochromatosis
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
Question:
Hemochromatosis finds
Answer:
after age 40 >20 iron; triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy,
hypogonadism, arhtropathy; HCC is common cause death
,Question:
Treatment Hemochromatosis
Answer:
repeat phlebotomy, chelation deferasirox, deferoxamine, oral deferiprone
Question:
Wolff Parkinson White Syndrome
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
Question:
Conduction pathway heart
Answer:
SA node> atira> AV node> bundle HIS, R and L bundle branches> purkinje fibers> ventricles L
branch anterior/posterior fascicles
Question:
Edema
Answer:
inc capillary pressure dec plasma proteins (dec oncotic capillary pressure) inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Question:
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
Question:
Musculocutaneous nerve C5-C7
Answer:
upper trunk compression cause injury; loss forearm flexion/supination; loss sensation over lateral
forearm
Question:
Axillary nerve C5-C6
Answer:
flat deltoid; loss arm abduction, loss sensation over deltoid and lateral arm
Question:
Radial C5-T1
Answer:
mid shaft fracture humerus, compression axilla find: dec grip, loss extension (wrist drop); loss
sensation posterior arm, dorsal hand
Question:
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
