COMLEX LEVEL 1 QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
cysteine stone - ANSWER - *Hexagonal* stones
- *Ground, glass appearance*
- *(+) urinary cyanide nitroprusside test
- Defect in renal transport of COLA: Cysteine, Ornithine, Lysine, Arginine
- Does NOT respond to shock wave therapy
angiodysplasia - ANSWER most common cause of lower GI bleeding in pt's >60
superior mesenteric artery - ANSWER supplies the lower portion of the duodenum, jejunum, ileum,
cecum, ascending colon, and transverse colon to the splenic flexure
pancreatic cancer - ANSWER -usually arises in the *head* of the pancreas
-is associated with *jaundice and pain* due to obstruction of the common bile duct
- it is the *4th* most common cause of cancer
-has a very poor prognosis
1. Calcium channel blockers--> specifically smooth muscle antagonists--> SM dilation
2. Alpha adrenergic receptor blockers --> cause dilation of vessels instead of constriction
3. Beta 2 agonists: causes dilation of smooth muscle vessels - ANSWER Patients with GERD normally have
a dysfunction with LES sphincter tone that allows acid to reflux into the esophagus, thus drugs that affect
sphincter tone would make GERD worse. What are the name of three drug categories that do this?
celiac disease - ANSWER malabsorption syndrome caused by an immune reaction to gliadian protein in
gluten
-Tissue transglutaminase
-results in villous atrophy of small intestine mucosa and causes steatorrhea, diarrhea, bloating and
abdominal pain
-*also associated with other autoimmune disorders like hashimotos thyroiditis*
,make NPO, Place on an NG tube and suction obstruction out--> this will usually resolve obstruction -
ANSWER after a patient comes to the ER with sudden onset of pain and abdominal distention W/O
peritoneal signs and after x-ray you diagnose her with a small bowel obstruction. What do you do next?
Low total calcium due to low albumin levels from cirrhosis (95% of Ca2+ is bound to albumin) and
normal ionized Ca2+ because PTH regulates free ionized Ca2+ independently--> that is why there are no
signs go hypocalcemia - ANSWER In a patient with liver cirrhosis what calcium levels would you expect to
see?
Would there be signs of hypocalcemia--> tetany, paresthesias, abdominal cramps?
T5-T11 - ANSWER where would you find a viserosomatic reflex resulting in placatory changes of the
pancreas?
Deferoxamine (Desferal) - ANSWER iron chelating agent used in the treatment of iron intoxication
short leg syndrome - ANSWER when a patient presents with a flexible scoliotic curve it is important to
evaluate for...
inferior trunk--> encompasses broadmann areas 22,39,40 which are in the temporal region - ANSWER
Infarct to what trunk of the Left MCA results in Wernicke's aphasia?
Superior division--> encompasses brooks area, frontal eye field, primary motor cortex and primary
somatosensory cortex - ANSWER Infarct to what trunk of the Left MCA results in Broca's aphasia?
Osteosarcoma - ANSWER bone tumor that is present in young adult males that involves the metaphysis
of the long bones
Ewing's sarcoma t(11;22) - ANSWER bone tumor that is present in young adult males that involves the
*diaphysis(mid-shaft)* of the long bones.
fibrosarcoma - ANSWER malignant fibroblasts within a collagenous matrix
,chondrosarcoma - ANSWER osseous sarcomas that affect older patients and has a predilection for flat
bones in the *shoulders and pelvis*
tyrosine, due to a defect in phenylalanine hydroxylase - ANSWER PKU presents as failure to thrive,
mental retardation, gapped teeth, etc. What is the amino acid that needs to be supplemented due to a
defect in what enzyme?
Rib 2 - ANSWER where does the posterior scalene attach to?
Paclitaxel - ANSWER used in the treatment of breast and ovarian cancer
MOA: hyper stabilization of polymerized microtubules--> prevents the breakdown of the mitotic spindle
restrictive barrier - ANSWER maximum distance a patient can actually move a joint, can be pathologic
narcissistic personality disorder - ANSWER patterns of grandiosity, need for admiration, lack of empathy
for others
A carotid massage causes an increase in stretch of the carotid baroreceptors which causes a reflexive
PARASYM response which slows down the conduction velocity through the AV node this slowing down
Heart Rate--> used in paroxysmal supra ventricular tachycardia - ANSWER what does a carotid massage
do and how does it affect the AV node?
Chronic myelogenous leukemia t(9;22)--> Philly chx - ANSWER a form of leukemia characterized by the
accumulation of abnormal, mature granulocytes (granulocytes are a type of white blood cell), mild
anemia, thrombocytosis and basophilia. What is the associated chromosomal translocation?
Burkitt's lymphoma t(8;14) - ANSWER germinal B celll lymphoma that is associated with a translocation
between c-MYC and the Ig heavy chain on which two chromosomes? It is endemic in the continent of
Africa which produces this
follicular lymphoma t(14;18) - ANSWER second most common lymphoma in the US, arises from germinal
center B-cells. Presents with painless peripheral lymphadenopathy w/ a history of lymph node
, enlargement . Positive for CD 10, CD 19 and CD 20 expression. Results in what chromosomal
translocation evolving the BCL-2 gene?
Acute promyelocytic leukemia t(15;17) - ANSWER PML/RARA fusion gene
associated with DIC, characteristic folded, bilobed nuclei are found in these certain type of cells. Coarse
azurorophilic granules and multiple Auer rods are also present on histo
Clopidogrel - ANSWER inhibits platelet aggregation by irreversibly blocking the P2Y12 component of ADP
receptors
Bacillus anthracis, tendonopathy - ANSWER textile industry worker that develops a low-grade fever, non-
productive cough and substernal chest pain have what bug? Treatment is with a fluroquinolone and why
are frequently associated with what ADR?
G-6-PD deficiency - ANSWER X-linked recessive disorder present in AAs and Mediterraneans that cause
an inability to generate reduced glutathione and lead to acute hemolysis when stress occurs. You will see
bite cells and Heinz bodies on peripheral blood smear.
Itranuclear opthalmoplegia - ANSWER seen in those with MS, causes impaired horizontal eye movement
w/ weak adduction of the affected eye and abduction nystagmus of the contralateral eye. Due to a lesion
in the MLF in the dorsomedial brainstem tegmentum of wither the pons or the midbrain
lead poisoning - ANSWER causes lethargy, seizures, or coma--> can also develop distal motor
neuropathies.
-leads to denaturation of the enzyme ribonuclease which causes ribosomes to persist in the the RBCs
and lead to basophilic stippling
myofasical release, BLT, FPR, counterstain - ANSWER what are indirect OMM techniques?
Articulatory technique - ANSWER OMM technique classified as low velocity, moderate to high amplitude
pericarditis - ANSWER EKG presents with PR depression, ST segment elevation and PR elevation in lead II.
They also have sharp, midsternal, non-radiating chest pain and mild lethargy. What do they have?
ANSWERS WITH SOLUTIONS 2024
cysteine stone - ANSWER - *Hexagonal* stones
- *Ground, glass appearance*
- *(+) urinary cyanide nitroprusside test
- Defect in renal transport of COLA: Cysteine, Ornithine, Lysine, Arginine
- Does NOT respond to shock wave therapy
angiodysplasia - ANSWER most common cause of lower GI bleeding in pt's >60
superior mesenteric artery - ANSWER supplies the lower portion of the duodenum, jejunum, ileum,
cecum, ascending colon, and transverse colon to the splenic flexure
pancreatic cancer - ANSWER -usually arises in the *head* of the pancreas
-is associated with *jaundice and pain* due to obstruction of the common bile duct
- it is the *4th* most common cause of cancer
-has a very poor prognosis
1. Calcium channel blockers--> specifically smooth muscle antagonists--> SM dilation
2. Alpha adrenergic receptor blockers --> cause dilation of vessels instead of constriction
3. Beta 2 agonists: causes dilation of smooth muscle vessels - ANSWER Patients with GERD normally have
a dysfunction with LES sphincter tone that allows acid to reflux into the esophagus, thus drugs that affect
sphincter tone would make GERD worse. What are the name of three drug categories that do this?
celiac disease - ANSWER malabsorption syndrome caused by an immune reaction to gliadian protein in
gluten
-Tissue transglutaminase
-results in villous atrophy of small intestine mucosa and causes steatorrhea, diarrhea, bloating and
abdominal pain
-*also associated with other autoimmune disorders like hashimotos thyroiditis*
,make NPO, Place on an NG tube and suction obstruction out--> this will usually resolve obstruction -
ANSWER after a patient comes to the ER with sudden onset of pain and abdominal distention W/O
peritoneal signs and after x-ray you diagnose her with a small bowel obstruction. What do you do next?
Low total calcium due to low albumin levels from cirrhosis (95% of Ca2+ is bound to albumin) and
normal ionized Ca2+ because PTH regulates free ionized Ca2+ independently--> that is why there are no
signs go hypocalcemia - ANSWER In a patient with liver cirrhosis what calcium levels would you expect to
see?
Would there be signs of hypocalcemia--> tetany, paresthesias, abdominal cramps?
T5-T11 - ANSWER where would you find a viserosomatic reflex resulting in placatory changes of the
pancreas?
Deferoxamine (Desferal) - ANSWER iron chelating agent used in the treatment of iron intoxication
short leg syndrome - ANSWER when a patient presents with a flexible scoliotic curve it is important to
evaluate for...
inferior trunk--> encompasses broadmann areas 22,39,40 which are in the temporal region - ANSWER
Infarct to what trunk of the Left MCA results in Wernicke's aphasia?
Superior division--> encompasses brooks area, frontal eye field, primary motor cortex and primary
somatosensory cortex - ANSWER Infarct to what trunk of the Left MCA results in Broca's aphasia?
Osteosarcoma - ANSWER bone tumor that is present in young adult males that involves the metaphysis
of the long bones
Ewing's sarcoma t(11;22) - ANSWER bone tumor that is present in young adult males that involves the
*diaphysis(mid-shaft)* of the long bones.
fibrosarcoma - ANSWER malignant fibroblasts within a collagenous matrix
,chondrosarcoma - ANSWER osseous sarcomas that affect older patients and has a predilection for flat
bones in the *shoulders and pelvis*
tyrosine, due to a defect in phenylalanine hydroxylase - ANSWER PKU presents as failure to thrive,
mental retardation, gapped teeth, etc. What is the amino acid that needs to be supplemented due to a
defect in what enzyme?
Rib 2 - ANSWER where does the posterior scalene attach to?
Paclitaxel - ANSWER used in the treatment of breast and ovarian cancer
MOA: hyper stabilization of polymerized microtubules--> prevents the breakdown of the mitotic spindle
restrictive barrier - ANSWER maximum distance a patient can actually move a joint, can be pathologic
narcissistic personality disorder - ANSWER patterns of grandiosity, need for admiration, lack of empathy
for others
A carotid massage causes an increase in stretch of the carotid baroreceptors which causes a reflexive
PARASYM response which slows down the conduction velocity through the AV node this slowing down
Heart Rate--> used in paroxysmal supra ventricular tachycardia - ANSWER what does a carotid massage
do and how does it affect the AV node?
Chronic myelogenous leukemia t(9;22)--> Philly chx - ANSWER a form of leukemia characterized by the
accumulation of abnormal, mature granulocytes (granulocytes are a type of white blood cell), mild
anemia, thrombocytosis and basophilia. What is the associated chromosomal translocation?
Burkitt's lymphoma t(8;14) - ANSWER germinal B celll lymphoma that is associated with a translocation
between c-MYC and the Ig heavy chain on which two chromosomes? It is endemic in the continent of
Africa which produces this
follicular lymphoma t(14;18) - ANSWER second most common lymphoma in the US, arises from germinal
center B-cells. Presents with painless peripheral lymphadenopathy w/ a history of lymph node
, enlargement . Positive for CD 10, CD 19 and CD 20 expression. Results in what chromosomal
translocation evolving the BCL-2 gene?
Acute promyelocytic leukemia t(15;17) - ANSWER PML/RARA fusion gene
associated with DIC, characteristic folded, bilobed nuclei are found in these certain type of cells. Coarse
azurorophilic granules and multiple Auer rods are also present on histo
Clopidogrel - ANSWER inhibits platelet aggregation by irreversibly blocking the P2Y12 component of ADP
receptors
Bacillus anthracis, tendonopathy - ANSWER textile industry worker that develops a low-grade fever, non-
productive cough and substernal chest pain have what bug? Treatment is with a fluroquinolone and why
are frequently associated with what ADR?
G-6-PD deficiency - ANSWER X-linked recessive disorder present in AAs and Mediterraneans that cause
an inability to generate reduced glutathione and lead to acute hemolysis when stress occurs. You will see
bite cells and Heinz bodies on peripheral blood smear.
Itranuclear opthalmoplegia - ANSWER seen in those with MS, causes impaired horizontal eye movement
w/ weak adduction of the affected eye and abduction nystagmus of the contralateral eye. Due to a lesion
in the MLF in the dorsomedial brainstem tegmentum of wither the pons or the midbrain
lead poisoning - ANSWER causes lethargy, seizures, or coma--> can also develop distal motor
neuropathies.
-leads to denaturation of the enzyme ribonuclease which causes ribosomes to persist in the the RBCs
and lead to basophilic stippling
myofasical release, BLT, FPR, counterstain - ANSWER what are indirect OMM techniques?
Articulatory technique - ANSWER OMM technique classified as low velocity, moderate to high amplitude
pericarditis - ANSWER EKG presents with PR depression, ST segment elevation and PR elevation in lead II.
They also have sharp, midsternal, non-radiating chest pain and mild lethargy. What do they have?
