COMSAE ALL EXAM QUESTIONS WITH
VERIFIED SOLUTIONS
COCAINE intoxication - -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
-Osteoporosis histo - -trabecular and cortical bone lose mass and
interconnection despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
-Gilbert Syndrome - -mild dec UDP glucuronosyltransferase conjugation and
impaired bilirubin uptake; asymptomatic or mild jaundice>> inc
unconjugated bilirubin w/o hemolysis; w/ fasting and stress
-Crigler Najjar - -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
-Dubin Johnson - -Conjugated hyperbilirubinemia b/c defective liver
excretion;
grossly black liver
Benign
-Rotor syndrome - -milder in presentation w/o black liver
impaired hepatic uptake and excretion
-wilson Disease - -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
-Hemochromatosis - -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
-Hemochromatosis finds - -after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy,
hypogonadism, arhtropathy; HCC is common cause death
-Treatment Hemochromatosis - -repeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
-Wolff Parkinson White Syndrome - -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
-Conduction pathway heart - -SA node> atira> AV node> bundle HIS, R and
L bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
-Edema - -inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
-Celiac Disease - -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
-Musculocutaneous nerve C5-C7 - -upper trunk compression cause injury;
loss forearm flexion/supination; loss sensation over lateral forearm
-Axillary nerve C5-C6 - -flat deltoid; loss arm abduction, loss sensation over
deltoid and lateral arm
-Radial C5-T1 - -mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm,
dorsal hand
, -Median C5-T1 - -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
-Ulnar C8-T1 - -Fracture medial epicondyle humerus; fractured hook hamate
(distal lesion)
ulnar claw on extension; radial deception wrist upon flexion (proximal lesion)
loss wrist flex, flex of medial fingers, abduction and adduction fingers; medial
2 lumbricals;
loss sensation over 1 1/2 fingers including hypothenar eminence
-Recurrent branch median nerve - -superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
-Treatment glaucoma: alpha agonists; epinephrine, brimonidine - -dec AH
synthesis> vasoconstriction; mydriasis alpha 1 (don't use in closed angle
glaucoma) blurry vision, ocular hyperemia, foreign body sensations ocular
allergy, pruritis
-Beta blockers: timolol, betaxolol, carteolol - -dec AH synthesis; no
pupil/vision changes
-Diuretics; acetazolamide - -dec AH synthesis by inhibiting carbonic
anhydrase; no vision/pupil change
-Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine,
echothiophate - -inc outflow of AH via contraction of ciliary muscle/open
trabecular mesh; pilocarpine in ER--very effective open meshwork into Canal
schlemm,
lead to miosis--and cyclospasm
-Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - -inc outflow AH;
darken iris (brown); eyelash growth
-alpha agonists should be avoided in - -closed angle glaucoma pts
VERIFIED SOLUTIONS
COCAINE intoxication - -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
-Osteoporosis histo - -trabecular and cortical bone lose mass and
interconnection despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
-Gilbert Syndrome - -mild dec UDP glucuronosyltransferase conjugation and
impaired bilirubin uptake; asymptomatic or mild jaundice>> inc
unconjugated bilirubin w/o hemolysis; w/ fasting and stress
-Crigler Najjar - -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
-Dubin Johnson - -Conjugated hyperbilirubinemia b/c defective liver
excretion;
grossly black liver
Benign
-Rotor syndrome - -milder in presentation w/o black liver
impaired hepatic uptake and excretion
-wilson Disease - -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
-Hemochromatosis - -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
-Hemochromatosis finds - -after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy,
hypogonadism, arhtropathy; HCC is common cause death
-Treatment Hemochromatosis - -repeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
-Wolff Parkinson White Syndrome - -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
-Conduction pathway heart - -SA node> atira> AV node> bundle HIS, R and
L bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
-Edema - -inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
-Celiac Disease - -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
-Musculocutaneous nerve C5-C7 - -upper trunk compression cause injury;
loss forearm flexion/supination; loss sensation over lateral forearm
-Axillary nerve C5-C6 - -flat deltoid; loss arm abduction, loss sensation over
deltoid and lateral arm
-Radial C5-T1 - -mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm,
dorsal hand
, -Median C5-T1 - -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
-Ulnar C8-T1 - -Fracture medial epicondyle humerus; fractured hook hamate
(distal lesion)
ulnar claw on extension; radial deception wrist upon flexion (proximal lesion)
loss wrist flex, flex of medial fingers, abduction and adduction fingers; medial
2 lumbricals;
loss sensation over 1 1/2 fingers including hypothenar eminence
-Recurrent branch median nerve - -superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
-Treatment glaucoma: alpha agonists; epinephrine, brimonidine - -dec AH
synthesis> vasoconstriction; mydriasis alpha 1 (don't use in closed angle
glaucoma) blurry vision, ocular hyperemia, foreign body sensations ocular
allergy, pruritis
-Beta blockers: timolol, betaxolol, carteolol - -dec AH synthesis; no
pupil/vision changes
-Diuretics; acetazolamide - -dec AH synthesis by inhibiting carbonic
anhydrase; no vision/pupil change
-Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine,
echothiophate - -inc outflow of AH via contraction of ciliary muscle/open
trabecular mesh; pilocarpine in ER--very effective open meshwork into Canal
schlemm,
lead to miosis--and cyclospasm
-Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - -inc outflow AH;
darken iris (brown); eyelash growth
-alpha agonists should be avoided in - -closed angle glaucoma pts
