COMSAE 2 Exam
Questions and
Complete Solutions
Graded A+
Denning [Date] [Course title]
,Sheehan Syndrome - Answer: A rare condition that occurs secondary to pituitary ischemia and
subsequent infarction following significant postpartum bleeding. This occurs due to the decreased
perfusion of the pituitary during the final stages of pregnancy and labor process. This can also occur due
to significant blood loss during labor, leading to hypoperfusion of the pituitary gland and subsequent
infarction. This will in turn cause a global decrease in the hormones that are produced in the anterior
pituitary.
The production of ADH and oxytocin is not affected because both hormones are produced in the
hypothalamus, and stored in the posterior pituitary gland.
Bosentan & Ambrisentan MOA - Answer: They treat pulmonary hypertension by competitively
antagonizing endothelin-1 receptors, thus, decreasing pulmonary vascular resistance.
Inclusion Body Myositis - Answer: Characterized by inflammation and endomysial infiltrates of CD8+ T
cells and macrophages that focally surround and invade myofibrils. The presence of rimmed vacuoles is
a characteristic feature. It is more common in males over the age of 50-years-old. It manifests as an
insidious onset of proximal muscle weakness, often with associated distal muscle weakness. The
distribution of weakness is variable, but unlike polymyositis and dermatomyositis, asymmetry is
common. Early involvement of the knee extensors, ankle dorsiflexors, and wrist and finger flexors is
characteristic. Weakness of the wrist and finger flexors is often greater than their extensor counterparts.
Hence, loss of finger dexterity and grip strength may be a prominent symptom. It also commonly causes
greater weakness in knee extension when compared with the hip flexors. Deep tendon reflexes may be
impaired or absent if weakness is severe. Laboratory results reveal a normal to slightly elevated level of
serum creatine kinase. Muscle biopsy is the gold standard for diagnosis.
Polymyalgia Rheumatica - Answer: A disease of the elderly that causes proximal myalgias of the hip and
shoulder girdles. The symptoms appear first in the shoulder girdle, and patients commonly complain of
stiffness after prolonged inactivity. The shoulder and hip girdles can be painful and stiff, causing difficulty
in rising from a chair or raising their arms over their shoulder. Patients also have morning stiffness that
typically lasts for more than one hour. There is no muscle weakness, as compared to dermatomyositis
and polymyositis. It is commonly associated with giant cell arteritis. Laboratory studies reveal an
erythrocyte sedimentation rate (ESR) > 40 mm/h. Treatment is with prednisone.
What is the genetic transmission of Duchenne & Becker Muscular Dystrophy? - Answer: XLR
5% Sheep Blood added to? - Answer: Blood agar usually contains 5% sheep blood and is used to
determine hemolysis patterns of Streptococcus
, Eosin-methylene blue is added to? - Answer: A staining agent used to visualize Escherichia coli that
show up as a metallic sheen.
Nystatin is added to help culture which organism? - Answer: Nystatin is a part of the VPN or Thayer-
Martin agar designed to grow Neisseria gonorrhoeae.
What 2 OMM techniques can be used to thin mucous secretions in a pt with Asthma? - Answer: Asthma
is the most common chronic disease in childhood and asthma symptoms include wheezing, shortness of
breath, chest tightness and cough. Asthma involves hypersensitivity of the bronchi and lower airways to
allergens, cold or other irritants. This results in inflammation, bronchospasm and mucous plugging. β-2-
agonists help dilate the bronchioles but do not directly affect the sympathetic nerves which regulate
secretions. Persistent asthma can drive the upper thoracic (particularly T1-T4) sympathetic nerves into a
chronically active state. One particularly significant physiologic response of this is proliferation of goblet
cells. These cells in the bronchial mucosa produce thick, tenacious secretions which are difficult to clear.
Rib raising is one method of normalizing (in this case, decreasing) sympathetic tone to thin the
secretions. Another useful method is the thoracic pump, which can be particularly helpful in normalizing
lymphatic flow out of congested tissues.
Sympathetic Vicerosomatics - Answer:
Isolated Tricuspid Stenosis MC from? - Answer: The most common causes are due to carcinoid heart
disease and right atrial myxoma.
What is the MOA of an Aspirin Overdose? - Answer: It causes the uncoupling of oxidative
phosphorylation and thereby reduces the amount of ATP produced. Aspirin transports protons
generated by the electron transport chain back into the mitochondrial matrix. This decreases the
amount of protons available for ATP synthase to use for formation of ATP. As a result, there is an
accumulation of carbon dioxide in the body. Which leads to a respiratory alkolosis which is then
followed by a Metabolic acidosis to recompensate (Mixed)
What is the Antidote for Cyanide Poisoning? - Answer: Amyl nitrite. Cyanide inhibits cytochrome
oxidase enzyme in the electron transport chain within mitochondria. This causes depletion of ATP.
Patients with cyanide poisoning present with elevated heart rates, drowsiness, and eventual coma and
death.
Questions and
Complete Solutions
Graded A+
Denning [Date] [Course title]
,Sheehan Syndrome - Answer: A rare condition that occurs secondary to pituitary ischemia and
subsequent infarction following significant postpartum bleeding. This occurs due to the decreased
perfusion of the pituitary during the final stages of pregnancy and labor process. This can also occur due
to significant blood loss during labor, leading to hypoperfusion of the pituitary gland and subsequent
infarction. This will in turn cause a global decrease in the hormones that are produced in the anterior
pituitary.
The production of ADH and oxytocin is not affected because both hormones are produced in the
hypothalamus, and stored in the posterior pituitary gland.
Bosentan & Ambrisentan MOA - Answer: They treat pulmonary hypertension by competitively
antagonizing endothelin-1 receptors, thus, decreasing pulmonary vascular resistance.
Inclusion Body Myositis - Answer: Characterized by inflammation and endomysial infiltrates of CD8+ T
cells and macrophages that focally surround and invade myofibrils. The presence of rimmed vacuoles is
a characteristic feature. It is more common in males over the age of 50-years-old. It manifests as an
insidious onset of proximal muscle weakness, often with associated distal muscle weakness. The
distribution of weakness is variable, but unlike polymyositis and dermatomyositis, asymmetry is
common. Early involvement of the knee extensors, ankle dorsiflexors, and wrist and finger flexors is
characteristic. Weakness of the wrist and finger flexors is often greater than their extensor counterparts.
Hence, loss of finger dexterity and grip strength may be a prominent symptom. It also commonly causes
greater weakness in knee extension when compared with the hip flexors. Deep tendon reflexes may be
impaired or absent if weakness is severe. Laboratory results reveal a normal to slightly elevated level of
serum creatine kinase. Muscle biopsy is the gold standard for diagnosis.
Polymyalgia Rheumatica - Answer: A disease of the elderly that causes proximal myalgias of the hip and
shoulder girdles. The symptoms appear first in the shoulder girdle, and patients commonly complain of
stiffness after prolonged inactivity. The shoulder and hip girdles can be painful and stiff, causing difficulty
in rising from a chair or raising their arms over their shoulder. Patients also have morning stiffness that
typically lasts for more than one hour. There is no muscle weakness, as compared to dermatomyositis
and polymyositis. It is commonly associated with giant cell arteritis. Laboratory studies reveal an
erythrocyte sedimentation rate (ESR) > 40 mm/h. Treatment is with prednisone.
What is the genetic transmission of Duchenne & Becker Muscular Dystrophy? - Answer: XLR
5% Sheep Blood added to? - Answer: Blood agar usually contains 5% sheep blood and is used to
determine hemolysis patterns of Streptococcus
, Eosin-methylene blue is added to? - Answer: A staining agent used to visualize Escherichia coli that
show up as a metallic sheen.
Nystatin is added to help culture which organism? - Answer: Nystatin is a part of the VPN or Thayer-
Martin agar designed to grow Neisseria gonorrhoeae.
What 2 OMM techniques can be used to thin mucous secretions in a pt with Asthma? - Answer: Asthma
is the most common chronic disease in childhood and asthma symptoms include wheezing, shortness of
breath, chest tightness and cough. Asthma involves hypersensitivity of the bronchi and lower airways to
allergens, cold or other irritants. This results in inflammation, bronchospasm and mucous plugging. β-2-
agonists help dilate the bronchioles but do not directly affect the sympathetic nerves which regulate
secretions. Persistent asthma can drive the upper thoracic (particularly T1-T4) sympathetic nerves into a
chronically active state. One particularly significant physiologic response of this is proliferation of goblet
cells. These cells in the bronchial mucosa produce thick, tenacious secretions which are difficult to clear.
Rib raising is one method of normalizing (in this case, decreasing) sympathetic tone to thin the
secretions. Another useful method is the thoracic pump, which can be particularly helpful in normalizing
lymphatic flow out of congested tissues.
Sympathetic Vicerosomatics - Answer:
Isolated Tricuspid Stenosis MC from? - Answer: The most common causes are due to carcinoid heart
disease and right atrial myxoma.
What is the MOA of an Aspirin Overdose? - Answer: It causes the uncoupling of oxidative
phosphorylation and thereby reduces the amount of ATP produced. Aspirin transports protons
generated by the electron transport chain back into the mitochondrial matrix. This decreases the
amount of protons available for ATP synthase to use for formation of ATP. As a result, there is an
accumulation of carbon dioxide in the body. Which leads to a respiratory alkolosis which is then
followed by a Metabolic acidosis to recompensate (Mixed)
What is the Antidote for Cyanide Poisoning? - Answer: Amyl nitrite. Cyanide inhibits cytochrome
oxidase enzyme in the electron transport chain within mitochondria. This causes depletion of ATP.
Patients with cyanide poisoning present with elevated heart rates, drowsiness, and eventual coma and
death.
