COMLEX Level 3 Deck 1-Questions with 100%
Correct Answers
Tx of acute chest syndrome requiring intubation:
1) Exchange transfusion with goal of reducing % of sickle Hgb to <30% to improve blood
flow/O2 delivery to tissues
Note that simple transfusion would not be good enough to change % of HgbS without markedly
increasing Hgb (higher viscosity/clot risk)
In pts with low Hgb <5, simple transfusion + hydration can be sufficient because it will dilute the
HgbS to nearly equal an exchange transfusion
Reynold's pentad is associated with
RUQ pain, fever, jaundice (charcot triad)
+
new onset confusion and possible septic shock
= ascending cholangitis
Abx treatment for ascending cholangitis
Escherichia, Klebsiella, Enterobacter...
Piperacillin-Tazobactam
or
Ceftriaxone + Metronidazole
viscerosomatic levels of foregut, midgut, and hindgut
,Foregut: T5-9
- esophagus --> proximal duodenum, liver/biliary tree/pancreas
Midgut: T10-11
-small intestine -->proximal 2/3 of transverse colon
Hindgut: T11-12
- distal 1/3 of transverse colon --> rectosigmoid
Nasopharyngeal carcinoma is is associated with what virus
EBV (Burkitt lymphoma)
pt presenting with dyspnea, loud P2, and bilateral lung infiltrates ......with hx of tightening of
skin around fingertips, severe GERD, and Raynaud syndrome
Scleroderma renal crisis (suspect if new onset HTN and rise of >50% in serum creatinine) -->
malignant hypertension with encephalopathy or retinopathy due to obliteration of the small
arterioles and glomerular destruction
Diffuse cutaneous systemic sclerosis (dcSSc)
vs
Limited cutaneous systemic sclerosis (lcSSc)
vs
Morphea
vs
Systemic sclerosis sine scleroderma
Autoimmune disease systemic sclerosis has several subsets:
1) dcSSC = "scleroderma"
- will have sclerosis of skin PROXIMAL to wrists
- symptoms can include hypopigmentation of skin, Raynaud's, GERD, clacinosis cutis,
,hyperpigmentation, telangiectasia, systemic HTN, renal failure, pulm HTN, ILD, intestinal
dysmotility
2) lcSSc = CREST syndrome
- distinguished by amount of skin thickening --- only involves the HANDS and minimal of
face/neck
- calcinosis, raynaud, esophageal dysmotility, sclerodactyly, telangectasias
3) Morphea
- limited skin thickening (generally spares hands and face) WITHOUT systemic organ
involvement
4) Systemic sclerosis sine scleroderma
- GI/lung/renal involvement as SSC but w/o skin thickening
Vasculitis associated with diabetics
Necrobiosis lipoidica
- shiny asymptomatic patches (red brown) on shin that progress to yellow depressed atrophic
plaques
- often painless vasculitis caused by collagen degeneration with granulomatous response,
thickening of blood vessel walls, and fat deposition
- Management: protect legs with elastic support stockings and leg rest to prevent
trauma/ulceration
Vasculitis associated with heavy tobacco use
Buerger disease (thromboangiitis obliterans)
- resting pain, ischemic ulcerations, gangrene of digits of hands/feet
Management of ITP
, Prednisone, IVIG, rituximab and if necessary, splenectomy
Etiology of disease: autoimmune (usually after acute infection) in which IgG Ab bind to platelets
and lead to their excessive destruction in the spleen --> isolated low platelet w/ no significant
PMH
Pseudohyphae budding yeast
Candida
tx: azoles or nystatin
Septate hyphae with acute angle branching
Aspergillus
tx: voriconazole + amphotericin B
Disc-shaped yeast on Wright stain
Pneumocystis
tx: TMP-SMX
Non-septate hyphae with WIDE-angle branching
Mucormycosis
tx: amphotericin B
Risser sign
Degree of calcification of pelvis as related to skeletal maturity
1: 25% calcified, early puberty
2: 50% calcified, just before growth spurt
3: 75% calcified, slowing of growth
4: 100% calcified, cessation of growth
5: 100% calcified, iliac apophysis fused to iliac crest
Common sleep aids
Correct Answers
Tx of acute chest syndrome requiring intubation:
1) Exchange transfusion with goal of reducing % of sickle Hgb to <30% to improve blood
flow/O2 delivery to tissues
Note that simple transfusion would not be good enough to change % of HgbS without markedly
increasing Hgb (higher viscosity/clot risk)
In pts with low Hgb <5, simple transfusion + hydration can be sufficient because it will dilute the
HgbS to nearly equal an exchange transfusion
Reynold's pentad is associated with
RUQ pain, fever, jaundice (charcot triad)
+
new onset confusion and possible septic shock
= ascending cholangitis
Abx treatment for ascending cholangitis
Escherichia, Klebsiella, Enterobacter...
Piperacillin-Tazobactam
or
Ceftriaxone + Metronidazole
viscerosomatic levels of foregut, midgut, and hindgut
,Foregut: T5-9
- esophagus --> proximal duodenum, liver/biliary tree/pancreas
Midgut: T10-11
-small intestine -->proximal 2/3 of transverse colon
Hindgut: T11-12
- distal 1/3 of transverse colon --> rectosigmoid
Nasopharyngeal carcinoma is is associated with what virus
EBV (Burkitt lymphoma)
pt presenting with dyspnea, loud P2, and bilateral lung infiltrates ......with hx of tightening of
skin around fingertips, severe GERD, and Raynaud syndrome
Scleroderma renal crisis (suspect if new onset HTN and rise of >50% in serum creatinine) -->
malignant hypertension with encephalopathy or retinopathy due to obliteration of the small
arterioles and glomerular destruction
Diffuse cutaneous systemic sclerosis (dcSSc)
vs
Limited cutaneous systemic sclerosis (lcSSc)
vs
Morphea
vs
Systemic sclerosis sine scleroderma
Autoimmune disease systemic sclerosis has several subsets:
1) dcSSC = "scleroderma"
- will have sclerosis of skin PROXIMAL to wrists
- symptoms can include hypopigmentation of skin, Raynaud's, GERD, clacinosis cutis,
,hyperpigmentation, telangiectasia, systemic HTN, renal failure, pulm HTN, ILD, intestinal
dysmotility
2) lcSSc = CREST syndrome
- distinguished by amount of skin thickening --- only involves the HANDS and minimal of
face/neck
- calcinosis, raynaud, esophageal dysmotility, sclerodactyly, telangectasias
3) Morphea
- limited skin thickening (generally spares hands and face) WITHOUT systemic organ
involvement
4) Systemic sclerosis sine scleroderma
- GI/lung/renal involvement as SSC but w/o skin thickening
Vasculitis associated with diabetics
Necrobiosis lipoidica
- shiny asymptomatic patches (red brown) on shin that progress to yellow depressed atrophic
plaques
- often painless vasculitis caused by collagen degeneration with granulomatous response,
thickening of blood vessel walls, and fat deposition
- Management: protect legs with elastic support stockings and leg rest to prevent
trauma/ulceration
Vasculitis associated with heavy tobacco use
Buerger disease (thromboangiitis obliterans)
- resting pain, ischemic ulcerations, gangrene of digits of hands/feet
Management of ITP
, Prednisone, IVIG, rituximab and if necessary, splenectomy
Etiology of disease: autoimmune (usually after acute infection) in which IgG Ab bind to platelets
and lead to their excessive destruction in the spleen --> isolated low platelet w/ no significant
PMH
Pseudohyphae budding yeast
Candida
tx: azoles or nystatin
Septate hyphae with acute angle branching
Aspergillus
tx: voriconazole + amphotericin B
Disc-shaped yeast on Wright stain
Pneumocystis
tx: TMP-SMX
Non-septate hyphae with WIDE-angle branching
Mucormycosis
tx: amphotericin B
Risser sign
Degree of calcification of pelvis as related to skeletal maturity
1: 25% calcified, early puberty
2: 50% calcified, just before growth spurt
3: 75% calcified, slowing of growth
4: 100% calcified, cessation of growth
5: 100% calcified, iliac apophysis fused to iliac crest
Common sleep aids
