COMLEX Level 2-Questions with 100% Correct
Answers
Acute Interstitial Nephritis Urinalysis Findings
WBC casts
WBCs
eosinophils
Group 1 Pulmonary Hypertension
Causes:
PAH:
- idiopathic
- drug/toxin induced
- heritable
- HIV
- schistosomiasis
Treatment:
prostacyclin pathway agonists
enodthelian receptor antagonists (eg bosentan)
PDE-5 inhibitors (eg sildenafil)
Microcytic Anemias
Carbonic Anhydrase MOA
,Inhibits CA --> prevents formation of H+ and bicarb in tubule cell, less H+ to exchange for Na in
tubule cell, less Na reabsorbed, less water reabsorbed
Act on PT
Cerebral Autosomal Dominant Arteriopathy with subcoritcal infarcts and
leukoencephalopathy (CADASIL)
characterized by recurrented ischemic cerebrovascular events and cognitive decline that usually
progresses to dementia
features of vascular dementia include gait impairment leading to recurrent falls as well as
dysarthria, focal neurologic deficits, and loss of executive function
multiple discrete hypodense foci and/or white matter lesions are often seen on imaging
Lead Poisoning Clinical Presentation
GI: abdominal pain (lead colic), constipation, anorexia
MSK: arthralgia, myalgia, muscle weakness (esp extensor muscles of the extremities)
Constitutional" fatigue, sleep disturbances, headaches
Neurologic and psychiatric: difficulty concentratiing, irritability, memory impairment,
depression
Other: anemia, nephropathy
Creutzfeldt-Jakob disease
type of prion disease
,aggressive neurodegenerative disorder characterized by spongiform changes within the brain
and clinical triad of rapidly progressive dementia, ataxia, and myoclonus
death occurs within 1 year
negative family history
MRI finding of cortical ribboning
Histopathology: coalescent clear vesicles with no inflammatory cells, producing vacuolation of
the neuropil (spongiform degeneration)
Constrictive pericarditis
Etiology:
inelastic pericaridum -> decreased venous return to the right heart -> right heart failure
Causes:
idiopathic or viral pericarditis
cardiac surgery
prior to mediastinal radiation therapy
TB pericarditis (if there is a hx of travel to endemic areas)
Clinical Presentation:
fatigue and dyspnea
signs of RHF: Increased JVP, ascites, peripheral edema, hepatomegaly
pericardial knock (mid-diastolic sound)
pulsus paradoxus
Kussmaul's sign
Diagnosis:
, ECG is often non-specific but can show low-voltage QRS complexes
jugular venous pulse tracing shows proment x and y descents
imaging shows pericardial thickening and calcification
Cardiac Complications of Cancer Treatment
Doxorubicin or Daunorubicin:
- heart failure due to dilated cardiomyopathy
Mediastinal Radiation (eg treatment of Hodgkin lymphoma):
- conduction defects
- constrictive pericarditis
- restrictive cardiomyopathy
- valvular damage
Trastuzumab (eg treatment of Her2 positive breast or gastric cancer):
- heart failure due to dilated cardiomyopathy
Dressler Syndrome
Criteria for a Positive PPD Test
Rouleaux formation
Stacking of red blood cells resembling coins.
Waldenstrom Macroglobulinemia (WM)
Pathophysiology:
B-cell malignancy
increase production of monoclonal IgM -> hyperviscosity syndrome
Clinical Presentation:
Answers
Acute Interstitial Nephritis Urinalysis Findings
WBC casts
WBCs
eosinophils
Group 1 Pulmonary Hypertension
Causes:
PAH:
- idiopathic
- drug/toxin induced
- heritable
- HIV
- schistosomiasis
Treatment:
prostacyclin pathway agonists
enodthelian receptor antagonists (eg bosentan)
PDE-5 inhibitors (eg sildenafil)
Microcytic Anemias
Carbonic Anhydrase MOA
,Inhibits CA --> prevents formation of H+ and bicarb in tubule cell, less H+ to exchange for Na in
tubule cell, less Na reabsorbed, less water reabsorbed
Act on PT
Cerebral Autosomal Dominant Arteriopathy with subcoritcal infarcts and
leukoencephalopathy (CADASIL)
characterized by recurrented ischemic cerebrovascular events and cognitive decline that usually
progresses to dementia
features of vascular dementia include gait impairment leading to recurrent falls as well as
dysarthria, focal neurologic deficits, and loss of executive function
multiple discrete hypodense foci and/or white matter lesions are often seen on imaging
Lead Poisoning Clinical Presentation
GI: abdominal pain (lead colic), constipation, anorexia
MSK: arthralgia, myalgia, muscle weakness (esp extensor muscles of the extremities)
Constitutional" fatigue, sleep disturbances, headaches
Neurologic and psychiatric: difficulty concentratiing, irritability, memory impairment,
depression
Other: anemia, nephropathy
Creutzfeldt-Jakob disease
type of prion disease
,aggressive neurodegenerative disorder characterized by spongiform changes within the brain
and clinical triad of rapidly progressive dementia, ataxia, and myoclonus
death occurs within 1 year
negative family history
MRI finding of cortical ribboning
Histopathology: coalescent clear vesicles with no inflammatory cells, producing vacuolation of
the neuropil (spongiform degeneration)
Constrictive pericarditis
Etiology:
inelastic pericaridum -> decreased venous return to the right heart -> right heart failure
Causes:
idiopathic or viral pericarditis
cardiac surgery
prior to mediastinal radiation therapy
TB pericarditis (if there is a hx of travel to endemic areas)
Clinical Presentation:
fatigue and dyspnea
signs of RHF: Increased JVP, ascites, peripheral edema, hepatomegaly
pericardial knock (mid-diastolic sound)
pulsus paradoxus
Kussmaul's sign
Diagnosis:
, ECG is often non-specific but can show low-voltage QRS complexes
jugular venous pulse tracing shows proment x and y descents
imaging shows pericardial thickening and calcification
Cardiac Complications of Cancer Treatment
Doxorubicin or Daunorubicin:
- heart failure due to dilated cardiomyopathy
Mediastinal Radiation (eg treatment of Hodgkin lymphoma):
- conduction defects
- constrictive pericarditis
- restrictive cardiomyopathy
- valvular damage
Trastuzumab (eg treatment of Her2 positive breast or gastric cancer):
- heart failure due to dilated cardiomyopathy
Dressler Syndrome
Criteria for a Positive PPD Test
Rouleaux formation
Stacking of red blood cells resembling coins.
Waldenstrom Macroglobulinemia (WM)
Pathophysiology:
B-cell malignancy
increase production of monoclonal IgM -> hyperviscosity syndrome
Clinical Presentation:
