COMLEX Level 3 Exam Study Set-Questions with
100% Correct Answers
During SUPINATION, the anterior radial head moves ___________
If patient has restricted range of motion in active/passive supination
During SUPINATION, anterior radial head moves ANTERIORLY (moves POSTERIOR on
pronation...think "p" with "p")
If pt has restricted ROM in supination, it is a POSTERIOR radial head
(b/c anterior/supination is mvmt of ease)
Management of lateral wrist swelling and reproducible pain over dorsal aspect of wrist at
base of thumb in FOOSH injury (no evidence of fracture or dislocation on X-ray)
Tx as occult scaphoid fracture with THUMB SPICA SPLINT or cast for 4-12 weeks if nondisplaced
(follow with Xray q2 weeks)
if displaced, need SURGERY
blood flow to scaphoid is from palmar carpal branch of radial artery and can be interrupted by
fx --> avascular necrosis
Management of alcoholic liver cirrhosis with ascites and signs of portal hypertension
1. Dietary sodium restriction to <2g/day, NSAID avoidance, alcohol cessation
2. Diuretic therapy
Spironolactone and Furosemide in 100:40 mg/day ratio
Notes:
- if severe hypokalemia then can use Spironolactone alone with K replacement then add in
Furosemide once potassium normalizes
- monitor daily weight! should not exceed 0.5 kg/day weight loss (if no edema) or 1 kg/day (if
,edema present)
- stop diuretics if MAP falls to 82 or below
- monitor BUN, K, and Cr
^these 2 are effective in 90% of pts with cirrhosis and ascites
If fails:
3. Large volume paracentesis with album infusion
4. TIPS - performed under conscious sedation by IR -- put shunt between portal and hepatic
veins to lower portal pressures; complications are common and incl hemorrhage and stent
stenosis/thrombosis
5. Liver transplant
Pt presenting from rural area with rapid development of respiratory failure with diffuse
interstitial edema involving all lung fields
Hantavirus Cardiopulmonary syndrome (HCPS)
- Reservoir: rodents
Incubation of 2-3 weeks --> prodromal sx of f/c/malaise --> n/v/d/SOB --> massive cpaillary leak
with pulm edema/shock/coagulopathy/arrhythmia and death
tx: supportive, ECMO if indicated
Note it is a a Category C bioterrorist agent
Q fever is caused by what pathogen
Coxiella Burnetti
self-limited flu-like syndrome with high fevers (40C), fatigue,HA, myalgias
,can have pulm symptoms, hepatitis, rash, acute endocarditis, or encephalitis
mild pneumonia
Hypertensive medication with side effect of inability to maintain erection
Beta blockers
Most appropriate test to diagnose lymphatic filariasis
Blood smear for microscopic examination
-- since there is a periodicity to worm burden in blood, should draw it between 10 pm and 2 am
Ab and Ag testing if negative
Lymphatic fiariasis (Wucheria bancrofit, Brugia malayi and timori) - introduced onto skin by
mosquito bite --> painful lymphadenopathy, lymphangitis, pulmonary eosinophilia
Ultrasonographic findings in diseases of the biliary tree
Acute cholecystitis = echogenic material (gallstones) with posterior acoustic shadowing (due to
shadowing from hyperechoic gallstones), pericholecystic fluid, and thickened gallbladder wall
Gallbladder carcinoma = diffuse mural thickening with large hypoechoic foci without
pericholecystic fluid
Gallstone ileus or gangrenous cholecystitis = echogenic material with posterior acoustic
shadowing w/o pericholecystic fluid and gas within the biliary tree
Biliary sludge vs acalculous cholecystitis= Hypoechogenic mobile liquid without shadowing,
pericholecystic fluid, and thickened gallbladder wall
Pectoralis muscle is most likely to tear during what stage of bench press
During downward motion
muscles are most likely to rupture during eccentric lengthening
, Man found in coma with mydriasis, retinal edema, and hyperemia of optic disk with afferent
pupillary defect. Elevated serum anion gap with mild lactic acidosis and marked respiratory
alkalosis. No ethanol in his serum. What do you give him?
Ethanol or Fomepizole
then dialysis
Pt has methanol toxicity ex from drinking antifreeze --> LOC, abd pain, loss of vision and kdiney
failure
Ethanol and Fomepizole are competitive inhibitors of ADH --> slows down methanol
metabolism to formic acid
Empiric treatment of UTI in pregnancy
Cefpodoxime (3rd gen PO abx)
Amoxicillin-Clavulanate (Augmentin)
Fosfomycin
If have sensitivities, can use:
Amoxicillin
Nitrofurantoin (avoid at term b/c of hemolytic anemia in newborn)
Cephalexin
Bactrim (avoid during 1st tri b/c of antifolate effect associated with neural tube defects and at
term b/c can cause kernicterus)
Possible complications of using physical restraints
Fracture, muscle atrophy, rhabdomyolysis (due to continuous struggle against restraints and
eventual muscle breakdown)
Differentiating lung cancers and risk factors
Non-small-cell-lung cancers
100% Correct Answers
During SUPINATION, the anterior radial head moves ___________
If patient has restricted range of motion in active/passive supination
During SUPINATION, anterior radial head moves ANTERIORLY (moves POSTERIOR on
pronation...think "p" with "p")
If pt has restricted ROM in supination, it is a POSTERIOR radial head
(b/c anterior/supination is mvmt of ease)
Management of lateral wrist swelling and reproducible pain over dorsal aspect of wrist at
base of thumb in FOOSH injury (no evidence of fracture or dislocation on X-ray)
Tx as occult scaphoid fracture with THUMB SPICA SPLINT or cast for 4-12 weeks if nondisplaced
(follow with Xray q2 weeks)
if displaced, need SURGERY
blood flow to scaphoid is from palmar carpal branch of radial artery and can be interrupted by
fx --> avascular necrosis
Management of alcoholic liver cirrhosis with ascites and signs of portal hypertension
1. Dietary sodium restriction to <2g/day, NSAID avoidance, alcohol cessation
2. Diuretic therapy
Spironolactone and Furosemide in 100:40 mg/day ratio
Notes:
- if severe hypokalemia then can use Spironolactone alone with K replacement then add in
Furosemide once potassium normalizes
- monitor daily weight! should not exceed 0.5 kg/day weight loss (if no edema) or 1 kg/day (if
,edema present)
- stop diuretics if MAP falls to 82 or below
- monitor BUN, K, and Cr
^these 2 are effective in 90% of pts with cirrhosis and ascites
If fails:
3. Large volume paracentesis with album infusion
4. TIPS - performed under conscious sedation by IR -- put shunt between portal and hepatic
veins to lower portal pressures; complications are common and incl hemorrhage and stent
stenosis/thrombosis
5. Liver transplant
Pt presenting from rural area with rapid development of respiratory failure with diffuse
interstitial edema involving all lung fields
Hantavirus Cardiopulmonary syndrome (HCPS)
- Reservoir: rodents
Incubation of 2-3 weeks --> prodromal sx of f/c/malaise --> n/v/d/SOB --> massive cpaillary leak
with pulm edema/shock/coagulopathy/arrhythmia and death
tx: supportive, ECMO if indicated
Note it is a a Category C bioterrorist agent
Q fever is caused by what pathogen
Coxiella Burnetti
self-limited flu-like syndrome with high fevers (40C), fatigue,HA, myalgias
,can have pulm symptoms, hepatitis, rash, acute endocarditis, or encephalitis
mild pneumonia
Hypertensive medication with side effect of inability to maintain erection
Beta blockers
Most appropriate test to diagnose lymphatic filariasis
Blood smear for microscopic examination
-- since there is a periodicity to worm burden in blood, should draw it between 10 pm and 2 am
Ab and Ag testing if negative
Lymphatic fiariasis (Wucheria bancrofit, Brugia malayi and timori) - introduced onto skin by
mosquito bite --> painful lymphadenopathy, lymphangitis, pulmonary eosinophilia
Ultrasonographic findings in diseases of the biliary tree
Acute cholecystitis = echogenic material (gallstones) with posterior acoustic shadowing (due to
shadowing from hyperechoic gallstones), pericholecystic fluid, and thickened gallbladder wall
Gallbladder carcinoma = diffuse mural thickening with large hypoechoic foci without
pericholecystic fluid
Gallstone ileus or gangrenous cholecystitis = echogenic material with posterior acoustic
shadowing w/o pericholecystic fluid and gas within the biliary tree
Biliary sludge vs acalculous cholecystitis= Hypoechogenic mobile liquid without shadowing,
pericholecystic fluid, and thickened gallbladder wall
Pectoralis muscle is most likely to tear during what stage of bench press
During downward motion
muscles are most likely to rupture during eccentric lengthening
, Man found in coma with mydriasis, retinal edema, and hyperemia of optic disk with afferent
pupillary defect. Elevated serum anion gap with mild lactic acidosis and marked respiratory
alkalosis. No ethanol in his serum. What do you give him?
Ethanol or Fomepizole
then dialysis
Pt has methanol toxicity ex from drinking antifreeze --> LOC, abd pain, loss of vision and kdiney
failure
Ethanol and Fomepizole are competitive inhibitors of ADH --> slows down methanol
metabolism to formic acid
Empiric treatment of UTI in pregnancy
Cefpodoxime (3rd gen PO abx)
Amoxicillin-Clavulanate (Augmentin)
Fosfomycin
If have sensitivities, can use:
Amoxicillin
Nitrofurantoin (avoid at term b/c of hemolytic anemia in newborn)
Cephalexin
Bactrim (avoid during 1st tri b/c of antifolate effect associated with neural tube defects and at
term b/c can cause kernicterus)
Possible complications of using physical restraints
Fracture, muscle atrophy, rhabdomyolysis (due to continuous struggle against restraints and
eventual muscle breakdown)
Differentiating lung cancers and risk factors
Non-small-cell-lung cancers
