COMLEX Level 3 Study Guide-Questions with 100%
Correct Answers
Kawasaki Disease
- Medium vessel vasculitis mainly affecting children under 5
- 25% can develop coronary artery aneurysms, require echo at diagnosis
- 5 days of fever + four criteria
(1) conjunctivitis*** (different from scarlet fever)
(2) "strawberry tongue" or cracked lips
(3) maculopapular rash
(4) edema of hands + feet, desquamating palms + soles
(5) unilateral painful cervical lymphadenopathy
- anemia, thrombocytosis, leukocytosis, increased ESR + CRP
- treatment is high dose aspirin + IVIG
Scarlet Fever
- symptoms of streptococcal pharyngitis for 1-3 days prior to rash
- "sandpaper rash" (blanching, papular)
- pastia lines in elbow creases
- "strawberry tongue"
- caused by S. pyogenes (GAS)
- treatment is penicillin (if allergic cephalexin, clindamycin, or azithromycin)
Rheumatic Fever
- sequela of untreated GAS infection
- Jones Criteria
(1) joint involvement - migratory polyarthritis
(2) carditis
(3) subcutaneous nodules
,(4) erythema marginatum - macule with central clearing, wavy
(5) sydenham's chorea
Minor - PR prolongation
- must be placed on penicillin prophylaxis to prevent recurrent GAS
- treatment is penicillin + anti-inflammatory meds
erythema multiforme
- target like lesions
- infectious, medication, autoimmune
erythema marginatum
- macule with central clearing sparing the face
- rheumatic fever
erythema nodosum
- inflammatory nodules
- infectious, autoimmune, medication, pregnancy
erythema migrans
- bull's eye appearance
- lyme disease
erythema infectiousum
- slapped cheek appearance
- parvovirus B19 infection
Addison disease
- primary adrenal insufficiency
- autoimmune adrenal cortical destruction
- skin hyperpigmentation, decreased glucocorticoids, decreased mineralocorticoids
, - hyperpigmentation is caused by increased ACTH secretion
- non-anion gap metabolic acidosis caused by decreased aldosterone
- weakness, fatigue, anorexia, GI complaints
- increased ACTH + hyperkalemia
- decreased cortisol, aldosterone, sodium
- (+) 21-hydroxylase antibodies
- morning cortisol low or indeterminate
- Cosyntropin stimulation test with minimal cortisol response
ITP (idiopathic thrombocytopenic purpura)
- IgG antibodies are formed against membrane protein Gp Iib/IIIa of platelets
- platelet-antibody complex is destroyed by the spleen
- bone marrow production of platelets is increased, with increased megakaryocytes in the
marrow
- most common immunologic disorder in females of childbearing age
- can affect children
- may have minor mucocutaneous bleeding, hematuria
- abrupt onset of hemorrhagic complications occurs after a viral illness with sudden self-limiting
purpura
- usually no treatment, but can use corticosteroids or IVIG
TTP (thrombotic thrombocytopenic purpura)
- deficiency of vWF cleaving enzyme (ADAMTS-13) resulting in abnormally large vWF multimers
that aggregate platelets and create platelet microthrombi
- more common in adults
Pentad "LMNOP"
Correct Answers
Kawasaki Disease
- Medium vessel vasculitis mainly affecting children under 5
- 25% can develop coronary artery aneurysms, require echo at diagnosis
- 5 days of fever + four criteria
(1) conjunctivitis*** (different from scarlet fever)
(2) "strawberry tongue" or cracked lips
(3) maculopapular rash
(4) edema of hands + feet, desquamating palms + soles
(5) unilateral painful cervical lymphadenopathy
- anemia, thrombocytosis, leukocytosis, increased ESR + CRP
- treatment is high dose aspirin + IVIG
Scarlet Fever
- symptoms of streptococcal pharyngitis for 1-3 days prior to rash
- "sandpaper rash" (blanching, papular)
- pastia lines in elbow creases
- "strawberry tongue"
- caused by S. pyogenes (GAS)
- treatment is penicillin (if allergic cephalexin, clindamycin, or azithromycin)
Rheumatic Fever
- sequela of untreated GAS infection
- Jones Criteria
(1) joint involvement - migratory polyarthritis
(2) carditis
(3) subcutaneous nodules
,(4) erythema marginatum - macule with central clearing, wavy
(5) sydenham's chorea
Minor - PR prolongation
- must be placed on penicillin prophylaxis to prevent recurrent GAS
- treatment is penicillin + anti-inflammatory meds
erythema multiforme
- target like lesions
- infectious, medication, autoimmune
erythema marginatum
- macule with central clearing sparing the face
- rheumatic fever
erythema nodosum
- inflammatory nodules
- infectious, autoimmune, medication, pregnancy
erythema migrans
- bull's eye appearance
- lyme disease
erythema infectiousum
- slapped cheek appearance
- parvovirus B19 infection
Addison disease
- primary adrenal insufficiency
- autoimmune adrenal cortical destruction
- skin hyperpigmentation, decreased glucocorticoids, decreased mineralocorticoids
, - hyperpigmentation is caused by increased ACTH secretion
- non-anion gap metabolic acidosis caused by decreased aldosterone
- weakness, fatigue, anorexia, GI complaints
- increased ACTH + hyperkalemia
- decreased cortisol, aldosterone, sodium
- (+) 21-hydroxylase antibodies
- morning cortisol low or indeterminate
- Cosyntropin stimulation test with minimal cortisol response
ITP (idiopathic thrombocytopenic purpura)
- IgG antibodies are formed against membrane protein Gp Iib/IIIa of platelets
- platelet-antibody complex is destroyed by the spleen
- bone marrow production of platelets is increased, with increased megakaryocytes in the
marrow
- most common immunologic disorder in females of childbearing age
- can affect children
- may have minor mucocutaneous bleeding, hematuria
- abrupt onset of hemorrhagic complications occurs after a viral illness with sudden self-limiting
purpura
- usually no treatment, but can use corticosteroids or IVIG
TTP (thrombotic thrombocytopenic purpura)
- deficiency of vWF cleaving enzyme (ADAMTS-13) resulting in abnormally large vWF multimers
that aggregate platelets and create platelet microthrombi
- more common in adults
Pentad "LMNOP"
