COMLEX LEVEL 1 COMBANK CARDS
EXAM QUESTIONS WITH CORRECT
ANSWERS
What causes Whipple Disease and what is its presentation? - ANS--Tropheryma
whipplei (intracellular gram positive bacilli), arthralgias, endoscopy shown pale yellow
shaggy mucosa that alternates with erythematous or friable mucosa. men > female bc
possibly HLA B27
What is the presentation and diagnostic tests used for Small Intestinal bacterial
overgrowth (SIBO)? - ANS--nonspecific increased villous blunting, bloating, flatulence,
abdominal pain. Hydrogen breath test measures exhaled hydrogen, xylose breath test
measures exhaled carbon after ingested D-xylose.
What are the macroscopic findings of Celiac Disease? - ANS--scalloping of duodenal
folds, decreased number of folds, submucosal vascular pattern
Draw out the sensitivity/specificity table calculation - ANS--PPV: positive predictive
value
NPV: Negative predictive value
TP: True Positive
FP: False Positive
TN: True Negative
FN: False Negative
Sensitivity: ability to detect the disease. High sensitivity means most people have the
disease test positive for it.
Specificity: tests ability to detect the absence of the disease. High specificity means
most people without the disease will test negative.
PPV: probability of positive test being true positive is great
NPV: probability of negative test result being true negative is great
What are mallory bodies and when/where can they be found? - ANS--accumulation of
fat and cytokeratin intermediate filaments. Alcoholic hepatitis, primary biliary cirrhosis,
Wilson disease, chronic cholestatic syndromes, hepatocellular tumors.
What are councilman bodies? - ANS--form due to apoptosis of hepatocytes infected
with a virus.
What are Ferruginous bodies? - ANS--hemosiderin-stained bodies seen in asbestosis.
Commonly found in the lungs, but not the liver.
,What is lipofuscin and when/where can it be found? - ANS--pigment of undigested lipids
derived from lipid peroxidation of cell membranes. It is common in aging and usually
asymptomatic.
What is toxic granulation and when/where can it be found? - ANS--associated with
inclusions seen in neutrophils during a severe bacterial infection.
What are some reasons for edema of the lower extremities? (Unilateral vs. bilateral) -
ANS--Unilateral: lymphatic blockage leading to increased interstitial colloid oncotic
pressure -->non-pitting edema. Prior surgery, radiation, tumors, parasites (lymphatic
filariasis). Anything obstructing the lymphatic system.
Bilateral: Cirrhosis of the liver due to decreased albumin production --> decreased
plasma colloid oncotic pressure
What will you find on biopsy for Crohn's disease and Ulcerative colitis? - ANS--Crohn's:
noncaseating or non-necrotizing granulomas
Ulcerative Colitis: crypt abscesses/collections of neutrophils within crypts of Leiberkuhn
A key feature of Crohn's disease is noncaseating granulomas, but what is the key
characteristic defining a granuloma? - ANS--Epithelioid histiocytes
Where does pain from the gallbladder and pancreas radiate? - ANS--Gallbladder:
shoulder or scapula
Pancreas: back
Where is Virchow's node and what does it indicate? - ANS--Location: left
supraclavicular fossa.
Supplied from lymph vessels in the abdominal cavity. A hard node is Troisier's sign and
is indicative of cancer in the abdomen
What is Courvoisier's sign? What is Murphy's sign? How do they differ? - ANS--
Courvoisier's Sign: signals an enlarged, palpable painless gallbladder. In the presence
of jaundice is most commonly associated with pancreatic cancer.
Murphy's sign: severe pain and inspiratory arrest with palpation of RUQ during
inspiration. Commonly associated with acute cholecystitis
What is Battle sign and what is it associated with? - ANS--Eccymosis behind the ear
that is associated with basilar skull fracture.
What is Homan's sign and what is it associated with? - ANS--Calf pain on forcible
dorsiflexion of the foot.
Associated with DVT
,What is CA-19-9 and what is it used for? What about CA-125? - ANS--CA-19-9: It is a
laboratory marker to monitor:
Pancreatic Adenocarcinoma
CA-125: associated with ovarian cancers
What is Primary Sclerosising Cholangitis? Associated with? What is tell tale diagnosis?
- ANS--middle aged male that has obliterative fibrosis of the intra and extrahepatic bile
ducts.
Associated with ulcerative colitis.
ERCP beading (stricture/narrowing then dilation then stricture, etc.)
What is Cholangiocarcinoma? What causes it? Diganosis? Tx? - ANS--most common
malignancy of the bile ducts (common bile duct) that has palpable gallbaldder,
hepatomegaly, and jaundice.
Primary Sclerosing Cholangitis, Clonorchis sinensis, choledochal cyst
ultrasound, ERCP
Surgery
What is Primary Biliary Cirrhosis? What is it Associated with? What can be found on
laboratory studies? Tx? - ANS--Middle aged female that has an autoimmune disorder
leading to lymphocytic infiltrate and granulomas that destroy the bile ducts in the portal
triad.
Associated with other autoimmune disease
Positive serum antinuclear antibody (ANA), antimitochondrial antibody (AMA)
Tx: immunosuppressants
What can cause secondary biliary cirrhosis? - ANS--Anything that can cause an
obstructive lesion extrahepatically which leads to increased intrahepatic pressure in the
bile ducts leading to extra and intrahepatic fibrosis.
Key to remember? Pancreatic cancer and gallstones
What are two key characteristics of a duodenal ulcer? - ANS--pain at night when
circadian stimulation of acid secretion is maximal, weight gain because people eat more
to have base secreted by pancreas into small intestine to neutralize acid
, What are the chapman points for the small intestine? - ANS--8th, 9th, and 10th medial
intercostal spaces.
What is the therapy for H. pylori? - ANS--Triple therapy:
Omeprazole: Proton Pump Inhibitor that reduces gastric acid secretion by inhibiting the
H+/K+ ATP pump in parietal cells.
Clarithromycin: Macrolide that inhibits RNA-dependent protein synthesis by binding to
the 50S ribosomal subunit.
Amoxicillin (Metronidazole if penicillin allergy): Interferes with cell wall synthesis
What is the therapy for acute pancreatitis? - ANS--Fluid resuscitation, pain
management,and sepsis control... aka supportive care
What is the function of Ursodeoxycholic acid? - ANS--To improve and prevent
obstructive gallstones by reducing the secretion of cholesterol from the liver
which would lead to a decreased cholesterol content in the bile.
What is the obturator test used for? How is it performed? and what is the the Obturator
sign? - ANS--The obturator test is used when acute appendicitis is suspected.
It is performed by bending hip to 90 degrees with the knee flexed. Doctor's hands hold
the ankle and knee. Ankle is abducted to induce internal rotation of the hip.
Pain during the test is positive Obturator sign.
Obturator Sign: Appendix becomes inflamed and enlarged. The appendix may come
into physical contact with the obturator internus muscle, which will be stretched when
this maneuver is performed on the right leg. Pain signals inflamed appendix.
What is the cause of an appendicitis in adults and children? - ANS--Adults: fecolith
Children: hyperplasia of submucosal follicles.
These obstruct the appendix lumen causing inflammation leading to increased pressure
within the lumen that can surpass the venous return pressure.
OMM: What are the viscerosomatic changes and chapman points associated with an
appendicitis? - ANS--Viscerosomatic reflex: T9-L1,
Chapman's Reflex: Anterior tip of right 12th rib, posterior TP of T11.
What are some important signs of Acute Mesenteric Ischemia? - ANS--little to no
tenderness at first but progresses to severe pain when bowel becomes necrotic
EXAM QUESTIONS WITH CORRECT
ANSWERS
What causes Whipple Disease and what is its presentation? - ANS--Tropheryma
whipplei (intracellular gram positive bacilli), arthralgias, endoscopy shown pale yellow
shaggy mucosa that alternates with erythematous or friable mucosa. men > female bc
possibly HLA B27
What is the presentation and diagnostic tests used for Small Intestinal bacterial
overgrowth (SIBO)? - ANS--nonspecific increased villous blunting, bloating, flatulence,
abdominal pain. Hydrogen breath test measures exhaled hydrogen, xylose breath test
measures exhaled carbon after ingested D-xylose.
What are the macroscopic findings of Celiac Disease? - ANS--scalloping of duodenal
folds, decreased number of folds, submucosal vascular pattern
Draw out the sensitivity/specificity table calculation - ANS--PPV: positive predictive
value
NPV: Negative predictive value
TP: True Positive
FP: False Positive
TN: True Negative
FN: False Negative
Sensitivity: ability to detect the disease. High sensitivity means most people have the
disease test positive for it.
Specificity: tests ability to detect the absence of the disease. High specificity means
most people without the disease will test negative.
PPV: probability of positive test being true positive is great
NPV: probability of negative test result being true negative is great
What are mallory bodies and when/where can they be found? - ANS--accumulation of
fat and cytokeratin intermediate filaments. Alcoholic hepatitis, primary biliary cirrhosis,
Wilson disease, chronic cholestatic syndromes, hepatocellular tumors.
What are councilman bodies? - ANS--form due to apoptosis of hepatocytes infected
with a virus.
What are Ferruginous bodies? - ANS--hemosiderin-stained bodies seen in asbestosis.
Commonly found in the lungs, but not the liver.
,What is lipofuscin and when/where can it be found? - ANS--pigment of undigested lipids
derived from lipid peroxidation of cell membranes. It is common in aging and usually
asymptomatic.
What is toxic granulation and when/where can it be found? - ANS--associated with
inclusions seen in neutrophils during a severe bacterial infection.
What are some reasons for edema of the lower extremities? (Unilateral vs. bilateral) -
ANS--Unilateral: lymphatic blockage leading to increased interstitial colloid oncotic
pressure -->non-pitting edema. Prior surgery, radiation, tumors, parasites (lymphatic
filariasis). Anything obstructing the lymphatic system.
Bilateral: Cirrhosis of the liver due to decreased albumin production --> decreased
plasma colloid oncotic pressure
What will you find on biopsy for Crohn's disease and Ulcerative colitis? - ANS--Crohn's:
noncaseating or non-necrotizing granulomas
Ulcerative Colitis: crypt abscesses/collections of neutrophils within crypts of Leiberkuhn
A key feature of Crohn's disease is noncaseating granulomas, but what is the key
characteristic defining a granuloma? - ANS--Epithelioid histiocytes
Where does pain from the gallbladder and pancreas radiate? - ANS--Gallbladder:
shoulder or scapula
Pancreas: back
Where is Virchow's node and what does it indicate? - ANS--Location: left
supraclavicular fossa.
Supplied from lymph vessels in the abdominal cavity. A hard node is Troisier's sign and
is indicative of cancer in the abdomen
What is Courvoisier's sign? What is Murphy's sign? How do they differ? - ANS--
Courvoisier's Sign: signals an enlarged, palpable painless gallbladder. In the presence
of jaundice is most commonly associated with pancreatic cancer.
Murphy's sign: severe pain and inspiratory arrest with palpation of RUQ during
inspiration. Commonly associated with acute cholecystitis
What is Battle sign and what is it associated with? - ANS--Eccymosis behind the ear
that is associated with basilar skull fracture.
What is Homan's sign and what is it associated with? - ANS--Calf pain on forcible
dorsiflexion of the foot.
Associated with DVT
,What is CA-19-9 and what is it used for? What about CA-125? - ANS--CA-19-9: It is a
laboratory marker to monitor:
Pancreatic Adenocarcinoma
CA-125: associated with ovarian cancers
What is Primary Sclerosising Cholangitis? Associated with? What is tell tale diagnosis?
- ANS--middle aged male that has obliterative fibrosis of the intra and extrahepatic bile
ducts.
Associated with ulcerative colitis.
ERCP beading (stricture/narrowing then dilation then stricture, etc.)
What is Cholangiocarcinoma? What causes it? Diganosis? Tx? - ANS--most common
malignancy of the bile ducts (common bile duct) that has palpable gallbaldder,
hepatomegaly, and jaundice.
Primary Sclerosing Cholangitis, Clonorchis sinensis, choledochal cyst
ultrasound, ERCP
Surgery
What is Primary Biliary Cirrhosis? What is it Associated with? What can be found on
laboratory studies? Tx? - ANS--Middle aged female that has an autoimmune disorder
leading to lymphocytic infiltrate and granulomas that destroy the bile ducts in the portal
triad.
Associated with other autoimmune disease
Positive serum antinuclear antibody (ANA), antimitochondrial antibody (AMA)
Tx: immunosuppressants
What can cause secondary biliary cirrhosis? - ANS--Anything that can cause an
obstructive lesion extrahepatically which leads to increased intrahepatic pressure in the
bile ducts leading to extra and intrahepatic fibrosis.
Key to remember? Pancreatic cancer and gallstones
What are two key characteristics of a duodenal ulcer? - ANS--pain at night when
circadian stimulation of acid secretion is maximal, weight gain because people eat more
to have base secreted by pancreas into small intestine to neutralize acid
, What are the chapman points for the small intestine? - ANS--8th, 9th, and 10th medial
intercostal spaces.
What is the therapy for H. pylori? - ANS--Triple therapy:
Omeprazole: Proton Pump Inhibitor that reduces gastric acid secretion by inhibiting the
H+/K+ ATP pump in parietal cells.
Clarithromycin: Macrolide that inhibits RNA-dependent protein synthesis by binding to
the 50S ribosomal subunit.
Amoxicillin (Metronidazole if penicillin allergy): Interferes with cell wall synthesis
What is the therapy for acute pancreatitis? - ANS--Fluid resuscitation, pain
management,and sepsis control... aka supportive care
What is the function of Ursodeoxycholic acid? - ANS--To improve and prevent
obstructive gallstones by reducing the secretion of cholesterol from the liver
which would lead to a decreased cholesterol content in the bile.
What is the obturator test used for? How is it performed? and what is the the Obturator
sign? - ANS--The obturator test is used when acute appendicitis is suspected.
It is performed by bending hip to 90 degrees with the knee flexed. Doctor's hands hold
the ankle and knee. Ankle is abducted to induce internal rotation of the hip.
Pain during the test is positive Obturator sign.
Obturator Sign: Appendix becomes inflamed and enlarged. The appendix may come
into physical contact with the obturator internus muscle, which will be stretched when
this maneuver is performed on the right leg. Pain signals inflamed appendix.
What is the cause of an appendicitis in adults and children? - ANS--Adults: fecolith
Children: hyperplasia of submucosal follicles.
These obstruct the appendix lumen causing inflammation leading to increased pressure
within the lumen that can surpass the venous return pressure.
OMM: What are the viscerosomatic changes and chapman points associated with an
appendicitis? - ANS--Viscerosomatic reflex: T9-L1,
Chapman's Reflex: Anterior tip of right 12th rib, posterior TP of T11.
What are some important signs of Acute Mesenteric Ischemia? - ANS--little to no
tenderness at first but progresses to severe pain when bowel becomes necrotic
