COMSAE ALL EXAM QUESTIONS AND
ANSWERS 2026
COCAINE intoxication - ANSWERSimpaired judgement, pupil dilate, hallucination (coke
bugs) sudden cardiac death; paranoid ideations, angina
Tx: alpha blockers/ benzos
caution B block bc can cause unopposed alpha
Osteoporosis histo - ANSWERStrabecular and cortical bone lose mass and
interconnection despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
Gilbert Syndrome - ANSWERSmild dec UDP glucuronosyltransferase conjugation and
impaired bilirubin uptake; asymptomatic or mild jaundice>> inc unconjugated bilirubin
w/o hemolysis; w/ fasting and stress
Crigler Najjar - ANSWERSABSENT UDP glucuronsyltransferase; early in life; die few
years
find: jaundice, kernicterus (in brain) inc unconjugated bilirubin;
tx: plasmapheresis and phototherapy; type II respond phenobarbital
Dubin Johnson - ANSWERSConjugated hyperbilirubinemia b/c defective liver excretion;
grossly black liver
Benign
Rotor syndrome - ANSWERSmilder in presentation w/o black liver
impaired hepatic uptake and excretion
wilson Disease - ANSWERScopper transporting ATPase; ATP7B on Chromosome 13
s/s: before 40 yo, liver dz, neurodisease, psych dz, Kayser Fleischer ring, hemolytic
anemia, renal dz;
find: dec serum ceruloplasmin, inc urine copper
tx: chelation w/ penicillamine or Tridentine, oral zinc
Hemochromatosis - ANSWERSrecessive, HFE, chromosome 6; abnormal iron sensing,
increase intestinal absorb
,find: inc ferritin, inc iron, dec TIBC, inc transferrin saturation
identify w/ Prussian blue stain/ liver MRI
Hemochromatosis finds - ANSWERSafter age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism,
arhtropathy; HCC is common cause death
Treatment Hemochromatosis - ANSWERSrepeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
Wolff Parkinson White Syndrome - ANSWERSMC ventricular pre excitation syndrome
abnml fast atria to ventricle (bundle of Kent); bypasses AV node>> ventricles begin
partially depolarization earlier (NOTED BY DELTA WAVE ON EKG) widened QRS and
shortened PR
Conduction pathway heart - ANSWERSSA node> atira> AV node> bundle HIS, R and L
bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - ANSWERSinc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Celiac Disease - ANSWERSsetting: 14 mo kid losing weight eating lots of foods;
histology: crypt abnormalities (hyperplasia); villous atrophy, lymphocytic infiltration
presents as malabsorbtion (diarrhea etc in kids)
in adults= short stature, anemia delayed puberty
Musculocutaneous nerve C5-C7 - ANSWERSupper trunk compression cause injury;
loss forearm flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - ANSWERSflat deltoid; loss arm abduction, loss sensation over
deltoid and lateral arm
Radial C5-T1 - ANSWERSmid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
Median C5-T1 - ANSWERSsupracondylar fracture humerus (proximal) CTS, wrist
laceration (distal)
, ape hand pope's blessing
loss wrist flexion, flex of lateral fingers, thumb opposition, lumbricals 2nd and 3rd digit;
loss sensation over thenar eminence and dorsal and palmar aspects of lateral 3 1/2
fingers w/ proximal
Ulnar C8-T1 - ANSWERSFracture medial epicondyle humerus; fractured hook hamate
(distal lesion)
ulnar claw on extension; radial deception wrist upon flexion (proximal lesion)
loss wrist flex, flex of medial fingers, abduction and adduction fingers; medial 2
lumbricals;
loss sensation over 1 1/2 fingers including hypothenar eminence
Recurrent branch median nerve - ANSWERSsuperficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Treatment glaucoma: alpha agonists; epinephrine, brimonidine - ANSWERSdec AH
synthesis> vasoconstriction; mydriasis alpha 1 (don't use in closed angle glaucoma)
blurry vision, ocular hyperemia, foreign body sensations ocular allergy, pruritis
Beta blockers: timolol, betaxolol, carteolol - ANSWERSdec AH synthesis; no pupil/vision
changes
Diuretics; acetazolamide - ANSWERSdec AH synthesis by inhibiting carbonic
anhydrase; no vision/pupil change
Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine,
echothiophate - ANSWERSinc outflow of AH via contraction of ciliary muscle/open
trabecular mesh; pilocarpine in ER--very effective open meshwork into Canal schlemm,
lead to miosis--and cyclospasm
Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - ANSWERSinc outflow AH;
darken iris (brown); eyelash growth
alpha agonists should be avoided in - ANSWERSclosed angle glaucoma pts
M3 agonist= pilocarpine/carbachol (direct) - ANSWERScontract the sphincter muscles
allowing passage of fluid; pilocarpine emergencies
ANSWERS 2026
COCAINE intoxication - ANSWERSimpaired judgement, pupil dilate, hallucination (coke
bugs) sudden cardiac death; paranoid ideations, angina
Tx: alpha blockers/ benzos
caution B block bc can cause unopposed alpha
Osteoporosis histo - ANSWERStrabecular and cortical bone lose mass and
interconnection despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
Gilbert Syndrome - ANSWERSmild dec UDP glucuronosyltransferase conjugation and
impaired bilirubin uptake; asymptomatic or mild jaundice>> inc unconjugated bilirubin
w/o hemolysis; w/ fasting and stress
Crigler Najjar - ANSWERSABSENT UDP glucuronsyltransferase; early in life; die few
years
find: jaundice, kernicterus (in brain) inc unconjugated bilirubin;
tx: plasmapheresis and phototherapy; type II respond phenobarbital
Dubin Johnson - ANSWERSConjugated hyperbilirubinemia b/c defective liver excretion;
grossly black liver
Benign
Rotor syndrome - ANSWERSmilder in presentation w/o black liver
impaired hepatic uptake and excretion
wilson Disease - ANSWERScopper transporting ATPase; ATP7B on Chromosome 13
s/s: before 40 yo, liver dz, neurodisease, psych dz, Kayser Fleischer ring, hemolytic
anemia, renal dz;
find: dec serum ceruloplasmin, inc urine copper
tx: chelation w/ penicillamine or Tridentine, oral zinc
Hemochromatosis - ANSWERSrecessive, HFE, chromosome 6; abnormal iron sensing,
increase intestinal absorb
,find: inc ferritin, inc iron, dec TIBC, inc transferrin saturation
identify w/ Prussian blue stain/ liver MRI
Hemochromatosis finds - ANSWERSafter age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism,
arhtropathy; HCC is common cause death
Treatment Hemochromatosis - ANSWERSrepeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
Wolff Parkinson White Syndrome - ANSWERSMC ventricular pre excitation syndrome
abnml fast atria to ventricle (bundle of Kent); bypasses AV node>> ventricles begin
partially depolarization earlier (NOTED BY DELTA WAVE ON EKG) widened QRS and
shortened PR
Conduction pathway heart - ANSWERSSA node> atira> AV node> bundle HIS, R and L
bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - ANSWERSinc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Celiac Disease - ANSWERSsetting: 14 mo kid losing weight eating lots of foods;
histology: crypt abnormalities (hyperplasia); villous atrophy, lymphocytic infiltration
presents as malabsorbtion (diarrhea etc in kids)
in adults= short stature, anemia delayed puberty
Musculocutaneous nerve C5-C7 - ANSWERSupper trunk compression cause injury;
loss forearm flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - ANSWERSflat deltoid; loss arm abduction, loss sensation over
deltoid and lateral arm
Radial C5-T1 - ANSWERSmid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
Median C5-T1 - ANSWERSsupracondylar fracture humerus (proximal) CTS, wrist
laceration (distal)
, ape hand pope's blessing
loss wrist flexion, flex of lateral fingers, thumb opposition, lumbricals 2nd and 3rd digit;
loss sensation over thenar eminence and dorsal and palmar aspects of lateral 3 1/2
fingers w/ proximal
Ulnar C8-T1 - ANSWERSFracture medial epicondyle humerus; fractured hook hamate
(distal lesion)
ulnar claw on extension; radial deception wrist upon flexion (proximal lesion)
loss wrist flex, flex of medial fingers, abduction and adduction fingers; medial 2
lumbricals;
loss sensation over 1 1/2 fingers including hypothenar eminence
Recurrent branch median nerve - ANSWERSsuperficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Treatment glaucoma: alpha agonists; epinephrine, brimonidine - ANSWERSdec AH
synthesis> vasoconstriction; mydriasis alpha 1 (don't use in closed angle glaucoma)
blurry vision, ocular hyperemia, foreign body sensations ocular allergy, pruritis
Beta blockers: timolol, betaxolol, carteolol - ANSWERSdec AH synthesis; no pupil/vision
changes
Diuretics; acetazolamide - ANSWERSdec AH synthesis by inhibiting carbonic
anhydrase; no vision/pupil change
Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine,
echothiophate - ANSWERSinc outflow of AH via contraction of ciliary muscle/open
trabecular mesh; pilocarpine in ER--very effective open meshwork into Canal schlemm,
lead to miosis--and cyclospasm
Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - ANSWERSinc outflow AH;
darken iris (brown); eyelash growth
alpha agonists should be avoided in - ANSWERSclosed angle glaucoma pts
M3 agonist= pilocarpine/carbachol (direct) - ANSWERScontract the sphincter muscles
allowing passage of fluid; pilocarpine emergencies
