COMSAE ALL EXAM QUESTIONS
WITH COMPLETE SOLUTIONS
COCAINE intoxication - ANSWERS-impaired 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 - ANSWERS-trabecular and cortical bone lose mass and interconnection
despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
Gilbert Syndrome - ANSWERS-mild dec UDP glucuronosyltransferase conjugation and impaired
bilirubin uptake; asymptomatic or mild jaundice>> inc unconjugated bilirubin w/o hemolysis; w/
fasting and stress
Crigler Najjar - ANSWERS-ABSENT 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 - ANSWERS-Conjugated hyperbilirubinemia b/c defective liver excretion;
grossly black liver
,Benign
Rotor syndrome - ANSWERS-milder in presentation w/o black liver
impaired hepatic uptake and excretion
wilson Disease - ANSWERS-copper 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 - ANSWERS-recessive, 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 - ANSWERS-after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism, arhtropathy;
HCC is common cause death
Treatment Hemochromatosis - ANSWERS-repeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
,Wolff Parkinson White Syndrome - ANSWERS-MC 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 - ANSWERS-SA node> atira> AV node> bundle HIS, R and L bundle
branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - ANSWERS-inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Celiac Disease - ANSWERS-setting: 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 - ANSWERS-upper trunk compression cause injury; loss forearm
flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - ANSWERS-flat deltoid; loss arm abduction, loss sensation over deltoid and
lateral arm
, Radial C5-T1 - ANSWERS-mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
Median C5-T1 - ANSWERS-supracondylar 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 - ANSWERS-Fracture 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 - ANSWERS-superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
WITH COMPLETE SOLUTIONS
COCAINE intoxication - ANSWERS-impaired 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 - ANSWERS-trabecular and cortical bone lose mass and interconnection
despite normal bone mineralization
assoc w/ Colles fracture- distal radial fracture; fracture of femoral neck
Gilbert Syndrome - ANSWERS-mild dec UDP glucuronosyltransferase conjugation and impaired
bilirubin uptake; asymptomatic or mild jaundice>> inc unconjugated bilirubin w/o hemolysis; w/
fasting and stress
Crigler Najjar - ANSWERS-ABSENT 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 - ANSWERS-Conjugated hyperbilirubinemia b/c defective liver excretion;
grossly black liver
,Benign
Rotor syndrome - ANSWERS-milder in presentation w/o black liver
impaired hepatic uptake and excretion
wilson Disease - ANSWERS-copper 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 - ANSWERS-recessive, 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 - ANSWERS-after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism, arhtropathy;
HCC is common cause death
Treatment Hemochromatosis - ANSWERS-repeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
,Wolff Parkinson White Syndrome - ANSWERS-MC 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 - ANSWERS-SA node> atira> AV node> bundle HIS, R and L bundle
branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
Edema - ANSWERS-inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
Celiac Disease - ANSWERS-setting: 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 - ANSWERS-upper trunk compression cause injury; loss forearm
flexion/supination; loss sensation over lateral forearm
Axillary nerve C5-C6 - ANSWERS-flat deltoid; loss arm abduction, loss sensation over deltoid and
lateral arm
, Radial C5-T1 - ANSWERS-mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
Median C5-T1 - ANSWERS-supracondylar 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 - ANSWERS-Fracture 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 - ANSWERS-superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
