1 | Page
COMSAE 110 QUESTIONS AND
ANSWERS
The wool collars are the biggest clue— Bacillus anthracis is
classically acquired from animal hides, wool, or livestock ,
causing cutaneous anthrax with a painless ulcer and black
necrotic eschar . - ANSWER-F. tularensis is associated with
rabbits, ticks, and deer flies , is a small Gram-negative
coccobacillus , and would not produce the large Gram-positive
rods.
High-dose prednisone commonly causes steroid-induced
psychosis or cognitive changes (impaired attention,
concentration, memory, mood changes), and albuterol can
cause a fine tremor . - ANSWER-Alcohol withdrawal usually
occurs 6-48 hours after stopping alcohol and presents with
autonomic hyperactivity (tachycardia, hypertension, sweating),
anxiety, agitation, and possibly seizures or delirium tremens
Multiple sharply circumscribed, firm, gray-white uterine nodules
are classic benign smooth-muscle fibroids, which commonly
cause heavy or irregular uterine bleeding. - ANSWER-
Endometrial polyps arise from the endometrial lining and are
usually soft, localized projections rather than multiple firm
myometrial nodules.
,2 | Page
Using a topical α- agonist decongestant such as phenylephrine
for more than about 3-5 days can cause rhinitis medicamentosa
, where congestion worsens as the drug wears off. - ANSWER-
Nasal polyps are associated more with chronic inflammation,
asthma, or aspirin sensitivity—not short-term decongestant
use.
Lactulose is an osmotic laxative fermented by colonic bacteria,
producing gas, bloating, abdominal distention, and potentially
profuse diarrhea. - ANSWER-Docusate is a stool softener and
is much less likely to cause marked flatulence and diarrhea.
The clue is that 45 people developed symptoms shortly after
moving into a newly built office , with normal labs, ABG, and
pulmonary function tests . - ANSWER-This is classic building-
related illness ("sick building syndrome") , caused by poor
ventilation or indoor irritants (volatile organic compounds, mold,
low humidity), leading to headaches, eye irritation, dry mucous
membranes, fatigue, and sometimes epistaxis .
A tracheostomy is typically performed between the 2nd and 4th
tracheal rings , where the thyroid isthmus lies directly in front of
the trachea. - ANSWER-During the procedure, the thyroid
,3 | Page
isthmus is retracted (or sometimes divided) to expose the
trachea. The parathyroid glands are located on the posterior
surface of the thyroid gland , well away from the anterior
surgical field of a tracheostomy, so they are not retracted during
the procedure.
The dog with hair loss , hyphae on skin scraping , and growth
on Sabouraud agar point to tinea (dermatophyte infection) ,
commonly transmitted from animals. - ANSWER-The usual
topical treatment is an azole (e.g., clotrimazole), which works
by inhibiting ergosterol synthesis , disrupting the fungal cell
membrane. 70s= macrolides
A patient with hypertension and diabetes who develops pure
sensory loss (numbness of the face and extremities on one
side) has a classic lacunar infarct of the ventral posterolateral
(VPL) and/or ventral posteromedial (VPM) thalamus . -
ANSWER-The VPL carries sensation from the body , and the
VPM carries sensation from the face . The posterior limb of the
internal capsule is the classic location for a pure motor lacunar
stroke , causing contralateral weakness without sensory loss .
She likely has functional hypothalamic amenorrhea from low
energy availability/excess exercise , so treatment is nutritional
rehabilitation and weight gain . - ANSWER-When feeding
resumes, insulin drives phosphate into cells , causing an initial
, 4 | Page
drop in serum phosphate—this is the key electrolyte change in
refeeding syndrome .
Perianal fistulas, fissures, and sinus tracts are classic for Crohn
disease because its inflammation is transmural . - ANSWER-
Condylomata acuminata causes HPV-related genital warts , not
diarrhea or fistulas.
Flank/right abdominal pain radiating to the groin with oliguria is
classic for an obstructing kidney stone . - ANSWER-Renal
artery stenosis causes chronic hypertension and renal
hypoperfusion, not acute colicky pain.
This patient has Alzheimer disease , which is treated
symptomatically with an acetylcholinesterase inhibitor to
increase brain acetylcholine. - ANSWER-GABA agonists
(benzodiazepines) can actually worsen confusion and memory
in older adults.
This patient is having a panic attack (normal ECG/troponins
with sudden chest pain, dyspnea, anxiety, impending doom),
which is rapidly relieved by a benzodiazepine like diazepam. -
ANSWER-Buspirone is for chronic generalized anxiety and
takes weeks to work.
COMSAE 110 QUESTIONS AND
ANSWERS
The wool collars are the biggest clue— Bacillus anthracis is
classically acquired from animal hides, wool, or livestock ,
causing cutaneous anthrax with a painless ulcer and black
necrotic eschar . - ANSWER-F. tularensis is associated with
rabbits, ticks, and deer flies , is a small Gram-negative
coccobacillus , and would not produce the large Gram-positive
rods.
High-dose prednisone commonly causes steroid-induced
psychosis or cognitive changes (impaired attention,
concentration, memory, mood changes), and albuterol can
cause a fine tremor . - ANSWER-Alcohol withdrawal usually
occurs 6-48 hours after stopping alcohol and presents with
autonomic hyperactivity (tachycardia, hypertension, sweating),
anxiety, agitation, and possibly seizures or delirium tremens
Multiple sharply circumscribed, firm, gray-white uterine nodules
are classic benign smooth-muscle fibroids, which commonly
cause heavy or irregular uterine bleeding. - ANSWER-
Endometrial polyps arise from the endometrial lining and are
usually soft, localized projections rather than multiple firm
myometrial nodules.
,2 | Page
Using a topical α- agonist decongestant such as phenylephrine
for more than about 3-5 days can cause rhinitis medicamentosa
, where congestion worsens as the drug wears off. - ANSWER-
Nasal polyps are associated more with chronic inflammation,
asthma, or aspirin sensitivity—not short-term decongestant
use.
Lactulose is an osmotic laxative fermented by colonic bacteria,
producing gas, bloating, abdominal distention, and potentially
profuse diarrhea. - ANSWER-Docusate is a stool softener and
is much less likely to cause marked flatulence and diarrhea.
The clue is that 45 people developed symptoms shortly after
moving into a newly built office , with normal labs, ABG, and
pulmonary function tests . - ANSWER-This is classic building-
related illness ("sick building syndrome") , caused by poor
ventilation or indoor irritants (volatile organic compounds, mold,
low humidity), leading to headaches, eye irritation, dry mucous
membranes, fatigue, and sometimes epistaxis .
A tracheostomy is typically performed between the 2nd and 4th
tracheal rings , where the thyroid isthmus lies directly in front of
the trachea. - ANSWER-During the procedure, the thyroid
,3 | Page
isthmus is retracted (or sometimes divided) to expose the
trachea. The parathyroid glands are located on the posterior
surface of the thyroid gland , well away from the anterior
surgical field of a tracheostomy, so they are not retracted during
the procedure.
The dog with hair loss , hyphae on skin scraping , and growth
on Sabouraud agar point to tinea (dermatophyte infection) ,
commonly transmitted from animals. - ANSWER-The usual
topical treatment is an azole (e.g., clotrimazole), which works
by inhibiting ergosterol synthesis , disrupting the fungal cell
membrane. 70s= macrolides
A patient with hypertension and diabetes who develops pure
sensory loss (numbness of the face and extremities on one
side) has a classic lacunar infarct of the ventral posterolateral
(VPL) and/or ventral posteromedial (VPM) thalamus . -
ANSWER-The VPL carries sensation from the body , and the
VPM carries sensation from the face . The posterior limb of the
internal capsule is the classic location for a pure motor lacunar
stroke , causing contralateral weakness without sensory loss .
She likely has functional hypothalamic amenorrhea from low
energy availability/excess exercise , so treatment is nutritional
rehabilitation and weight gain . - ANSWER-When feeding
resumes, insulin drives phosphate into cells , causing an initial
, 4 | Page
drop in serum phosphate—this is the key electrolyte change in
refeeding syndrome .
Perianal fistulas, fissures, and sinus tracts are classic for Crohn
disease because its inflammation is transmural . - ANSWER-
Condylomata acuminata causes HPV-related genital warts , not
diarrhea or fistulas.
Flank/right abdominal pain radiating to the groin with oliguria is
classic for an obstructing kidney stone . - ANSWER-Renal
artery stenosis causes chronic hypertension and renal
hypoperfusion, not acute colicky pain.
This patient has Alzheimer disease , which is treated
symptomatically with an acetylcholinesterase inhibitor to
increase brain acetylcholine. - ANSWER-GABA agonists
(benzodiazepines) can actually worsen confusion and memory
in older adults.
This patient is having a panic attack (normal ECG/troponins
with sudden chest pain, dyspnea, anxiety, impending doom),
which is rapidly relieved by a benzodiazepine like diazepam. -
ANSWER-Buspirone is for chronic generalized anxiety and
takes weeks to work.
