COMSAE Actual Exam Questions and
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• COCAINE intoxication -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓Conjugated hyperbilirubinemia b/c defective liver excretion;
grossly black liver
Benign
• Rotor syndrome -✓✓milder in presentation w/o black liver
impaired hepatic uptake and excretion
• wilson Disease -✓✓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 -✓✓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 -✓✓after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism,
arhtropathy; HCC is common cause death
• Treatment Hemochromatosis -✓✓repeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
• Wolff Parkinson White Syndrome -✓✓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 -✓✓SA node> atira> AV node> bundle HIS, R and L
bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
• Edema -✓✓inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
• Celiac Disease -✓✓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 -✓✓upper trunk compression cause injury; loss
forearm flexion/supination; loss sensation over lateral forearm
• Axillary nerve C5-C6 -✓✓flat deltoid; loss arm abduction, loss sensation over
deltoid and lateral arm
• Radial C5-T1 -✓✓mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
• Median C5-T1 -✓✓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 -✓✓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 -✓✓superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
Correct Detailed Answers (Verified
Solutions) | Already Graded A+ |
Complete Review Pack
• COCAINE intoxication -✓✓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 -✓✓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 -✓✓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 -✓✓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 -✓✓Conjugated hyperbilirubinemia b/c defective liver excretion;
grossly black liver
Benign
• Rotor syndrome -✓✓milder in presentation w/o black liver
impaired hepatic uptake and excretion
• wilson Disease -✓✓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 -✓✓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 -✓✓after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy, hypogonadism,
arhtropathy; HCC is common cause death
• Treatment Hemochromatosis -✓✓repeat phlebotomy, chelation deferasirox,
deferoxamine, oral deferiprone
• Wolff Parkinson White Syndrome -✓✓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 -✓✓SA node> atira> AV node> bundle HIS, R and L
bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
• Edema -✓✓inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
• Celiac Disease -✓✓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 -✓✓upper trunk compression cause injury; loss
forearm flexion/supination; loss sensation over lateral forearm
• Axillary nerve C5-C6 -✓✓flat deltoid; loss arm abduction, loss sensation over
deltoid and lateral arm
• Radial C5-T1 -✓✓mid shaft fracture humerus, compression axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior arm, dorsal hand
• Median C5-T1 -✓✓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 -✓✓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 -✓✓superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
