COMSAE ALL PRACTICE ASSESSMENT 2026
FULL QUESTION BANK AND REVIEWED
SOLUTIONS
◉ Crigler Najjar. Answer: 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. Answer: Conjugated hyperbilirubinemia b/c
defective liver excretion;
grossly black liver
Benign
◉ Rotor syndrome. Answer: milder in presentation w/o black liver
impaired hepatic uptake and excretion
◉ wilson Disease. Answer: 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. Answer: 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. Answer: after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy,
hypogonadism, arhtropathy; HCC is common cause death
◉ Treatment Hemochromatosis. Answer: repeat phlebotomy,
chelation deferasirox, deferoxamine, oral deferiprone
◉ Wolff Parkinson White Syndrome. Answer: 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. Answer: SA node> atira> AV node>
bundle HIS, R and L bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
◉ Edema. Answer: inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
◉ Celiac Disease. Answer: 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. Answer: upper trunk
compression cause injury; loss forearm flexion/supination; loss
sensation over lateral forearm
◉ Axillary nerve C5-C6. Answer: flat deltoid; loss arm abduction,
loss sensation over deltoid and lateral arm
◉ Radial C5-T1. Answer: mid shaft fracture humerus, compression
axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior
arm, dorsal hand
◉ Median C5-T1. Answer: 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. Answer: Fracture medial epicondyle humerus;
fractured hook hamate (distal lesion)
FULL QUESTION BANK AND REVIEWED
SOLUTIONS
◉ Crigler Najjar. Answer: 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. Answer: Conjugated hyperbilirubinemia b/c
defective liver excretion;
grossly black liver
Benign
◉ Rotor syndrome. Answer: milder in presentation w/o black liver
impaired hepatic uptake and excretion
◉ wilson Disease. Answer: 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. Answer: 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. Answer: after age 40
>20 iron;
triad: cirrhosis, DM, skin pigmentation; dilated cardiomyopathy,
hypogonadism, arhtropathy; HCC is common cause death
◉ Treatment Hemochromatosis. Answer: repeat phlebotomy,
chelation deferasirox, deferoxamine, oral deferiprone
◉ Wolff Parkinson White Syndrome. Answer: 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. Answer: SA node> atira> AV node>
bundle HIS, R and L bundle branches> purkinje fibers> ventricles
L branch anterior/posterior fascicles
◉ Edema. Answer: inc capillary pressure
dec plasma proteins (dec oncotic capillary pressure)
inc capillary permeability
increase interstitial fluid colloid oncotic pressure
◉ Celiac Disease. Answer: 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. Answer: upper trunk
compression cause injury; loss forearm flexion/supination; loss
sensation over lateral forearm
◉ Axillary nerve C5-C6. Answer: flat deltoid; loss arm abduction,
loss sensation over deltoid and lateral arm
◉ Radial C5-T1. Answer: mid shaft fracture humerus, compression
axilla
find: dec grip, loss extension (wrist drop); loss sensation posterior
arm, dorsal hand
◉ Median C5-T1. Answer: 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. Answer: Fracture medial epicondyle humerus;
fractured hook hamate (distal lesion)
