COMSAE 2 QUESTIONS AND ANSWERS
Sheehan Syndrome - Answers - A rare condition that occurs secondary to pituitary
ischemia and subsequent infarction following significant postpartum bleeding. This
occurs due to the decreased perfusion of the pituitary during the final stages of
pregnancy and labor process. This can also occur due to significant blood loss during
labor, leading to hypoperfusion of the pituitary gland and subsequent infarction. This will
in turn cause a global decrease in the hormones that are produced in the anterior
pituitary.
The production of ADH and oxytocin is not affected because both hormones are
produced in the hypothalamus, and stored in the posterior pituitary gland.
Bosentan & Ambrisentan MOA - Answers - They treat pulmonary hypertension by
competitively antagonizing endothelin-1 receptors, thus, decreasing pulmonary vascular
resistance.
Inclusion Body Myositis - Answers - Characterized by inflammation and endomysial
infiltrates of CD8+ T cells and macrophages that focally surround and invade myofibrils.
The presence of rimmed vacuoles is a characteristic feature. It is more common in
males over the age of 50-years-old. It manifests as an insidious onset of proximal
muscle weakness, often with associated distal muscle weakness. The distribution of
weakness is variable, but unlike polymyositis and dermatomyositis, asymmetry is
common. Early involvement of the knee extensors, ankle dorsiflexors, and wrist and
finger flexors is characteristic. Weakness of the wrist and finger flexors is often greater
than their extensor counterparts. Hence, loss of finger dexterity and grip strength may
be a prominent symptom. It also commonly causes greater weakness in knee extension
when compared with the hip flexors. Deep tendon reflexes may be impaired or absent if
weakness is severe. Laboratory results reveal a normal to slightly elevated level of
serum creatine kinase. Muscle biopsy is the gold standard for diagnosis.
Polymyalgia Rheumatica - Answers - A disease of the elderly that causes proximal
myalgias of the hip and shoulder girdles. The symptoms appear first in the shoulder
girdle, and patients commonly complain of stiffness after prolonged inactivity. The
shoulder and hip girdles can be painful and stiff, causing difficulty in rising from a chair
or raising their arms over their shoulder. Patients also have morning stiffness that
typically lasts for more than one hour. There is no muscle weakness, as compared to
dermatomyositis and polymyositis. It is commonly associated with giant cell arteritis.
Laboratory studies reveal an erythrocyte sedimentation rate (ESR) > 40 mm/h.
Treatment is with prednisone.
What is the genetic transmission of Duchenne & Becker Muscular Dystrophy? -
Answers - XLR
5% Sheep Blood added to? - Answers - Blood agar usually contains 5% sheep blood
and is used to determine hemolysis patterns of Streptococcus
, Eosin-methylene blue is added to? - Answers - A staining agent used to visualize
Escherichia coli that show up as a metallic sheen.
Nystatin is added to help culture which organism? - Answers - Nystatin is a part of the
VPN or Thayer-Martin agar designed to grow Neisseria gonorrhoeae.
What 2 OMM techniques can be used to thin mucous secretions in a pt with Asthma? -
Answers - Asthma is the most common chronic disease in childhood and asthma
symptoms include wheezing, shortness of breath, chest tightness and cough. Asthma
involves hypersensitivity of the bronchi and lower airways to allergens, cold or other
irritants. This results in inflammation, bronchospasm and mucous plugging. β-2-agonists
help dilate the bronchioles but do not directly affect the sympathetic nerves which
regulate secretions. Persistent asthma can drive the upper thoracic (particularly T1-T4)
sympathetic nerves into a chronically active state. One particularly significant
physiologic response of this is proliferation of goblet cells. These cells in the bronchial
mucosa produce thick, tenacious secretions which are difficult to clear. Rib raising is
one method of normalizing (in this case, decreasing) sympathetic tone to thin the
secretions. Another useful method is the thoracic pump, which can be particularly
helpful in normalizing lymphatic flow out of congested tissues.
Sympathetic Vicerosomatics - Answers -
Isolated Tricuspid Stenosis MC from? - Answers - The most common causes are due to
carcinoid heart disease and right atrial myxoma.
What is the MOA of an Aspirin Overdose? - Answers - It causes the uncoupling of
oxidative phosphorylation and thereby reduces the amount of ATP produced. Aspirin
transports protons generated by the electron transport chain back into the mitochondrial
matrix. This decreases the amount of protons available for ATP synthase to use for
formation of ATP. As a result, there is an accumulation of carbon dioxide in the body.
Which leads to a respiratory alkolosis which is then followed by a Metabolic acidosis to
recompensate (Mixed)
What is the Antidote for Cyanide Poisoning? - Answers - Amyl nitrite. Cyanide inhibits
cytochrome oxidase enzyme in the electron transport chain within mitochondria. This
causes depletion of ATP. Patients with cyanide poisoning present with elevated heart
rates, drowsiness, and eventual coma and death.
Alkpatonuria - Answers - An AR disorder that results from deficient activity of the
enzyme homogentisic oxidase. It results in elevated levels of homogentisic acid which
forms a pigment that is deposited in connective tissue and joints throughout the body. It
typically presents in the 3rd decade of life, with initial pigmentation occurring in the ear
cartilage and sclera of the eyes. A dark pigment is also deposited in the large joints and
the lumbosacral spine. This leads to early onset arthritis and can result in joint
replacements at a younger age. The disorder is characterized by urine that is of a
Sheehan Syndrome - Answers - A rare condition that occurs secondary to pituitary
ischemia and subsequent infarction following significant postpartum bleeding. This
occurs due to the decreased perfusion of the pituitary during the final stages of
pregnancy and labor process. This can also occur due to significant blood loss during
labor, leading to hypoperfusion of the pituitary gland and subsequent infarction. This will
in turn cause a global decrease in the hormones that are produced in the anterior
pituitary.
The production of ADH and oxytocin is not affected because both hormones are
produced in the hypothalamus, and stored in the posterior pituitary gland.
Bosentan & Ambrisentan MOA - Answers - They treat pulmonary hypertension by
competitively antagonizing endothelin-1 receptors, thus, decreasing pulmonary vascular
resistance.
Inclusion Body Myositis - Answers - Characterized by inflammation and endomysial
infiltrates of CD8+ T cells and macrophages that focally surround and invade myofibrils.
The presence of rimmed vacuoles is a characteristic feature. It is more common in
males over the age of 50-years-old. It manifests as an insidious onset of proximal
muscle weakness, often with associated distal muscle weakness. The distribution of
weakness is variable, but unlike polymyositis and dermatomyositis, asymmetry is
common. Early involvement of the knee extensors, ankle dorsiflexors, and wrist and
finger flexors is characteristic. Weakness of the wrist and finger flexors is often greater
than their extensor counterparts. Hence, loss of finger dexterity and grip strength may
be a prominent symptom. It also commonly causes greater weakness in knee extension
when compared with the hip flexors. Deep tendon reflexes may be impaired or absent if
weakness is severe. Laboratory results reveal a normal to slightly elevated level of
serum creatine kinase. Muscle biopsy is the gold standard for diagnosis.
Polymyalgia Rheumatica - Answers - A disease of the elderly that causes proximal
myalgias of the hip and shoulder girdles. The symptoms appear first in the shoulder
girdle, and patients commonly complain of stiffness after prolonged inactivity. The
shoulder and hip girdles can be painful and stiff, causing difficulty in rising from a chair
or raising their arms over their shoulder. Patients also have morning stiffness that
typically lasts for more than one hour. There is no muscle weakness, as compared to
dermatomyositis and polymyositis. It is commonly associated with giant cell arteritis.
Laboratory studies reveal an erythrocyte sedimentation rate (ESR) > 40 mm/h.
Treatment is with prednisone.
What is the genetic transmission of Duchenne & Becker Muscular Dystrophy? -
Answers - XLR
5% Sheep Blood added to? - Answers - Blood agar usually contains 5% sheep blood
and is used to determine hemolysis patterns of Streptococcus
, Eosin-methylene blue is added to? - Answers - A staining agent used to visualize
Escherichia coli that show up as a metallic sheen.
Nystatin is added to help culture which organism? - Answers - Nystatin is a part of the
VPN or Thayer-Martin agar designed to grow Neisseria gonorrhoeae.
What 2 OMM techniques can be used to thin mucous secretions in a pt with Asthma? -
Answers - Asthma is the most common chronic disease in childhood and asthma
symptoms include wheezing, shortness of breath, chest tightness and cough. Asthma
involves hypersensitivity of the bronchi and lower airways to allergens, cold or other
irritants. This results in inflammation, bronchospasm and mucous plugging. β-2-agonists
help dilate the bronchioles but do not directly affect the sympathetic nerves which
regulate secretions. Persistent asthma can drive the upper thoracic (particularly T1-T4)
sympathetic nerves into a chronically active state. One particularly significant
physiologic response of this is proliferation of goblet cells. These cells in the bronchial
mucosa produce thick, tenacious secretions which are difficult to clear. Rib raising is
one method of normalizing (in this case, decreasing) sympathetic tone to thin the
secretions. Another useful method is the thoracic pump, which can be particularly
helpful in normalizing lymphatic flow out of congested tissues.
Sympathetic Vicerosomatics - Answers -
Isolated Tricuspid Stenosis MC from? - Answers - The most common causes are due to
carcinoid heart disease and right atrial myxoma.
What is the MOA of an Aspirin Overdose? - Answers - It causes the uncoupling of
oxidative phosphorylation and thereby reduces the amount of ATP produced. Aspirin
transports protons generated by the electron transport chain back into the mitochondrial
matrix. This decreases the amount of protons available for ATP synthase to use for
formation of ATP. As a result, there is an accumulation of carbon dioxide in the body.
Which leads to a respiratory alkolosis which is then followed by a Metabolic acidosis to
recompensate (Mixed)
What is the Antidote for Cyanide Poisoning? - Answers - Amyl nitrite. Cyanide inhibits
cytochrome oxidase enzyme in the electron transport chain within mitochondria. This
causes depletion of ATP. Patients with cyanide poisoning present with elevated heart
rates, drowsiness, and eventual coma and death.
Alkpatonuria - Answers - An AR disorder that results from deficient activity of the
enzyme homogentisic oxidase. It results in elevated levels of homogentisic acid which
forms a pigment that is deposited in connective tissue and joints throughout the body. It
typically presents in the 3rd decade of life, with initial pigmentation occurring in the ear
cartilage and sclera of the eyes. A dark pigment is also deposited in the large joints and
the lumbosacral spine. This leads to early onset arthritis and can result in joint
replacements at a younger age. The disorder is characterized by urine that is of a
