COMSAE ALL EXAM QUESTIONS AND ANSWERS
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
-Treatment glaucoma: alpha agonists; epinephrine, brimonidine - -dec AH synthesis>
vasoconstriction; mydriasis alpha 1 (don't use in closed angle glaucoma) blurry vision,
ocular hyperemia, foreign body sensations ocular allergy, pruritis
-Beta blockers: timolol, betaxolol, carteolol - -dec AH synthesis; no pupil/vision changes
-Diuretics; acetazolamide - -dec AH synthesis by inhibiting carbonic anhydrase; no
vision/pupil change
-Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine, echothiophate
- -inc outflow of AH via contraction of ciliary muscle/open trabecular mesh; pilocarpine in
ER--very effective open meshwork into Canal schlemm,
lead to miosis--and cyclospasm
-Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - -inc outflow AH; darken iris
(brown); eyelash growth
-alpha agonists should be avoided in - -closed angle glaucoma pts
-M3 agonist= pilocarpine/carbachol (direct) - -contract the sphincter muscles allowing
passage of fluid; pilocarpine emergencies
-pervasive development disorder - -what you think of when you consider autism
spectrum: can't be touched, comforted, can't understand speech
-Mifepristone/ulipristal (mifetuspleasebegone) - -competitive inhibitor progestins at
progesterone receptors;
terminate pregnancy (mifepristone w/ misoprostol); ER contraception (ulipristal)
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
-Treatment glaucoma: alpha agonists; epinephrine, brimonidine - -dec AH synthesis>
vasoconstriction; mydriasis alpha 1 (don't use in closed angle glaucoma) blurry vision,
ocular hyperemia, foreign body sensations ocular allergy, pruritis
-Beta blockers: timolol, betaxolol, carteolol - -dec AH synthesis; no pupil/vision changes
-Diuretics; acetazolamide - -dec AH synthesis by inhibiting carbonic anhydrase; no
vision/pupil change
-Cholinomimetics M3; direct pilocarpine carbachol; indirect physostigmine, echothiophate
- -inc outflow of AH via contraction of ciliary muscle/open trabecular mesh; pilocarpine in
ER--very effective open meshwork into Canal schlemm,
lead to miosis--and cyclospasm
-Prostaglandin- bimatoprost, iatanoprost PGF2 alpha - -inc outflow AH; darken iris
(brown); eyelash growth
-alpha agonists should be avoided in - -closed angle glaucoma pts
-M3 agonist= pilocarpine/carbachol (direct) - -contract the sphincter muscles allowing
passage of fluid; pilocarpine emergencies
-pervasive development disorder - -what you think of when you consider autism
spectrum: can't be touched, comforted, can't understand speech
-Mifepristone/ulipristal (mifetuspleasebegone) - -competitive inhibitor progestins at
progesterone receptors;
terminate pregnancy (mifepristone w/ misoprostol); ER contraception (ulipristal)
