COMSAE Form 113 Practice Exam
Version 1 Questions And Correct
Answers (Verified Answers) Plus
Rationales
1. a 20 year old female presents to the emergency department after
she slipped
on ice and hit her mouth on the sidewalk. Her medial maxillary
incisors are fractured and she is intense pain. the nerve most likely
conveying this pain sensation is the?
a. anterior superior alveolar b. infraorbital c. middle superior
alveolar d. na- sopalatine e. posterior superior alveolar:
The nerve most likely conveying the pain sensation in this scenario is the infraorbital nerve (option
b).
The infraorbital nerve is a branch of the maxillary nerve, which is a division of the trigeminal nerve
(cranial nerve V). The maxillary nerve provides sensory innervation to the maxillary teeth, maxillary
sinus, upper gingiva, and the skin of the lower eyelid, lateral nose, and upper lip.
In the given case, the patient experienced a traumatic injury to her mouth, specifically fracturing her
medial maxillary incisors. The intense pain she is feeling is likely transmitted through the sensory
branches of the maxillary nerve, including the infraorbital nerve.
The infraorbital nerve travels through the infraorbital canal, emerges on the face through the
infraorbital foramen, and supplies sensation to the skin of the lower eyelid, lateral nose, and upper
,lip. The fractured incisors would have damaged the associated nerve endings, leading to significant
pain in those areas.
Therefore, the nerve most likely conveying the pain sensation in this patient's case is the infraorbital
nerve (option b).
2. a 25 year old female presents to the office for evaluation of
headaches, diplopia and loss of peripheral vision which have
progressively worsened over the past week. she reports
galactorrhea and amenorrhea. physical exami- nation is
unremarkable and Beta-HCG is negative for pregnancy. MRI of
the brain is obtained. The secretory cells that are most likely
causing this patient's conditions are? a.corticotrophs
b.gonadotrophs c.lactotrophs d.somatotrophs e.thyrotrophs: Based
on the provided information, the secretory cells most likely causing this patient's condi- tions are
lactotrophs.
The symptoms of headaches, diplopia (double vision), and loss of peripheral vision along with
galactorrhea (abnormal breast milk production) and amenorrhea (absence of menstrual periods)
suggest a hormonal imbalance. These symptoms are commonly associated with a condition known
as hyperprolactinemia, which is characterized by high levels of prolactin hormone.
Lactotrophs are the cells in the anterior pituitary gland responsible for producing and secreting
prolactin. In this case, the lactotrophs are overactive, leading to an excessive secretion of prolactin.
This excess prolactin production can result in the symptoms described by the patient.
An MRI of the brain is obtained to assess the pituitary gland and rule out any structural abnormalities,
such as a pituitary
, adenoma (a benign tumor). A pituitary adenoma involving the lactotrophs is a common cause of
hyperprolactinemia. Therefore, the most likely secretory cells causing this patient's conditions are
lactotrophs (option c).
3. HELLP syndrome: Preeclampsia with thrombotic microangiopathy of liver. Hemolysis,
elevated liver enzymes, low platelets. may occur in the absence of hypertension and proteinuria.
blood smear shows DIC (due to release of tissue factor from injured placenta)
treatment: immediate delivery
4. Brachioradilias Innervation: C6
5. 3,500 kcal: 1lb of body fat is equivalent to?
6. a 35 year old female is evaluated for mental status changes on
day 4 of hospi- talization for status asthmaticus. she is being
treated with albuterol, predisone, and ipratropium. Social history is
negative for substance use. neurologic exam- ination is nonfocal,
but she shows impairment of attention, concentration and recall.
she has a minor resting hand tremor but no patholigc reflexes.
ECG and mri of the brain are both negaitve. this patient's mental
status change is most likely due?: Given the information provided, the most likely
cause of the mental status changes in this case would be option C: medication effect. The patient's
symptoms, such as impairment of attention, concentration, recall, and a minor resting hand tremor,
are consistent with the known side effects of medications like albuterol, prednisone, and ipratropium,
which she is currently receiving for the treatment of status asthmaticus.
Alcohol withdrawal (option A) typically presents with a constellation of symptoms such as tremors,
anxiety, agitation, hallucinations, and seizures, which are not described in the given scenario.
Version 1 Questions And Correct
Answers (Verified Answers) Plus
Rationales
1. a 20 year old female presents to the emergency department after
she slipped
on ice and hit her mouth on the sidewalk. Her medial maxillary
incisors are fractured and she is intense pain. the nerve most likely
conveying this pain sensation is the?
a. anterior superior alveolar b. infraorbital c. middle superior
alveolar d. na- sopalatine e. posterior superior alveolar:
The nerve most likely conveying the pain sensation in this scenario is the infraorbital nerve (option
b).
The infraorbital nerve is a branch of the maxillary nerve, which is a division of the trigeminal nerve
(cranial nerve V). The maxillary nerve provides sensory innervation to the maxillary teeth, maxillary
sinus, upper gingiva, and the skin of the lower eyelid, lateral nose, and upper lip.
In the given case, the patient experienced a traumatic injury to her mouth, specifically fracturing her
medial maxillary incisors. The intense pain she is feeling is likely transmitted through the sensory
branches of the maxillary nerve, including the infraorbital nerve.
The infraorbital nerve travels through the infraorbital canal, emerges on the face through the
infraorbital foramen, and supplies sensation to the skin of the lower eyelid, lateral nose, and upper
,lip. The fractured incisors would have damaged the associated nerve endings, leading to significant
pain in those areas.
Therefore, the nerve most likely conveying the pain sensation in this patient's case is the infraorbital
nerve (option b).
2. a 25 year old female presents to the office for evaluation of
headaches, diplopia and loss of peripheral vision which have
progressively worsened over the past week. she reports
galactorrhea and amenorrhea. physical exami- nation is
unremarkable and Beta-HCG is negative for pregnancy. MRI of
the brain is obtained. The secretory cells that are most likely
causing this patient's conditions are? a.corticotrophs
b.gonadotrophs c.lactotrophs d.somatotrophs e.thyrotrophs: Based
on the provided information, the secretory cells most likely causing this patient's condi- tions are
lactotrophs.
The symptoms of headaches, diplopia (double vision), and loss of peripheral vision along with
galactorrhea (abnormal breast milk production) and amenorrhea (absence of menstrual periods)
suggest a hormonal imbalance. These symptoms are commonly associated with a condition known
as hyperprolactinemia, which is characterized by high levels of prolactin hormone.
Lactotrophs are the cells in the anterior pituitary gland responsible for producing and secreting
prolactin. In this case, the lactotrophs are overactive, leading to an excessive secretion of prolactin.
This excess prolactin production can result in the symptoms described by the patient.
An MRI of the brain is obtained to assess the pituitary gland and rule out any structural abnormalities,
such as a pituitary
, adenoma (a benign tumor). A pituitary adenoma involving the lactotrophs is a common cause of
hyperprolactinemia. Therefore, the most likely secretory cells causing this patient's conditions are
lactotrophs (option c).
3. HELLP syndrome: Preeclampsia with thrombotic microangiopathy of liver. Hemolysis,
elevated liver enzymes, low platelets. may occur in the absence of hypertension and proteinuria.
blood smear shows DIC (due to release of tissue factor from injured placenta)
treatment: immediate delivery
4. Brachioradilias Innervation: C6
5. 3,500 kcal: 1lb of body fat is equivalent to?
6. a 35 year old female is evaluated for mental status changes on
day 4 of hospi- talization for status asthmaticus. she is being
treated with albuterol, predisone, and ipratropium. Social history is
negative for substance use. neurologic exam- ination is nonfocal,
but she shows impairment of attention, concentration and recall.
she has a minor resting hand tremor but no patholigc reflexes.
ECG and mri of the brain are both negaitve. this patient's mental
status change is most likely due?: Given the information provided, the most likely
cause of the mental status changes in this case would be option C: medication effect. The patient's
symptoms, such as impairment of attention, concentration, recall, and a minor resting hand tremor,
are consistent with the known side effects of medications like albuterol, prednisone, and ipratropium,
which she is currently receiving for the treatment of status asthmaticus.
Alcohol withdrawal (option A) typically presents with a constellation of symptoms such as tremors,
anxiety, agitation, hallucinations, and seizures, which are not described in the given scenario.
