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COMSAE Exam with complete solutions 2024_2025.
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COMSAE Exam with complete solutions 2024_2025.
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COMSAE Exam with complete solutions2024/2025
COCAINE intoxication - ANSWER- 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 - ANSWER- 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 - ANSWER- 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 - 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)
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 - ANSWER- superficial laceration palm
ape hand; loss thenar muscles
no loss sensation
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