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COMSAE EXAM QUESTIONS AND ANSWERS
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COMSAE EXAM QUESTIONS AND ANSWERS
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COMSAE EXAM QUESTIONS AND ANSWERSA 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. Nasopalatine 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).
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 examination 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
conditions 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).
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
Brachioradilias innervation
C6
3,500 kcal
1lb of body fat is equivalent to?
A 35 year old female is evaluated for mental status changes on day 4 of hospitalization
for status asthmaticus. She is being treated with albuterol, predisone, and ipratropium.
Social history is negative for substance use. Neurologic examination 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.
Hypercapnia (option b), which is an abnormally high level of carbon dioxide in the blood,
can lead to altered mental status. However, it is less likely in this case since the
patient's neurological examination is described as nonfocal and there is no mention of
respiratory distress or other signs of severe respiratory compromise.
Seizures (option d) and stroke (option e) can both cause mental status changes, but
there are no indications in the scenario to suggest these as the likely causes. The
absence of pathological reflexes and negative mri of the brain make these options less
likely.
Therefore, based on the information provided, the most likely cause of the mental status
changes is a medication effect from the medications being used to treat the patient's
status asthmaticus. However, it is important to consult a healthcare professional for a
comprehensive evaluation and definitive diagnosis.
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