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COMSAE ALL EXAM|177 QUESTIONS AND ANSWERS|
UPDATED 2025|100% PASS
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
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-C upper trunk compression cause injury; loss forearm flexion/supination; loss sensation over lateral forearm Axillary nerve C5-C
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
Reversible inhibitor of H1 histamine receptors 1st generation antihistamines diphenhydramine, dimenhydrinate, chlorpheniramine "en/ine" or "en/ate" use: allergy motion sick, sleep aid AE: sedation, antimuscarinic, anti alpha adrenergic 2nd generation antihistimes loratadine, fexofenadine, desloratadine, cetgirizine "adines" use: allergy; far less sedation than first gen bc dec entry into CNS Decompression disease/caisson dz) Air emboli--nitrogen bubbles precipitate in ascending divers> tx hyperbaric O2; can be iatrogenic due to invasive procedures Bronchiectasis
chronic necrotizing infection bronchi>> perm dilated airways, purulent sputum, recurrent infecting, hemoptysis, digital clubbing; assoc: obstruction, poor ciliary motility (Kartagener syndrome, smoking) CF, allergic bronchopulmonary aspergillosis Kartagener Syndrome -- primary ciliary dyskinesia immotile cilia b/c dyne arm defect; male and female infertility, inc risk ectopic pregnancy; causes bronchiectasis, recurrent sinusitis, and situs inversus Myasthenia gravis Most C NMJ disorder; autos to postsynaptic ACh receptor;; clinical-ptosis diplopia weakness, worsen w/ MUSCLE USE==WORSEEE Assoc: thymoma, thyme hyperplasia tx: pyridostigmine, edrophonium to diagnose==AChE inhibitor Lambert Eaton myasthenia syndrome
Left Lower quadrantic anopia right parietal lesion MCA--dorsal optic radiation Left hemianopia w/ macular sparing PCA infarct Central scotoma macular degeneration Cranial nerve III damage
poss cause DM >> inc sorbitol; due dc O2/nutrients S/s: ptosis, down and out; diminished/absent pupillary light reflex, blown pupil CN IV damage
eye moves upward; esp C/l gaze, head tilt toward side lesion; problems going downstairs; present w/ compensatory head tilt in app direction CNVI damage medially direct eye that cannot abduct eye nerves remember LR6, So4, R Acetaminophen moa: reversibly inhibit COX, mostly CNS; AE: OD>> hepatic necrosis; NAPQI depletes glutathione>> toxic byproducts liver; NAC= antidote>> regenerate glutathione Vecuronium neuromuscular blocking drugs>> muscle paralysis in surgery or mechanical ventilation; NONDEPOLARIZING (CUR'S)
moa: block reuptake NE and 5HT AE: sedation, alpha 1 block effects>> postural hypotension and atropine like (anticholinergic) side effects>> tachycardia, urinary retention, dry mouth, GLAUCOMA LIKE, prolong QT TriC's: Convulsions, Coma, Cardiotoxicity (arrhythmia due to NA channel inhibit) Conduct disorder precursor to antisocial personality disorder=sociopath animal harm, illegal activity, destruction property, theft, aggression heroin miosis? respiratory depression methadone or burpnorphine + naloxone treatment
Scalded skin syndrome Staphylococcal-- exotoxin destroy attaches in stratum granulosum fever; general rash, sloughing upper layers epidermis heals completely; + Nkolsy; newborns, children and adults w/ renal insufficiency Placenta accrete/increta/percreta -defective decidual layer>> abnormal attach and separate after delivery (risk factor C section, inflammation, placenta prevue_ 3 types: Placenta accreta attaches myometrium; no penetration Placenta increta placenta INTO myometrium
ischemic infarct pituitary follow post part bleeding; pregnancy induced pit grow>> inc susceptible to hypoperfusion assoc: fail lactate, absent menstruation, cold intolerance Starling curve force contraction is proportional to end diastolic length cardiac muscle fiber (preload) inc contractility w/ catecholamines; positive inotropes (digoxin) dec contractility (MI, BB's, Non DHP calcium channel blockers, dilated cardiomyopathy) Baroreceptors hypotension: dec arterial pressure, dec stretch, dec afferent receptor firing, increase efferent sympathetic firing, dec efferent parasympathetic stimulation>> vasoconstriction> inc HR/contractility/BP response to severe hemorrhage Carotid massage
inc pressure carotid sinus>> inc stretc>> inc afferent baroreceptor firing>> inc AV node refractory period> dec HR fluoxetine Selective serotonin reuptake inhibitors: fluvoxamine, paroxetine, sertraline, escitalopram, citalopram SSRIs-- flu/flu/paro/sert/escit/cit MOA: inhibit 5 HT reuptake use: depression, GAD, panic, OCD, bulimia, social anxiety disorder, PTSD, premature ejaculation, premenstrual dysphoric disorder AE: GI distress, SIADH, sex dysfunction; anorgasmia, dec libido Carbamazepine MOA: block sodium channels-- first line partial seizures, also use tonic clonic seizures AE: diplopia, ataxia, agranulocytosis aplastic anemia, liver tox, teratogenesis, induce CYP450; SIADH, Stevens Johnson
