COMLEX most missed *final*

jmanderson's version from 2017-06-18 18:13

combank 1-3

Question Answer
Initial tx for upper GI bleedIVF, NG tube, PPI - order endoscopy
Rx for DB gastroparesisErythromycin or metoclopramide (motility agent)
Rx for UTI in pregnancyfosfomycin
Image of choice to confirm thoracic aneurysmCT w/ contrast
Rx for hemodynamically stable pt with sustained V tach or SVTamiodarone
Young F with b/l conductive hearing loss (BC > AC with Rinne) and +fam hx (AD)Otosclerosis (loss of stapedial reflex)
Dx, eval- pt with knee pain, wam fluid lesion in popliteal lesionBaker’s cyst, U/S
Oral retinoid s/e’sSuicidal ideations, teratogen, high TG/chol/AST/ALT
Rifampin moaBacterial dependent DNA-dep RNA polymerase inhibitor
QoL tx for PNHPrednisone, eculizumab
renal lab of waterhouse friderichsenElevated renin
Ppx for MAC in HIVazithromycin
Child with abd pain, hematochezia, HSP, s/p URIIntussusception
Succinylcholine electrolyte s/ehyperK
Rx for neutropenic fever in chemo ptsPseudomonal abx (ceftazadime, zosyn, meropenem, imipenem, cefepime)
Testicular ca assoc. with peutz Jeghers (intestinal polyposis) and Carney’s synd (mucosal melanin spots)Sertoli cell tumors (stimulated by FSH for spermatogenesis)
Serology in window period of Hep Banti-HBc (IgM) only
Unstable WPW pt with irregularly irregular rhythm, dx/txA fib, cardioversion
Tx afib in stable WPW ptIV procainamide
DOC for dyskinesia of huntington’s Tetrabenazine (VMAT inhb, dec DA, 5HT, NE)
Complex regional pain synd type 1 stage- limb swollen/red/burn, diaph., sx near site (wks)1 (acute)
Imaging of choice for Budd ChiariDoppler u/s
Infant days old with cardiogenic shock, s/sx of CHF, weak LE pulses- dx and txCoarctation of the aorta (s/p DA closure), tx with PGE1 (keep PDA open)
Ambiguous genitalia, no uterus/ovaries, masses in inguinal canal, nL electrolytes5 alpha reductase def. (XY, elevated T, low DHT)
Tx for post menopausal hot flashes if h/o breast caSSRIs (E is contraindicated)
Infarction of 2nd metatarsal headFreiberg dz
Electrolyte d/o - confusion, lethargy, ha, sz, diffuse STEhypoNa
Electrolyte d/o - tetany, hyper DTR, dysrhythmias, STD, u waves, QRS wideninghypoMg
Artery involved w/ occulomotor n paralysis?Posterior communicating
Rx for sjogren syndromePilocarpine (muscarinic agonist)
DOC for cutaneous larval migransThiabendazole (2nd line - albendazole, ivermectin)
Tx for H ducreyi penile lesionSingle dose azithromycin, 3x dose ceftriaxone 7d, or cipro bid 3d
Tx crytpococcol meningitisAmphotericin B and flucytosine
Pt with wk/fatigue, sore tongue, paresthesias, wt loss, constipation, anorexia, abd fullness, loss of proprioception (+ rhomberg), dx?Pernicious anemia (IF d/o of parietal cells, dec B12 absorption)
Tumor marker for seminomabhcg

combank 4-7

Question Answer
rx for acute interstitial nephritisprednisone
dx: osteonecrosis of navicular tarsal boneKohler's dz
pediatric bone pain in metaphysis of long bone with elevated periosteumosteosarcoma
abx for necrotizing fasciitisclindamycin , pcn G, vancomycin
heel lift start for fragile vs young pt1.5 mm (1/16") fragile or 3.2 mm (1/8") young
EM of kidney in alport syndbasement membrane splitting
dx: saddle nose defomrity, bilat auricular inflamm on mult occasionsrelapsing polychondritis
image w/u for portal HTNegd
image w/u for hepatic abscessabd u/s
psoas CS location and txmedial to ASIS, hip F and ER
hep C txribavirin and weekly IFN alpha
bug causing neonatal conjunctivitischlamydia
fungal lung infxn: oval yeast cells, cave exploring, ohio river valley, bird/bat poophistoplasma
rx for symptomatic paget's of the breastbisphosphonate
mc cardiac d/o with Turner syndbicuspid aortic valve (aortic stenosis)
ovarian ca assoc with virilizationsertoli-leydig cell tumor
nephritis bx EM with bumpy deposits of IgG and C3post-infectious
current tx of choice for HCVledipasvir and sofosbuvir
rx for burkitt lymphomarituximab (CD20 ab, rids B cells)
age: baby crawls, pulls themselves up, immature pincer, waves10 mo
tx PP endometritis (PP fever with tender fundus)IV clindamyciin and gentamycin
translocation in mantle cell lymphomat(11;14) bcl-1
translocation in follicular lymphomat(14;18) bcl-2
DOC for animal bites (pasteurella)amoxicillin-clavulanate
+ speed's (resisted extension of forearm and flexion shoulder)biceps tendonitis
CO, PVR, and PCWP in anaphylactic (distributive) shockhigh CO, low PVR, low PCWP
CO, PVR, and PCWP in hypovolemic shocklow CO, high PVR, low PCWP
dx: pregn F with bleeding and dilation of cx, but no expulsion of products of conceptioninevitable abortion
rx for long term Crohn's remissionimmunomodulators (azothioprine, TNF-alpha inh.)

misc (endocrine, gu, cv, neuro, sexual)

Question Answer
Ig for mixed connective tissue dzanti-RNP ANA
dx: adrenal insuf s/sx (hotn, fatigue, low Na, high K) with high ACTH addison dz
MOA of sulfonyureasclose K+ channel in B cell membrane causes cell to depolarize. Insulin release via increased calcium influx.
amylin analogpramlintide
What are the SGLT-2 inhibitorscanagliflozin
MOA of canagliflozinblocks reabsorption of glucose in PCT. Requires kidney to work
Toxicity of canagliflozinglucosuria increased creatinine.
type II heart block mobitz txtransvenous pacing
rx actinomycespcn and drainage of abscess
chf labs (bnp, ADH, Na, K)high bnp and ADH, low Na and K
HTN w/ low HR is c/winc ICP (cushing phenomenon)
2 vv best for swan ganz cathleft subclavian, R IJV
contraction with approx of origin/insertion w/o change in tensionisotonic
contraction w/o approx of origin/insertion w/ inc in tensionisometric
harsh holoystolic murmur radiating to axilla, widely split S2, midsystolic clickmitral regurg
if pericardial exudate, w/u forneoplasm, fibrotic d/o, TB
testicle ca with inc Estromal cell
dx- quad screen low hcg, low papp-a, nl afp, nl ue3tri 13 (patau)

infectious dz

Question Answer
mc cold virusrhinovirus
rx for advanced Lyme'sceftriaxone, pcn G
mcc severe dehydrating gastroenteritis in kids <5y/o (esp daycare) rotavirus (non enveloped, icosahedral, dsRNA)
abx for gonococcal arthritisceftriaxone and azithromycin
RSV ppx in high risk kidspalivizumab
abx for MRSA copd pt w/ pna, but allergic to zosynvanc and ceftazidime
empiric UTI delerium abxvanc (GP, MRSA) and cefapime (GNB, pseudomonas)
abx in advance lyme dz in pregnant pt with pcn all azithromycin (doxy c/i in preg)
worst s/e of linezolidbone marrow suppresion (low plt, anemia)
bug: unvaccinated, URI s/sx (fever, runny nose, cough, malaise), progress to emesis, spasmswhooping cough, bordatella pertussis (aerobic, GNC)
bug: GPC in chains, beta hemolytic, catalase (-)strep pyogenes
doc for strongyloides infxnivermectin
corynebacterium diphtheriae virulenceAB exotoxin (ADP ribosylation of EF2, inh protein synth)
bact: abd pain, bloody diarrhea, RLQ pain, fever, pork, fresh produceyersinia enterocolitica
parasite: mild/severe bloody diarrhea, abd pain, cysts/trophozoites in stool, water, poor sanitationentamoeba histolytica
rx entameobametronidazole, paromomycin
parasite: watery diarrhea, abd pain, malaise, acid fast, food/water, immunocompromisedcryptosporidium parvum
rx crryptosporidumctrl immune suppression, nitazoxanide
parasite: fever, myalgias, periorbital edema, eosinophilia, undercooked porktrichinella spiralis
rx trichinellaalbendazole, mebendazole if CNS or cardiac sx
parasite: mild diarrhea, CNS sx (neurocysticercosis), undercooked porktaenia solium
rx taenia soliumpraziquantel for intestinal, albendazole + steroids for neurocysticercosis
rx malaria P ovale and P vivax (tertian fever cycle, latency, dormant liver hypnozoite)primaquine
1st line antimalarialschloroquine, primaquine, quinine
antimalarials for chlorquine-resistent P falciparum proguanil or mefloquine
dx- 5d fever followed by trunk to head diffuse rashHHV-6 (roseola)

board vitals

Question Answer
Abx for shigellaMacrolides (azithromycin)
Child with abd pain, cramping, gross bloody diarrhea, pets at homeC jejuni
Child with 9 d h/o fever, diarrhea, b/l conjunctivitis, sick contacts, preauricular LADadenovirus
MCC mesenteric ischemiaEmbolism to SMA
Dx- fever, fatigue, itchy rash, jt pain, jaundice, elevated ALT/ASTAcute hep b
Best image to localize abd ulcerCT abd/pelvis
Type of anemia assoc with hookworm infxnFe loss
Spinal level tested in resisted wrist extensionC6
False ribs8-12 (don’t directly attach to sternum)
5 elements of primary respiratory motion- Motility of brain and spinal cord; Fluctuation of CSF; Mobility of intracranial and intraspinal membranes; mobility of cranial bones; involuntary mobility of the sacrum
ME for exhalation rib s/d Rib 1pt raises head to ceiling
ME for exhalation rib s/d Rib 2pt turns head 30 deg away, head to ceiling
ME for exhalation rib s/d Ribs 10-12pt adducts arm
Heel walk tests what spinal levelL5
Absolute CI to CSTSkull fxr, inc ICP, acute bleed
Relative CI to CST Known sz d/o, TBI
Why L4-5 is common for herniationPosterior longitudinal ligament is thinner
what CNs exit superior orbital fissureIII, IV, V1
Mc type of lymphoma in MALT lymphomaNon-hodgkin's b cell lymphoma
Adolescent with abd distension, ileocecal mass, bx with LN, t(8;14) c-myc;IgMBurkitt lymphoma
Type of study with monozygotic v dizygotic twins to examine heritability of a d/oconcordance
% subjects w/in 1, 2, and 3 SD from mean68%, 95%, 99.7% (68 - 95 - 99.7 rule)
Term - prob a study will find a statistical diff when one does truly existPower (increased by N)
s/e of 2nd gen antipsychoticsWt gain, HoTN, inc BG, HLD
Psych pt >50 y/o with acute AMS, nxt stepBrain MRI (r/o SAH or fxr)
Rx that increase lithium levelsNSAIDs, ACEIs, ARBs, diuretics (renally exc)
Donepezil (for alzheimer’s) s/eGI upset, brady, heart block, sick sinus synd
Abx for chlamydia PNA in pregnancyAzithromycin (50s synth inh macrolide)- tetracyclines (doxy) are c/i
Post op c-sect fever that doesn’t respond to abx, no abscess or infected hematoma, dx?Septic pelvic thrombophlebitis (start IV heparin)
Mcc of fetal tachy, and txSVT, digoxin to prevent hyrdops fetalis
How to improve post-op outcome for gyn surgAbx ppx, smoke cess, post-op feeding, BB
Gestational age where heart probs most likely occur w/ teratogensWk 3-6
Gestational db dx1hr 50g OGT >140 plus >2 of … 3hr 100g (FBG >95, 1hr >180, 2hr >155, 3hr >140)
Asx pregnant woman with recent flu exposureGive oseltamivir for ppx
Tumor marker for ovarian caCA 125
Warm agglutinin autoimmune hemolytic anemia - type of HSRType II (cytotoxic, IgG/IgM bound to cell surface w/ compliment)
Immunocompromised kid w/ VZV mgmtIVIG VZV
Dx and ca assoc - wk, fatigue, tensilon +Myasthenia gravis (ct for thymoma)
Dx and periph smear - sz, recur skin and uri infxn, albinismChediak-higashi (AR, LYST gene), giant granules in PMNs
Mcc PNA in HIVCAP (even more than p jiroveci)
Tx of serum sicknessGlucocorticoid taper and H2blockers
Dx- >4y/o gets anaphylaxis after IVIGIgA def.
HSR of sarcoidosisT4 HSR (noncaseating granulomas, T-cell)
Young male recurrent uri/lri infxn, no sisters have it, low B cells - dx and txBruton or x-linked agammaglobulinemia, order western blot (Btk protein, low Igs)
Dx- young male with recurrent bact, vir, fungal infxn with low plt and eczemaWiskott-aldrich syndrome (WASp def), tx supp, abx, IVIG, bone marrow transplant
Dx- high fever, maculopapular rash from chest out, 5th day no fever, but stocking glove erythema and B-sxHHV-6 Roseola
Rx to increase breathing in croupDexamethasone (humidified O2, racemic epi)
Mcc atraumatic hip pain in <6y/oTransient synovitis (tx- nsaids, rest)
Infant with fatty foul diarrhea, growth failure, recurrent infxn, AML, aplastic anemia- dxshwachman -diamond syndrome (AR d/o with pancreas, bone marrow, and blood abnl)
dx lipid d/o - hepatosplenogaly, MR in infantile formGaucher’s (glucocerebroside high, def. beta-glucosidase)
dx lipid d/o- hepatosplenogaly, MR, not infantile formKrabbe’s dz (galactocerebrocide high, def. beta galactosidase)
Child with rash, kidney failure, pain in LE, siblings with kidney failureFabry’s
Age to draw square5
Dx- partial albino, whtie forelock, hearing lossWaardenburg syndrome (AD)
Dx- young F with recurrent ENT infxn, cardiac d/o, cleft palate, hypoCa DiGeorge Synd (22q11 deletion)
MCC afebrile sz in newbornhypoNa (2/2 water intoxication)
Dx- fever, sore throat, n/v, bloody diarrhea after sick dog exposureYersinia
Testicular feminization pt wants to get preg., w/uOrder karyotype (XY in androgen. insensitiv.)
Oral hypoglycemics with no wt changeDdp4 inhibitors (sitagliptin) and acarbose
Itchy extremity papules in ESRD/DB ptKyrle dz (assoc. Chr dialysis)
Child w/ maculopapular rash starts on head move to trunk, fever, cervical LAD, HARubella (german measles) via togavirus (ssRNA enveloped)
Other rx that can cause SJSAllopurinol, carbamazepine, phenytoin
Apocrine gland NT innervAdrenergic (assoc. with hair follicles)
Immunocompromised pt with blood ca, in shock, oval lesions with halo erythema and necrotic centerEcthyma gangrenosum (pseudomonas infection)
Abx for lung abscessClindamycin (anaerobes and strep)
Ventilation adjustment in ARDs to improve survivalDecrease Vt
DOC for CF assoc. w/ P aeruginosaInhaled tobramycin 28d
Rx for paranoid delusions in Parkinson’sQuetiapine (atypical antipsychotic) due to low D2 and ACh blockade (worsens Parkinson’s)
Cofactor for B6 in tx of WernickeMagnesium
Rx for migraine ppx in heavy ptTopiramate (se of wt loss)
Dx- teen goes to bed late and has hard time waking in mornDelayed sleep phase syndrome (circadian d/o)
Antiepileptic Rx with SE of aggressionlevetiracetam
Dx- pt with spastic paresis and low proprioception of LE, takes Zn Cu def. 2/2 inc. Zn intake
Dx- F w/ hx pelvic ca has radicular pain in LE with asymmetric sensory and motor lossCauda equina syndrome
Antibody for peripheral neuropathy 2/2 SCCanti-Hu (anti-ANNA-1)
Dx and w/u- PP female with HA, increased ICP, hx of dvtCerebral venous sinus thrombosis, order MR-venography
Ptosis (lid lax) worse in evening, suggestsMyasthenia gravis
Postpartum CMP sx and txLV systolic dysfxn, MR. Tx with ACEI
R heart overload (increased pulm vasculature), RVH on ekg, fixed split S2ASD
What HTN Rx is DOC in pregnancyLabetalol (low AEs), methyldopa (more AEs)