COMLEX page 2

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Inheritance patterns of disease

Pattern of InheritanceDisease
X-linked recessiveFragile X, Duchenne’s muscular dystrophy, hemophilia A and B, Fabry’s disease, G6PD-deficiency, Hunter’s syndrome, and Wiskott-Aldrich syndrome.
Mitochondrialprogressive external ophthalmoplegia and myoclonus
Autosomal recessive cystic fibrosis, albinism, alpha-1 antitrypsin deficiency, phenylketonuria, thalassemias, sickle-cell, glycogen storage diseases, and hemochromatosis.
Autosomal dominantadult polycystic disease, familial hypercholesterolemia (Type IIa), Marfan’s , neurofibromatosis (Types 1 and 2), Von Hippel-Lindau, Huntington’s disease, familial adenomatous polyposis, and hereditary spherocytosis.

Overdose and metabolic disturbances

Acetaminophen N-acetylcysteine.
Acid/alkali ingestion Upper endoscopy to evaluate for stricture.
Anticholinesterases, organophosphates Atropine, pralidoxime.
Antimuscarinic/anticholinergic agents Physostigmine.
Arsenic, mercury, gold Succimer, dimercaprol.
β-blockers Glucagon.
Barbiturates (phenobarbital) Urine alkalinization, dialysis, activated charcoal, supportive care.
BenzodiazepinesFlumazenil (can precipitate withdrawal, mainly used for acute ingestion)
Black widow bite Calcium gluconate, methocarbamol.
Carbon monoxide 100% O2, hyperbaric O2.
Copper, arsenic, lead, gold Penicillamine.
Cyanide Hydroxycobalamin, amyl nitrate, sodium nitrate, sodium thiosulfate.
Digitalis Normalize K+ but avoid giving Ca2+, Mg2+, or lidocaine (for torsades); anti-digitalis Fab.
Heparin Protamine sulfate.
INH Pyridoxine.
Iron salts Deferoxamine.
Lead Succimer, CaEDTA, dimercaprol.
Methanol, ethylene glycol (antifreeze) EtOH, fomepizole, dialysis, calcium gluconate for ethylene glycol.
Methemoglobin Methylene blue.
Opioids Naloxone.
Salicylates Urine alkalinization, dialysis, activated charcoal.
TCAsSodium bicarbonate (for QRS prolongation) diazepam or lorazepam (for seizures) cardiac monitor (for arrhythmias.)
TheophyllineActivated charcoal. (Consider repeat doses)
tPA, streptokinase Aminocaproic acid.
Warfarin Vitamin K, FFP.


Electrolyte abnormalityTreatment
Hyperkalemia.C BIG K: calcium gluconate (give first to stabilize conduction), bicarb (useful for acidotic states), insulin and glucose (give after calcium to drive potassium intracellularly) Kayexalate (Long onset, good for chronic cases)
Hypernatremia.Normal Saline. (if unstable vital signs; D5W or ½ NS to replace free-water loss.)
hypercalcemia.IV hydration then Furosemide to excrete excess calcium



Question Answer
New York Heart Association (NYHA) classificationClassifies heart failure into 4 groups
New York Heart Association (NYHA) Class I heart failure with no limitation
New York Heart Association (NYHA) Class IIsymptoms with strenuous physical activity.
New York Heart Association (NYHA) Class IIIsymptoms with little physical activity
New York Heart Association (NYHA) Class IVsymptoms of heart failure, even at rest.
Debakey SystemClassifies Aortic Dissection by types 3 types (I, II, III)
Type Iinvolves the ascending aorta, arch and descending thoracic aorta.
Type IIAscending Aorta only
Type IIIaIIIa involves the descending thoracic aorta distal to the left subclavian artery and proximal to the celiac artery
Type IIIbinvolves the thoracic and abdominal aorta distal to the left subclavian artery.
Stanford SystemClassifies Aortic Dissection as either type A or B
Type ADissection of the Ascending Aorta
Type BAll others
Rai staging systemused to stage leukemia
Rai stage 0Lmphocytosis greater than 15,000
stage I lymphocytosis + lymphadenopathy
stage IIlymphocytosis + splenomegaly
stage IIIlymphocytosis + anemia
stage IV is lymphocytosis + thrombocytopenia
Ottowa rule Determines of X-ray is needed.
Criteria for X-rayCan't bear weight after injury and on presentation, Tenderness to palpation around medial and lateral malleoli