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COMSAE 110 PRACTICE GUIDE UPDATED
2026 TESTED SOLUTIONS
⫸ Patient is retching, vomiting small amount of blood, history of AUD. Nonpentrating mucosal tear of the posterior wall superior to the gastroesophageal junction that continues to the esophageal wall compromises Answer: vagal trunk (runs posterior to the esophagus). Mallory-Weiss syndrome. ⫸ PMH of calcium disorder which he ran out of supplements. BP is 110/70 and taking BP elicits carpal spasm. PT is short, stocky and shortened medial digits (Albright Hereditary Osteodystrophy). Phosphate and cAMP don't respond to IV PTH. The cause is decreased Answer: Galphas mediated signaling. Pseudohypoparathyroidism type 1a (PHP1A). ⫸ Fever, dry cough, GI upset with COPD. Patchy opacities. Gram neg bacilli. They acquired the bacteria via Answer: inhalation if environmental aerosols (usually HVAC person). Legionella pneumophila. ⫸ Sudden loss of consciousness that lasted for less than 1 minute. No tongue biting or urinary incontinence. Most likely cause Answer: idioventricular rhythm. sudden drop in cerebral perfusion due pacemaker failure.
⫸ 50 yr old man presents for annual visit. FMH lung and bladder cancer. Drinks alcohol. PMH hemorrhoids. Screening for him Answer: colonoscopy. Should be done starting at 45yrs old for everyone. ⫸ Low grade lumbosacral achiness for as long as he can remember. Narrow lucency down the middle of the L5 spinous process present. Patent sacroiliac joints. Congenital abnormality Answer: spina bifida occulta. ⫸ 68 yr old woman with T2DM, HTN, hyperlipidemia. Menopause at
- DXA scan - 2.1. Add calcium, vitamin D and what med Answer: alendronate to prevent osteoporosis (Inhibits osteoclast activity, reducing bone resorption - bisphosphonate) ⫸ What is the Pearson correlation value for this data set? Answer: correlation close to 0.00. ⫸ 78 yr old presents to office with 1 week history of lower abdominal pain and urinary hesitancy with interrupted flow. Enlarge, firm, tender prostate. PSA is normal. Gram pos, catalase neg coccus. Etiological agent Answer: Enterococcus faecalis. ⫸ 75 yr old pruritic vulvar lesion which she first noticed 1 week. White, flaky, slightly roughened lesion with focal areas of ecchymoses from scratching. Thinning of the squamous epithelium. Hypocellular collagenous tissue. Dx Answer: lichen sclerosus et atrophicus.
sparing the apices and bases. DX Answer: hypersensitivity pneumonitis. (Type III/IV hypersensitivity) ⫸ Folic acid will ensure fetus has adequate methylene tetrahydrofolate for Answer: conversion of dUMP to dTMP. (limits neural tube risk) ⫸ Nausea, headache, breast tenderness. Mother of 4 and taking monophasic combine oral contraceptive therapy for 3 months. Consider a different contraceptive. Switch her to Answer: administer depot medroxyprogesterone acetate injections. (estrogen is causing issues - switch to a progesterone only med) ⫸ 62 yr old tired by the end of the day. More breathless and burning sensation in legs when he jogs. PMH HTN for 20 yrs untreated. Labs- NA ↑, BUN↑, glucose ↑, GFR↓. Exercise tolerance impaired b/c Answer: arterial blood oxygen content is reduced. Chronic kidney disease leading to anemia. He wouldn't be able to jog is there was a ↓in cardiac output. ⫸ 5 day history of R elbow pain that began shortly after tennis tournament. Winces when shaking hands/ Diminished flexion of the wrist and tender end point at the R lateral epicondyle. Additional tender point is found at Answer: extensors of the wrist. Extensors connect directly to the lateral epicondyle, pronator teres is wrong because that attaches to the medial epicondyle. ⫸ 54 yr old man present with increasing difficulty initiating urination, which results in multiple nocturnal attempts to void. Which receptor
should the pharm aim for to provide relief Answer: block of alpha 1 adrenergic receptor in the prostate. ⫸ Pt has HTN. Multiple medication has not allowed for control. She has no meds currently. Exam reveals edema with LOW potassium. Etiology Answer: renal artery stenosis. No EDEMA IN CUSHING SYNDROME! ⫸ You review article result sin which 1,000 patient s with and without heart disease had this test performed with 900 positive results (p value of 0.5). you conclude that Answer: the observed difference is due to chance. No type 1 error present b/c you didn't incorrectly reject the null hypothesis. ⫸ 45 yr old man has L lower extremity edema. Surgical history reveals a L inguinal hernia repair 2 weeks ago. Anterior innominate rotation present. Edema most likely because Answer: mechanical obstruction to absorptive flow. Obstruction most likely due to PMH of recent surgery. ⫸ History of palpitations and dyspnea + PMH of coronary artery disease and HTN. Lungs are clear to auscultation. Most appropriate pharm agent to control the HR Answer: diltiazem. Adenosine is a short- acting agent that temporarily blocks AV nodal conduction. It's primarily used for paroxysmal supraventricular tachycardia (PSVT), especially in cases of reentrant arrhythmias involving the AV node (like AV nodal reentry tachycardia).
would show Answer: multiple cerebral cortical infarcts. Vascular dementia leads to UMN and has a PMH of HTN. ⫸ PMH of 1 yr w/ worsening pain during and after sex. Laparoscopy reveals red, punctate, weakly bleeding spots measuring 8-10 mm in diameter on the pelvic peritoneum(gun-powder lesions). The pelvic lesions are caused by Answer: response to locally produced estradiol. Dx is Endometriosis. ⫸ 6 month history of fatigue and joint pain. Brother and sister have similar sx. Physical exam shows increased skin pigmentation and hepatomegaly. His fasting glucose is 180. What is the following process most likely to be abnormal Answer: intestinal iron uptake. DX Hereditary hemochromatosis. Decreased hepcidin, increased ferroprotein, increases iron overload. ⫸ 3 yr old boy brought in ED during the night by parents who reported patient was sent home from daycare w/ fever of 101. Parents say he has vomited several times, spiked fever 104, and become intermittently confused. LB recommended but declined due to fear it would hurt the child. Parents request to sign out the son AMA w/ plans to take him to the private pediatrician in the morning. Most appropriate step is to Answer: enlist help of private pediatrician in convincing the parents to allow for the procedure. Don't proceed right away with procedure since its not a surgery, more a matter of hours rather than minutes. ⫸ 3 month history of pelvic pain, a sense of pelvic fullness, diarrhea. Physical exam reveals pelvic mass. Ultrasound reveals an ovarian mass. Initial Mets of tumor cells from this mass via lymphatics will most likely
involve which nodes Answer: lumbar. Primary lymph node drainage for ovarian cancer is lumbar and (para-aortic) and preaortic nodes. ⫸ 5o yr old present with 6 month fatigue, lethargy, constipation, decreased libido. Erectile dysfunction, and lightheadedness. PMH 2 week episode of severe headache and blurred vision 6 months ago. Orthostatic BP present. Most likely dx Answer: panhypopituitarism. Sudden with vision changes and low FSH/LH leading to low testosterone sx. Addisons would not affect sex hormones. ⫸ 2 weeks history of severe pain across her face. Intense pain while chewing and applying her makeup. Unilateral hypersensitivity across the region of the lower face involving the upper lip. Which nerve is responsible Answer: mandibular. (v3) of trigeminal branch causing trigeminal neuralgia. Facial nerve would be responsible for movement, not sensation. ⫸ 42 yr old presents with 1 month history of erectile dysfunction. Able to achieve erection but is not able to achieve orgasm and ejaculation. PMH T1DM. mechanism for his sexual dysfunction is Answer: decreased sympathetic tone. "point and shoot" ⫸ 28 yr old man presents with sudden onset of several headaches. He complains of stick neck, vomits, loses consciousness. Bilateral abdominal masses are noted in the flanks. A lumbar puncture reveals increases pressure and blood. Which is the abnormal proteins most likely present Answer: polycystin 1. ADPKD is present
Answer: abdominal aortic aneurysm. Don't screen for asymptomatic CAD, always screen for AAA if they are 65-75 who have ever smoked. ⫸ 2yr old has 2 week history of vomiting and contipatio. Appears pale and in distress. Lab studies reveal hemoglobin low and serum lead level high. TX is Answer: sodium edetate. Ferrous sulfate would be to correct iron deficiency anemia in a small child. ⫸ 53 yr old women presents with polyuria. PMH T2DM. Consumes 15 L of water daily to cleanse toxins in her system. Labs show sodium ↓,creatinine ↑, BUN normal. Most likely cause Answer: osmotic suppression of vasopressin release. primary polydipsia (compulsive water drinking), leading to osmotic suppression of vasopressin. ⫸ 47 yr old man has 6 month history of anxiety. He is employed as a taxi driver. Anxiety doesn't fluctuate through the day. Tx is Answer: buspirone (5-HT1A partial agonist) "bus drivers take buspirone" , benzos are too sedating. ⫸ 18 yr old women presents with 3 day history of yellow sclerae. She is anxious about the appearance. Her hepatic bilirubin UDP glucuronosyltransferase activity is 30% normal. Recommendation should be Answer: avoid worrying because her condition is benign. Gilbert Syndrome. ⫸ 32 yr old man is brought to ED in a disoriented and extremely agitated state. He is restrained after several attempt to bite first responders. He is vomiting, hallucinations, not oriented to time or place.
Physical exam reveals several extremely painful bite marks which have been cleaned by the patient. His companion reports that the injuries occurred when he was attacked by a raccoon 3 weeks ago. Cytoplasmic inclusion bodies(Negri bodies) associated with this patients disorder are most likely to be found in Answer: the hippocampus. Rabies. Neurotopic RNA virus that infects the hippocampal pyramidal neurons that lead to hallucinations and cerebellum for motor ataxia. ⫸ 13 yr old boy is brought to the office for visible breast growth. Breast size is 3cm and symmetrical and a ridge of glandular tissue can be palpated around the nipple areolar complex. The patient has Answer: normal pubertal development. transient imbalance of estrogen > androgens, appears around Tanner stage 2-4. Palpable subareolar tissue = true gynecomastia. ⫸ pt presents with 24 hr history of intense, throbbing pain in his R index finger after he inadvertently touched a hot stove. Exam revels swollen, inflamed, blistered area at the distal end. What transmitters are most likely to account for the patient's pain Answer: substance P. Nociceptic neuron that does perception, sensitization, inflammation. GABA would modulate pain signals. ⫸ 40 yr old woman present for annual visit. PMH hysterectomy with bilateral oophorectomy 10 yrs ago to treat dysfunction uterine bleeding. She east processed foods and smokes fewer than 5 cigs per day. What should she get screening for Answer: mammography. 40+= mammography, 45+ =colonoscopy.
⫸ 54 yr old man presents with 6 week history of fever, night, sweats, anorexia, and productive cough. History reveals immigration from eastern Europe. Cachectic man with abnormal chest sounds. Lab is negative for HIV. Chest radiograph reveals a small cavity with interstitial opacities in the left upper lobe and calcified lung lesion and lymph node. Sputum analysis is acid fast organism. The agent is Answer: TB. Nocardia would have granulomatous inflammation. ⫸ 78 yr old is admitted to the hospital due to the severe fatigue 3 days after the onset of diarrhea. Analysis of 24 hr urine collection reveals a clear, deep yellow coloration with volume less than 400 mL, benign urinary sediment and no protein on dipstick testing. The fractional excretion of sodium is less than 1%. Oliguria is due to Answer: reduction in renal blood flow. Pre-renal AKI. ↑GFR= polyuria. ⫸ 45 yr old man has an 8 week history of inability to concentrate, constant fatigue, and lack enjoyment. He states he goes to be and sleeps to until 6AM but now he wakes up at 2AM. He skips breakfast and lunch because he is not hungry. DX Answer: major depressive disorder. ⫸ 40 yr old presents to the office with 1 week history of severe drowsiness after he was started on diphenhydramine for allergic rhinitis. Patient is a bus driver. Med is changed to fexofenadine. The pharmacokinetic parameter that best supports the use of this is Answer: ionizable at physiological pH. Diphenhydramine is NOT ionizable and crosses the BBB. Ionizable fexofenadine stays in the periphery, reducing sedation.
⫸ Full term neonate is noted to have generalized petechia and jaundice at birth. Few hours later, he is seizing. A CT reveals ventriculomegaly and periventricular calcifications. Otoacoustic emission are absent. Mother indicates that she had the flu like illness lasting 10 days at the beginning of her second trimmest. The neonate is infected with Answer: CMV. ⫸ 20 year old has a positive seated flexion test on the R and deep sacral sulcus on the R. the R inferior lateral angle is inferior and posterior. The SD is Answer: sight unilateral sacral flexion. Positive L seated flexion test and NO spring test gets you here. ⫸ 48 yr old women presents with inability to shoulder abduct. The spinal nerve dysfunction is Answer: C5-6. C7-8 would be klumpkes claw. ⫸ 87 yr old woman is under hospice for end stage dementia. She has a pacemaker for a-fib. She is now unresponsive and has a DNR and refusal for feeding tubes/breathing support. The family asks if the pacemaker is keeping her from dying. You should tell them Answer: maintain the pacemaker because it won't interfere with end of life progression. Won't stop the organ failure, just ticks in the background. ⫸ 22 yr old consumed pills at a party 1 hr ago. BP is 150/95 and heart rate is 120/min. Pt is anxious, sweating with dilated pupils. The substance is a Answer: monoamine reuptake inhibitor. Cocaine, amphetamines, or ecstasy. 5-HT₂A agonists (like LSD, psilocybin) would be hallucinogens.
⫸ 66 year old man is admitted to the hospital with a 4 week history of increasing shortness of breath, dyspnea on exertion, and pronounced fatigue and weakness. HE gained 6.8kg during this period. He also describes a 2 week history of a productive cough that worsens at night, and he indicates that he now has to sleep sitting up. He has a 10 yr history of untreated HTN and hypercholesterolemia. He has 3+ pitting edema, nail clubbing, and rales. In the tx of this patients signs, inhibition of which of the following target is most likely effective Answer: Na-K- 2CL symporters (loop diuretics - furosemide). Left ventricular dysfunction. Use loop diuretics for acute management of reducing fluid overload vs ACE-I for long term improvement of heart function. ⫸ 63 yr old man presents to the ED with 45 min history of sudden onset diplopia and left sided weakness. Past medical history is significant for hyperlipidemia and HTN. Presents with Answer: impaired abduction of R eye, left sided hemiparesis, decreased fine touch and proprioception in the L extremity, extensor plantar reflex on L, globally intact pinprick, ability to wrinkle the forehead symmetrically, dropping of the left corner of the mouth. Ischemia was most likely in the : pontine tegmentum. Posterior part of pons which contains CN 6,7 , medial lemniscus, reticular formation, portions of the corticobulbar tracts. ⫸ 72 yr old man has 6 month history of bilateral pain and fatigue in his legs while walking that resolves within minutes of resting. He smokes w/ 62 pack history. PMH reveals T2DM, hyperlipidemia, HTN. Physical exam reveals bilaterally diminished femoral, popliteal, posterior tibial, and dorsal pedis pulses. His ankle brachial index is 0.35. The most likely cause is Answer: ischemia. Claudication due to an obstruction. Venous stasis would cause edema and wouldn't be relieved by rest.
⫸ 62 yr old woman presents for eval of an ill defined palpable mass of the R subareolar region that was discovered during mammogram. She denies pain, but reports occasional thick white nipple secretion. The mass is excised and histo shows fibrosis and scarring with chronic inflammation surrounding the dilated ducts that contain foamy macs. The dx Answer: mammary duct ectasia. "ectasia in elderly" ⫸ 68 yr old man brought in after MVA, where he struck his head on the steering wheel. He is admitted after an MRI shows petechial hemorrhage in the basilar frontal lobes. The next day he is lethargic, inattentive, and sleepy. He is confused as to where he is, has difficulty concentrating on various tasks and has difficulty finding the right words to express himself. The most likely additional finding is Answer: anosmia. The cribiform plate is where the olfactory bulbs are, if they are smashed with orbital/basilar injury = no attention or smell. "frontal trauma knocks out the smell and focus". ⫸ 26 year old primigravid woman present to the office for a prenatal exam. She is a full time employee. According to the FMLA, the patient is entitled to be off from work for 12 weeks. Answer: ⫸ 35 yr old woman presents to the emergency department for evaluation of facial drooping that began 3 hours ago suddenly. She is concerned she is having a stroke. Mouth is drooping on the right side, drooling, unable to close her right eye or wrinkle her forehead on the right side. The lesion is located in the Answer: stylomastoid foramen. Facial nerve exits here which does only movement. Geniculate ganglion would have facial paralysis + taste loss, dry eye, hyperacusis. "styloid smile only"
