COMLEX/What You Missed From Truelearn

These are mostly concepts/wordings/tip-offs/distinguishing details that I learned from my mistakes on Truelearn and other resources while preparing for COMLEX.

“Prolonged time to release grip” which condition?

Myotonic dystrophy

High arches and high step age gate, defective proteins in myelin, duplication of PMP22 gene. Which disease?

Charcot-Marie-Tooth

Pancytopenia with normocytic anemia, increased erythropoietin, bruising and fatigue. Which disease?

Aplastic anemia

HIV patient, dies a few weeks later, signs of dementia, multinucleated giant cells. Which disease?

AIDS-related dementia

“Spongiform changes”

Creutzfeldt-Jakob

Necrosis of the temporal lobes in patients with aids.

Herpes encephalitis

aids patient with a cd4 count less than 200, ring enhancing lesions, cerebral abscesses. Which pathogen

Toxoplasmosis

Cleft palate, 3rd and 4th branchial pouches defective, absent parathyroid glass and thymic shadow, hypocalcemia, deletion on chromosome 22.

DiGeorge syndrome

Trisomy 21, intellectual disability, hypotonia, single palmar crease, flattened face, low set ears and increased sandal gap.

Down Syndrome

Maternal uncle with condition, sensorialnueral hearing loss, thinning of lens capsule, dot and fleck on the eyes, no previous illness, vision loss, blood in urine, defect in type 4 collagen which affects glomerular basement membrane,

Alpert syndrome

Difficulty preforming rapid alternating movements, trouble writing, tremor when reaching for objects, cerebellum damage, weakness that resolves spontaneously,

Multiple schelosis

X-linked recessive, factor 8 deficient, normal platelet count, bleeding in muscles, joint or GI tract, prolong bleeding at circumcision,

Hemophilia A

New seizure, spreads both hemispheres, pseudopalsading pleomorphic tumor cells with central areas of necrosis and hemorrhage, GFAP protein, 64 something year old, personality changes, focal defects, cells from astrocytes

Glioblastoma

Mutation on chromosome 11, valine to glutamic acid on the beta globulin chain, stroke as a kid, sharp pain from a Vado-occulative crisis, difficulty breathing, splenic sequestration,

Sickle cell anemia

“Only 80 percent of people with with gene express the phenotype” is called

Incomplete penetrance; expressivity is to what degree they express it

Beckwith-wiedemann, Angelman and Prader-Willi, depends on which parent the allele is from

Imprinting

Tumor of the ependymal cells that line the ventricles, in fourth ventricle in kids, vomiting, vision loss,

Ependymoma

Loud diastolic rumble, long arms and legs, defect on chromosome 15, blood pressure difference between right and left arm, mutation in fibrillin-1 (FBN1) which affects connecting tissue, dislocation of lens, aortic dissection, retinal detachment, aortic root dilation, mitral valve prolapse,

Marfan syndrome

Middle cerebral artery stroke presents with weakness, but also,

Lack of speech typically.

New treatment for familial migraines acutely and preventively

Calcitonin gene-related peptide

Median nerve neuropathy, forearm pain, negative Tinea and phalen test, parasthesia in thenar eminence, median nerve compressed between the 2 heads of the Pronator teres, worse in the day

Pronator teres

Paresthesias in the fourth and fifth digits, positive finklestein,

Cubital tunnel

The one muscle responsible for external rotation in the rotator cuff?

Infraspinatus

“Attaches to lesser tubercle of the humerus”

Subscapularis

“CTG Trinucleotide repeat expansion in the DMPK gene on Chromosome 19” Which condition?

Myotonic Dystrophy

“states that when he takes off his sock, he has an elastic imprint on his shins; low blood pressure; history of alcoholism; mild distension; anasarca; somatic dysfunction at T6-T9” which condition?

Cirrhosis of the liver

increased capillary hydrostatic pressure typically happens in

cardiac failure

increased interstitial glycosaminoglycans acclamation typically happens in

Grave’s Disease

Decreased plasma colloid oncotic pressure is typically in

liver cirrhosis

C3 is responsible for

Opsonization

“a lot of respiratory infections” defect in what?

C3b

buzzwords for leukocyte adhesion deficiency type 1

delayed separation to the umbilical cord; C18 deficiency

“elevated triiodothyronine and thyroxine with decreased thyroid-stimulating hormone” is a tip-off for

Grave’s Disease

Buzzwords for Alport syndrome:

blood in urine for 2 days; family member or patient with sensorineural hearing loss and end-stage hearing loss”

“Increasing flailing arm and leg movements; he is experiencing symptoms sooner than his grandfather and father; depression” which disease?

Huntington’s

“Pelvic exam reveals purulent, yellow cervical discharge, gram negative diplococci” which disease?

Gonorrhea or Chlamydia

“green, frothy, and malodorous discharge” which disease

trichomoniasis

“spirochete; painless genital ulcer (chancre); positive treponemal” which disease

syphilis

“cardiomegaly/cardiac abnormalities; tests show increased serum creatine kinase, lactate dehydrogenase, and aspartate aminotransferase; no hypoglycemia” which disease?

Pompe disease

“cardiomegaly, myopathy, elevated creatine kinase” is buzzwords for

Cori Disase

“hypotonia, progressive proximal myopathy, absent reflexes” which disase?

Spinal muscular atrophy 1

“Short; has not had first period; shortened fourth mtacarpal bone; 3/6 systolic murmur”

Turner Syndrome

“intellectual disability, long face, large ears, autistic-like behaviors” which disease

Fragile X

“decreased sense of smell; delayed puberty; low GnRH, LH, FSH”

Kallman Syndrome

“15-35 years old; precocious puberty, gynecomastia; testicular tumors do not transilluminate” which disease

testicular choriocarcinoma

“weakness and aneurysms in vessels; frequent bruising, hypermobile joints; defect in types 1,3,5 collagen; mother/father has it”

ehlers'-Danlos

“autosomal Dominant; mutation in FBN-1; defects in heart valves and aorta; subluxation of crystalline lens”

Marfan Sydrome

“Splenomegaly, anemia, thrombocytopenia, hepatosplenomegaly; no central nervous system involvement”

Gaucher Type 1

“subcutaneous nodules; accumulation of joint contractures; hoarse voice” which disease?

Farber disease (acid ceramide deficiency)

“severe episodes of shooting, stabbing or sharp pain on the face that last for a few seconds to a minute; responds well to sodium channel blocking seizure drugs”

Trigeminal neuralgia

“breastfeeding has ended; introduces foods like apples; tired and sweats” which disease?

Hereditary fructose intolerance (missing aldolase B)

“anticentromere antibodies”

CREST Sydrome

“Anti-dsDNA”

systemic lupus eryrethema

“antimicrosomal antibodies”

Hashimoto thyroiditis

“antimitochondrial antibodies”

primary biliary cholangitis

“antihistone antibodies”

drug-induced lupus

“patient took; procainamide, hydralazine, or penicillamine; has antihistone antibodies” which condition?

drug-induced lupus

“Worker makes fluorescent light bulbs, batteries, or thermometers” which kind of poisoning could they have?

Mercury poisoning

How to treat a left anterior radial head somatic dysfunction?

flex the elbow and pronate the forearm, while the physician slowly and gently articulates the forearm into pronation which is against the restrictive barrier

“Patient has been on first gen antipsychotic for 4+ months; lip smacking” is a tip off for

Tardive dyskinesia (caused by the up regulation of dopamine receptors)

“Patient has been on first gen antipsychotic and feels like he cannot sit still”

Akathisia; treat with beta blockers

“Patient has been on antipsychotic for 4 hours or less and has sustained contraction of facial muscles” tip off for?

Acute dystonia reaction

“Patient has been on antipsychotic for 4 weeks and has bilateral tremor” tip off for

Parkinsonism/bradykinesia

Community-acquired pneumonia caused by Klebsiella tip off terms?

Right upper lobar pneumonia (crackles/rales); patient has diabetes/heart problems; productive cough

Atypical pneumonia (Legionella pneumophilia) tip off words

Dry cough; exposure to ACs or sprinklers;

“Rusty spectrum; thick blood septum; causes severe sickness in those without a spleen or with sickle cell anemia”

Community acquired pneumonia caused by streptococcus pneumoniae

“Young adult; dry hacking cough; interstitial infiltrates”

Atypical pneumonia caused by mycoplasma pneumoniae

Diphtheria and tetanus are both ___ vaccines

Toxoid

Hepatitis B, HPV, pnerumococcus and H. Influenza are all ___ vaccines

Subunit

“When she tries to track a pen light to the right, everything is fine, but when she tries to track it to the left, neither eye will go past midline” what is damaged ?

Left paramedian pontine reticular formation

“Alzheimer’s symptoms before 65” is a tip off for

Early- onset Alzheimer’s

Apolipoprotein E genes are associated with

Late-onset AD

“Rapidly progressive dementia, myoclonus, and ataxia; patient dies in a few months” which disease

Creutzfeldt-Jacob

“Tau protein mutations”

Frontotemporal Dementia

“Lewy bodies (intracellular aggregations or alpha-synuclein)”

Lewy body dementia

“manic episode involves severe function impairment, hospitalization, or psychosis and lasts for more than or equal to 4 days”

Bipolar 1

“Violent psychosis/delirium and psychomotor agitation” which drug?

PCP

“Tachycardia, high blood pressure, paranoid, anxiety” which illicit drug?

Cocaine- treat with benzodiazepines

“Euphoria, awake for days, bad teeth, cardiac arrest” which illegal drug

Amphetamines

“No confusion (aware that symptoms are drug induced); out of body feeling; hallucinations” which drug?

LSD

“Women stops being able to walk in mall; physical test says that legs are weak, but she’s not freaking out about it; no other cause”

Conversion disorder

If she has vague symptoms, but is anxious about it, it’s somatic symptom disorder

____ describes a pattern of depressive symptoms persisting for at least 2 years. The diagnosis requires the presence of a depressed mood accompanied by 2 or more of the following: poor appetite/overeating, insomnia/hypersomnia, fatigue or low energy, low self-esteem, poor concentration or difficulty making decisions, or feelings of hopelessness.

Persistent depressive disorder

“Repeatedly clears throat, shakes head, and blinks”

Tourette’s

“Earliest antibody produced during infection”

IgM

IgD and IgM serve as a ___ receptor

B cell

“Unvaccinated child, muffled voice, inspiratory stridor”

H. Influenzae

“Positive direct Coombs test, chronic lymphocytic leukemia, spherocytes” which disease

Warm autoimmune hemolytic anemia

“Low total iron-binding capacity” is associated with

Anemia of chronic disease

“ had a diarrheal infection a few weeks ago, absent reflexes and muscle weakness, ascending paralysis”

Guillain-Barré syndrome

“Normal glucose in CSF and elevated leukocyte count (with mainly lymphocytes)”

Viral meningitis

“Performs neutrophil chemotaxis”

C5a

“Leads to vulnerability of Neisseria infections” which deficiency

C5-9

Myasthenia gravis and Graves’ disease are both which subtype of type 2 hypersensitivity

Noncytotoxic

“Receives blood transfusion and almost immediately has difficulty breathing, worsening hypotension, blood in urine, and flank pain”

Acute hemolytic transfusion reaction due to ABO incompatibility

“Patient receives blood transfusion and and in less than 6 hours experiences respiratory distress and pulmonary edema”

“Donor antibodies bind recipient neutrophils and leads to their activation”

Which condition

Transfusion-related acute lung injury caused by donor anti-leukocyte antibodies against host neutrophils and pulmonary endothelial cells