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

“Erythematous crusted rash on one breast and histological findings of epithelial cells with a lot of cytoplasm (intraepithelial adenocarcinoma cells) “

Paget disease of the breast

Most common cause of middle ear infection in kids

H influenza

S. Pyogenese produces an enzyme that dissolves

Fibrin clots

Strep pyrogenes can cause

Superantigen activity to form a rash in scarlet fever

Cold agglutination disease involves

C3b

Antibodies to glycoproteins IIb-IIIa, and Ib-IX are found in

Idiopathic thrombocytopenic purpura

A splenectomy is mainly indicated for patients with sickle cell if

They have had a splenic crisis more than 1 time

Vaso-occlusive crisis typically happen in sickle cell when

The person gets sick

Flaps hands+falls a lot of work+brown pigmentation in iris+ATP7B

Wilson disease— decreased serum ceruloplasmin levels

Ceruplasmin is the protein carrier of ___ in the blood

Copper

Patients with ___ are at an increased risk for Alzheimer’s

Down syndrome

“Traumatic head injury; bones intact; sub epidural hemorrhage; worsening state; primitive reflexes appear (like sucking on anything that touches their face”

Subfalcine herniation

Medial aspect of the frontal lobe, cingulate gyrus herniates across the midline u def the free edge of the anterior falx

Subfalcine herniation

The two choices to treat acute gout

Non-aspirin NSAIDs, glucocorticoids or colchicine

“Large intracytoplasmic vacuoles”

Creutzfeldt Jakob

Huntington onset

20-50 years (if outside of that, it’s probably CJD)

Medication to detox from iron

Deferoxamine

Fomepizole uses

Treats overdose of alcohol, antifreeze and mentanol

____is characterized by acute low back pain, incontinence, and saddle anesthesia with lower motor neuron findings.

Cauda equina syndrome

What is used to diagnose peripheral nerve and muscles disorders

Electromyogram

Which method is used to diagnose cauda equina syndrome

Emergent MRI of lumbar spine

Serum creatinine measures

Muscle damage

Orthostatic hypertension, what’s not being stimulated

Alpha 1 receptors

Charcot-Marie-tooth underlying cause

Defective proteins found in myelin

“Demyelination secondary to enzymatic deficiency”

Cause of metachromatic leukodystrophy

Barrett esophagus is linked to

GERD

Cardiomyopathy+megacolon+achakasia+from South America

Chagas’ disease

“Liver issues, dizziness, numbness, being treated for TB”

Ionizid

Dopamine and norepinephrine are derived from

Tyrosine

Donepezil MOA

Prevents breakdown of Ach

____is a phosphodiesterase inhibitor used for intermittent claudication.

Cilostazol

Rotenone mechanism

Inhibits mitochondrial complex 1 which causes symptoms similar to Parkinson’s

Antimycin A mechanism

Inhibits complex 3 by binding to Qi site of cytochrome c reductase

“Farmer+ found in fish poison+ respiratory depression+pulmonary edema and shock”

Antimycin A

Arsenic exposure leads to the inhibition of

Pyruvate kinase

The hypothalamus is located next to the inferior aspect of the

3rd ventricle

Ataxia is seen in a lesion involving the

Cerebellum

Lesion in the hippocampus could lead to

Anterograde amnesia

The characteristic histopathology of psoriasis includes

hyperkeratosis, parakeratosis, thickening of the spiny layer, elongation of the rete ridges, small accumulations of neutrophils in the epidermis, and increased mitotic activity in the epidermis. The dermal papillae are elongated and hypervascular.

NSAIDs inhibit cyclooxygenase, thus preventing the synthesis of

prostaglandins and thromboxanes.

Priapism can be a complication of

Sickle cell disease

Treatment for vaso-occlusive crisis

Hydroxyurea

Fresh frozen plasma contains

Clotting factors

Serotonin is derived from

Tryptophan

woman has a stroke. Afterward, she cannot perform simple calculations, cannot write, cannot distinguish right from left, and cannot identify individual fingers.

Which structure is most likely damaged?

Angular gyrus.

Brief positional vertigo + positive Dix-Hallpike maneuver → mechanism?

Otoliths in the posterior semicircular canal.
Buzzwords: positional vertigo, posterior canal, Dix-Hallpike, Epley maneuver.

Viral illness + vertigo + tinnitus + hearing loss → diagnosis?

Labyrinthitis.
Buzzwords: vertigo, hearing loss, tinnitus, viral illness.

Clindamycin — mechanism + classic toxicity?

Binds 50S and inhibits translocation; anaerobic/oral infections and aspiration pneumonia; C. difficile pseudomembranous colitis.

Caloric testing: warm water in one ear produces no nystagmus → lesion where?

Ipsilateral vestibular apparatus.
Buzzwords: caloric reflex, warm water, absent nystagmus, vestibular apparatus.

Giardia lamblia — board buzzwords

Untreated stream water; campers; foul-smelling greasy diarrhea; bloating; steatorrhea; trophozoites attach but do not invade; metronidazole.

Pilocarpine — board buzzwords

Muscarinic agonist; increases salivation; Sjögren dry mouth; miosis; contracts ciliary muscle; increases aqueous humor outflow.

A patient develops bloody diarrhea followed several weeks later by a liver abscess. Which organism is most likely responsible?

Entamoeba histolytica

Recurrent Neisseria infections → immune defect?

Terminal complement deficiency → impaired membrane attack complex formation.
Buzzwords: Neisseria, terminal complement, membrane attack complex.

Dapsone — classic toxicity?

Used for leprosy; oxidative hemolysis in glucose-6-phosphate dehydrogenase deficiency → Heinz bodies + bite cells.

Intracellular viral antigen presented to cytotoxic T lymphocytes → processing step?

Proteasomal degradation before major histocompatibility complex class I presentation.
Buzzwords: intracellular antigen, proteasome, major histocompatibility complex class I, cytotoxic T lymphocyte.

Beta-2 microglobulin deficiency → which immune function is impaired?

Cytotoxic T-lymphocyte activation via major histocompatibility complex class I.
Buzzwords: beta-2 microglobulin, major histocompatibility complex class I, cytotoxic T lymphocytes.

Tetracycline — toxicity of expired drug?

Expired tetracycline → Fanconi syndrome (proximal renal tubular dysfunction)

A patient from South America develops chronic pulmonary symptoms, cervical lymphadenopathy, and painful oral mucosal ulcers. Microscopy shows yeast with multiple buds radiating from a central cell.

Which organism is most likely responsible?

Paracoccidioides brasiliensis

Pyridostigmine — board buzzwords

Myasthenia gravis long-term treatment; acetylcholinesterase inhibitor; increases acetylcholine at the neuromuscular junction; quaternary amine.

Macrolides — classic adverse effects?

50S inhibitors; increased gastrointestinal motility, cholestatic jaundice, QT prolongation; cytochrome P450 inhibition.

Rifabutin — key board associations?

Used for Mycobacterium avium complex; rifamycin; induces cytochrome P450.

Leishmania donovani — board buzzwords

Sand fly; amastigotes in macrophages; visceral leishmaniasis; hepatosplenomegaly + pancytopenia; “black fever.”

Infant with severe infections of all types + absent thymic shadow + absent lymphoid tissue → most likely defect?

Common gamma-chain mutation causing severe combined immunodeficiency.
Buzzwords: severe combined immunodeficiency, absent thymus, absent tonsils, combined T- and B-cell dysfunction.

A patient receiving an antibiotic for a serious gram-positive infection develops optic neuropathy and stocking-glove peripheral neuropathy after prolonged therapy.

Which drug was most likely responsible?

Linezolid

girl has recurrent Staphylococcus aureus skin abscesses, eczematous dermatitis, and retained primary teeth.

Which diagnosis is most likely?

Hyper-immunoglobulin E syndrome.

Recurrent sinopulmonary infections + atopy + Giardia → immune defect?

Immunoglobulin A deficiency → impaired humoral immunity.
Buzzwords: Giardia, asthma, recurrent respiratory infections, mucosal immunoglobulin deficiency.

Brimonidine — board buzzwords

Alpha-2 agonist; chronic open-angle glaucoma; decreases aqueous humor production.

A patient with an intestinal parasitic infection is treated with an aminoglycoside that remains primarily within the intestinal lumen rather than being used systemically.

Which drug was most likely prescribed?

Paromomycin

patient with plague caused by Yersinia pestis is treated with an aminoglycoside that is also used for tularemia.

Which drug was most likely prescribed?

Streptomycin

A patient develops fever, chills, dyspnea, bilateral crackles, and hypoxemia 2 hours after a blood transfusion. There is no evidence of heart failure.

Cytokine-mediated activation of neutrophils in the lungs

Orbital floor fracture + impaired upward gaze → entrapped muscles?

Inferior rectus + inferior oblique.
Buzzwords: blowout fracture, enophthalmos, diplopia, cheek numbness.

Pseudomonas aeruginosa — board buzzwords

Burn patients; blue-green pigment; fruity/grape odor; ecthyma gangrenosum; cystic fibrosis pneumonia; hot-tub folliculitis; swimmer’s ear.

man had a stroke 5 months ago that caused loss of sensation on the left side of his body. He now develops severe, constant burning pain involving the same side despite no new injury.

Damage to which structure most likely caused this complication?

Right thalamus.

Vemurafenib — key board association?

BRAF kinase inhibitor; V600E BRAF-positive melanoma.

man with hypertension suddenly becomes unable to recognize familiar faces. He can see objects clearly but cannot identify them visually unless he touches them or hears the sounds they make.

Infarction of which artery is most likely responsible?

Posterior cerebral artery

Erlotinib — mechanism + buzzwords?

Epidermal growth factor receptor tyrosine kinase inhibitor; non-small cell lung cancer; acneiform rash + diarrhea.

Uvula deviates left → which nerve is damaged?

Right vagus nerve.
Buzzwords: vagus lesion, palate weakness, uvula points away from lesion.

Ipsilateral blown pupil + “down and out” eye + contralateral hemiparesis?

Weber syndrome — midbrain lesion.
Buzzwords: cranial nerve III palsy, crus cerebri, posterior cerebral artery.

A patient develops pharyngitis followed several weeks later by migratory polyarthritis and carditis. Which bacterial virulence factor is most strongly associated with this delayed complication?

M protein

A patient treated for tuberculosis develops decreased visual acuity and difficulty distinguishing red from green. Which drug is most likely responsible?

Ethambutol

Synthetic heroin + acute parkinsonism → damaged structure?

Substantia nigra

Actinomycin D — mechanism + classic uses?

DNA intercalator; blocks DNA/RNA synthesis; pediatric tumors such as Wilms tumor and rhabdomyosarcoma.

Lower-extremity vibration/proprioception → dorsal column tract?

Fasciculus gracilis.
Buzzwords: lower limb, vibration, proprioception, positive Romberg.

Pyrazinamide — board buzzwords

Hyperuricemia; gout; hepatotoxicity.

Amphotericin B — board buzzwords

Binds ergosterol → membrane pores; severe systemic fungal infections; nephrotoxicity; hypokalemia; magnesium wasting; infusion-related fever/chills.

Mucormycosis — board buzzwords

Diabetic ketoacidosis; broad nonseptate hyphae; 90-degree branching; angioinvasion; black nasal eschar; debridement + amphotericin B.

Imatinib — second major kinase target besides BCR-ABL?

Inhibits c-KIT tyrosine kinase → gastrointestinal stromal tumor.

Histoplasma capsulatum — board buzzwords

Ohio/Mississippi River valleys; bird/bat droppings; caves; small intracellular yeast in macrophages; can mimic tuberculosis; disseminates to liver/spleen.

Tacrolimus — mechanism?

Binds FK-binding protein 12 → inhibits calcineurin → ↓ interleukin-2 → ↓ T-cell activation.

A 24-year-old man has decreased taste sensation over the anterior two-thirds of the left side of his tongue.

Which nerve is most likely damaged?

Left facial nerve.

Glucose-6-phosphate dehydrogenase deficiency is ___

X-linked recessive

fabry disease, hemophilia A, DMD, and WAS are all

X-linked recessive

Alpert syndrome, fragile X are both

X linked dominant

Sickle cell anemia, Wilson disease, thalassemias, friedreich ataxia, and phenylketonuria are all

Autosomal recessive

If a patient has sickle cell anemia and osteomyelitis is suspected, what should be started empirically

Ciprofloxacin and vancomycin

NSAID exacerbated respiratory disease

Asthma, chronic rhinitis, nasal polyps, caused by leukotriene production

Steven’s Johnson syndrome is a type __ reaction

4

Drug induced hemolytic anemia, neutropenia/agranulocytosis and thrombocytopenia are examples of

Type 2 reactions

This is characteristic of

Rocky Mountain Spotted Fever