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COMLEX LEVEL 3 EXAM 2025-
QUESTIONS AND ANSWERS GRADED A+
TESTBANK GUARANTEED PASS
Atypical squamous cells of undetermined significance (ASC-US) can be managed in 2 ways. What are they
The first option is to repeat cytology in one year and perform colposcopy if follow- up smears are abnormal.
The second option (preferred) is to perform an HPV test and return for testing in 3 years if it is negative or perform colposcopy if HPV test is positive
If pt has positive hpv test and colposcopy is negative then whats the next step
pt will need repeat HPV test in 3 yrs.
the most common cause of a protraction disorder is
inadequate uterine activity.
is the position in which the fetal biparietal diameter fits best in the average female pelvis.
right occiput anterior
Some examples of malpresentation are
an extended fetal head, brow or face presentation, and occiput posterior.
Neuroleptic malignant syndrome (NMS)
a life threatening neurological emergency. As indicated by the name, it is most commonly associated with neuroleptic medications such as haloperidol, chlorpromazine, risperidone, etc. Symptoms include extreme muscular rigidity, mental status changes, hyperthermia, tachycardia, tachypnea, and profuse diaphoresis
Although malignant hyperthermia has a very similar clinical presentation to NMS, it is more common in the setting of
inhaled halogen anesthetic use, such as halothane.
difference between serotonin syndrome vs neurlopetic and malignant hyperthermia
serotonin syndrome doesn't present with fever
_____is the first line treatment for hyperthyroidism in pregnancy during the first trimester. ______ is used after the first trimester.
Dx criteria for hyperemesis gravidarum
Hyperemesis gravidarum is based on the presence of nausea and vomiting, plus loss of > 5% of patient's prepregnancy weight, dehydration and electrolyte imbalance
The first step in the management of pyloric stenosis is
fluid resuscitation and correction of electrolyte abnormalities.
Methotrexate (Rheumatrex)
laprascopy if unstable
Patients who are stable with no hepatic or renal impairment who will be able to follow-up can be offered ______for treatment of an ectopic pregnancy.
MOST ANSWERS ARE BEFORE THE QUESTIONS FROM THIS POINT
active ischemia (incl transient st elevation seen in prinzmetal), cardiac failure, or hemodynamically compromising valvular insufficiency.
3 contraindications to stress testing
Coronary angiography demonstrating transient coronary spasm
the diagnostic hallmark of Prinzmetal variant angina
Anion gap metabolic acidosis
acute renal failure from od of methanol will demonstrate what kind of acid base disturbance
opioids (incl morphine)
Yawning and piloerection (goosebumps) are very specific for what kind of withdrawal
cocaine
Patients going through _____withdrawal will have symptoms very similar to major depressive disorder including increased sleep, appetite, psychomotor slowing, severe depression and suicidal ideation.
HBeAb
is an antibody to the "e" antigen and, when positive in the system, indicates low transmissibility of the virus.
HBsAb
This antibody signifies immunity to the hepatitis B virus
Pts. receiving receiving Warfarin will have extrisinc pathway affected - i.e. increased PT
Normal PT
Increased PTT
Normal Bleeding Time
Normal Platelet Count
Von Willbrand Disease (VWD) (Autosomal Dominant)
MC inherited bleeding disorder and is transmitted as AD trait. Affects platelet binding and is also a carrier protein for factor VIII (intrinsinc, PTT)
Normal PT
Increased PTT Increased Bleeding Time
Normal Platelet Count
DIC
Increased PT
Increased PTT
Increased Bleeding Time
Low Platelet Count
BMP and UA (least costly and invasive and most readily available)
In pts with suspected BPH and urinary retention what 2 dx tests would be most important order first
Renal US - to eval for hydronephrosis and bladder outlet obstruction
Any pt with BPH and renal insufficiency (elevated Cr) should have a ____ performed
it's only effective if given within hours after being bitten
anaphylaxis and serum sickness so it is reserved for severe cases
When is antivenin indicated
What are 2 feared complications
opthlamic flq. make sure to tx both eyes
tx for bacterial conjunctivitis
uterine rupture risk factors (5)
- previous rupture
- previous uterine surgery (esp transfundal)
- use of prostaglandins or oxytocin
- short inter-pregnancy interval
- hydatidiform mole (a type of gestational trophoblastic disease)
vasa previa (definition)
a condition in which the fetal vessels course through the membranes, over the cervical os and insert into the placenta close to the os.
bedside abdominal US to confirm that the placenta is overlyling the cervical os
Do this before jumping to c-section immediately
Confirm dx of suspected placenta previa with
Expectant mgmt if the pt remains stable and her bleeding subsides.
If hemorrhage worsens or persists or there are signs of fetal distress, immediate C- section is warranted
Tx options for placenta previa (2)
placenta accreta (definition)
severe OB complication involving an abnormally deep attachment of the placenta through the endometrium and into the myometrium (middle layer of the uterine wall)
placenta accreta risk factors (7)
- advanced maternal age
- multiparity
- multiple gestation
- hx of placenta previa
- leiomyomas
- smoking
- cocaine use
uterine inversion
complication of placenta accreta
- large myeloblasts with notched nuclei and auer rods
- 20-
AML
- definition
- symptoms
- lab findings
- 2 findings on blood smear
- demo
- males >
- lymphadenopathy, splenomegaly (40%), hepatomegaly (20%), anemia, recurrent infections
- asymptomatic leukocytosis vs penia in ALL and AML with WBC >50,
CLL
- demo
- sx
- labs
- Hairy cell leukemia (<2% of adult leukemia cases)
- elderly males
- diagnosed based on history, physical exam and labs but the diagnosis is confirmed through the identification of hairy cells in the blood, blood marrow or spleen. TRAP (tartrate resistant acid phosphatase) stain and flow cytometry are helpful in distinguishing the pathognomonic hairy cells.
- malignant disorder of well differentiated B lymphocytes
- On physical exam, 80-90% of patients have an enlarged spleen, which can be massive. less likely among patients who are diagnosed at an early stage.
- notably, most of these patients have a dry tap due to marrow fibrosis on bone marrow biopsy unlike CML
- Cladribine (2CDA) and pentostatin (DCF) are the two most common first-line therapies. They both belong to a class of medications called purine analogs
- what is it
- demographic
- dx
- what type of malignancy
- PE finding
- bone marrow tap
- tx
Rituximab (Rituxan). It is also used in a variety of B cell dependant conditions as it is an antibody against the B-cell surface marker CD20.
treatment for Burkitt's lymphoma
- radiation exposure
- bcr-abl t(9;22) translocation which forms the classic Philadelphia chromosome
- constitutional sx - fatigue, weight loss, night sweats, fever, splenomegaly
- blast crisis - can lead to death. enlarged spleen and low-grade fevers as well as signs of disrupted bone marrow function (anemia and thrombocytopenia)
- WBC very high, sometimes > 500,000, low Hg. LDH and uric acid are elevated due to increased cell turnover. This is not seen in the chronic phase of CLL.
- First line treatment for CML is with imatinib or allogenic stem cell transplant while the treatment for the blast phase of CML is dasatinib or stem cell transplant. Imatinib targets and inhibits bcr-abl tyrosine kinase and eliminated the CML clone, leading to rapid hematologic and cytogenetic remission.
CML
- definition
- demo
- risk factor
- pathognomic finding
- sx
- complication
- labs
- tx
is associated with mantle cell lymphoma.
t(11;14) bcl-
The translocation in Burkitt's lymphoma
t(8;14) c-myc
translocation which forms the classic Philadelphia chromosome - CML
bcr-abl t(9;22)
Ewing sarcoma
t(11;22)(q24;q12) translocation which fuses the EWS gene on chromosome 22 with the FLI1 gene on chromosome 11
CLL (case)
65 year old male found to have a leukocyte count of 58,000 during a routine yearly exam
- painless lymphadenopathy
- nodular sclerosing (80% of cases)
- Sensitivity
- TP / TP + FN (A / A + C)
The probability that a screening test will be positive in pts with a disease is...
1.?
- equation
1. NPV
2. TN / FN + TN (D / C + D)
The probabilty that a pt with a negative test does not have a disease
1.?
- equation
- specificity
- TN / FP + TN (D / B + D)
The probability that a testd will be negative in pts without a disease
1.?
- equation
1. PPV
2. TP / TP + FP (A / A + B)
probablity that a pt with a positive test has a disease
1.?
- equation
- odds ratio
- (TP TN) / (FP FN) (A D)/(BC)
the odds of exposure among pts with a disease compared with odds of exposure among pts without a disease. determined through case control studies
- equation
- Vulvar cancer (Paget's, squamous cell (mc) )
- wide local exicision
- colposcopy
Post menopausal woman with vulvar pruritis.
- what do you suspect?
- what if lesions or plaques are present - what next?
- if no lesions what do you do?
