Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) Internal Medicine and Medical Subspecialties Flashcards

24 sample cards from the Internal Medicine and Medical Subspecialties deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. What pattern of liver enzymes suggests hepatocellular versus cholestatic injury?

   Hepatocellular: predominant AST/ALT elevation (AST:ALT >2 suggests alcohol). Cholestatic: predominant alkaline phosphatase and GGT elevation with bilirubin (biliary obstruction/PBC/PSC).

2. What is Charcot's triad and Reynolds' pentad in acute cholangitis?

   Charcot's triad: fever, RUQ pain, jaundice. Reynolds' pentad adds hypotension and altered mental status, indicating suppurative cholangitis requiring urgent biliary decompression.

3. What are Ranson's criteria used for and name two on-admission markers of severe acute pancreatitis?

   Ranson's criteria estimate severity/mortality of acute pancreatitis. On-admission markers include age >55, WBC >16,000, glucose >200, AST >250, and LDH >350.

4. How do you clinically distinguish upper from lower GI bleeding?

   Upper GI bleed (proximal to ligament of Treitz): hematemesis, coffee-ground emesis, melena, elevated BUN/Cr ratio. Lower GI bleed: hematochezia (bright red blood per rectum), though brisk upper bleeds can also cause hematochezia.

5. What is the initial management priority and key pharmacologic agents in variceal upper GI hemorrhage?

   Resuscitation (IV fluids/blood, two large-bore IVs), then octreotide (splanchnic vasoconstriction), IV PPI, prophylactic antibiotics (ceftriaxone), and urgent endoscopy with band ligation.

6. Classify anemia by MCV and give one cause in each category.

   Microcytic (MCV <80): iron deficiency, thalassemia, anemia of chronic disease (late). Normocytic (80-100): acute blood loss, hemolysis, chronic disease. Macrocytic (>100): B12/folate deficiency, alcohol, hypothyroidism, MDS.

7. What lab profile distinguishes iron deficiency anemia from anemia of chronic disease?

   Iron deficiency: low ferritin, low serum iron, high TIBC, low transferrin saturation. Anemia of chronic disease: normal/high ferritin, low serum iron, low TIBC, with elevated hepcidin.

8. Compare sickle cell disease and the alpha/beta thalassemias by underlying defect.

   Sickle cell: point mutation (Glu->Val) in beta-globin causing HbS polymerization/vaso-occlusion. Thalassemias: reduced quantity of normal globin chains (alpha = deletions of alpha genes; beta = mutations reducing beta-chain synthesis) causing microcytic anemia.

9. What coagulation test abnormalities are seen in hemophilia A versus von Willebrand disease?

   Hemophilia A (factor VIII deficiency, X-linked): prolonged aPTT, normal PT, normal platelets/bleeding time. von Willebrand disease: prolonged aPTT (low VIII) +/- prolonged bleeding time/abnormal platelet function, with mucocutaneous bleeding; most common inherited bleeding disorder.

10. What lab pattern (PT, aPTT, platelets, fibrinogen, D-dimer) defines disseminated intravascular coagulation?

    Prolonged PT and aPTT, low platelets, low fibrinogen, and elevated D-dimer (with schistocytes on smear), reflecting simultaneous consumption of clotting factors and fibrinolysis.

11. Distinguish Hodgkin from non-Hodgkin lymphoma, including the pathognomonic cell.

    Hodgkin lymphoma: Reed-Sternberg cells (CD15+/CD30+), contiguous nodal spread, bimodal age, often with B symptoms; better prognosis. Non-Hodgkin: more heterogeneous, often disseminated/extranodal, B- or T-cell origin.

12. What translocations are classically associated with CML and Burkitt lymphoma?

    CML: t(9;22) Philadelphia chromosome (BCR-ABL fusion), treated with tyrosine kinase inhibitors like imatinib. Burkitt lymphoma: t(8;14) (c-MYC), 'starry sky' appearance on histology.

13. What autoantibodies are associated with systemic lupus erythematosus, and which are most specific?

    ANA is sensitive (screening). Most specific: anti-dsDNA (correlates with disease activity/nephritis) and anti-Smith. Anti-histone antibodies suggest drug-induced lupus.

14. Differentiate rheumatoid arthritis from osteoarthritis by joint involvement and stiffness pattern.

    RA: symmetric small-joint inflammation (MCP, PIP, wrists), morning stiffness >1 hour, RF/anti-CCP positive, spares DIP. OA: asymmetric, weight-bearing/DIP joints (Heberden nodes), brief (<30 min) stiffness, worse with use.

15. What antibody and clinical features characterize systemic sclerosis (scleroderma), including the CREST syndrome?

    Diffuse: anti-Scl-70 (topoisomerase I). Limited (CREST): anti-centromere antibody. CREST = Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasias.

16. What are the most common bacterial causes of community-acquired pneumonia and the empiric outpatient treatment?

    Streptococcus pneumoniae is most common (also H. influenzae, atypicals like Mycoplasma). Outpatient empiric: a macrolide or doxycycline (or a respiratory fluoroquinolone / beta-lactam + macrolide if comorbidities).

17. What organisms cause uncomplicated cystitis and what is first-line therapy?

    Most commonly E. coli (also Klebsiella, Proteus, Staphylococcus saprophyticus). First-line: nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin.

18. What CSF findings distinguish bacterial from viral meningitis?

    Bacterial: high opening pressure, neutrophilic pleocytosis (high WBC), low glucose, high protein. Viral: lymphocytic pleocytosis, normal glucose, mildly elevated protein.

19. At what CD4 count do you start prophylaxis for Pneumocystis jirovecii and what agent is used?

    Start PCP prophylaxis when CD4 <200 cells/mm3 (or oropharyngeal candidiasis); first-line is trimethoprim-sulfamethoxazole.

20. Match HIV opportunistic infections to their CD4 thresholds: PCP, Toxoplasmosis, MAC, CMV retinitis.

    PCP: CD4 <200. Toxoplasma encephalitis: CD4 <100. CMV retinitis and disseminated MAC: CD4 <50.

21. What is the time-window and mechanism of tPA (alteplase) for acute ischemic stroke?

    IV alteplase (a thrombolytic that activates plasminogen to dissolve clot) is given within 4.5 hours of symptom onset after hemorrhage is excluded by CT and contraindications are checked.

22. Distinguish the headache features of migraine, cluster, and tension-type headache.

    Migraine: unilateral, pulsating, moderate-severe, photophobia/phonophobia/nausea, +/- aura, lasts 4-72 hours. Cluster: severe unilateral orbital pain with ipsilateral autonomic signs (tearing, rhinorrhea, ptosis), short attacks in clusters. Tension: bilateral, band-like, pressing, mild-moderate, no nausea.

23. What clinical features distinguish a focal seizure with impaired awareness from a generalized tonic-clonic seizure?

    Focal impaired-awareness: starts in one hemisphere, automatisms, altered/impaired consciousness, often with postictal confusion, may have aura. Generalized tonic-clonic: bilateral from onset, loss of consciousness, tonic stiffening then clonic jerking, tongue-biting/incontinence, postictal state.

24. Contrast the core motor and cognitive features of Parkinson disease and Alzheimer disease.

    Parkinson: resting tremor, bradykinesia, cogwheel rigidity, postural instability from dopaminergic nigrostriatal loss. Alzheimer: progressive anterograde memory loss then global cognitive decline, with amyloid plaques and neurofibrillary (tau) tangles.

What this deck covers

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