A Beginners Guide To COMLEX Level 1 - (COMQUEST)

A Beginners guide To COMLEX Level 1
Prepared by COMQUEST Osteopathic Specialists LLC

A.T. Still, MD DO
An osteopath is only a human engineer, who should understand
all the laws governing his engine and thereby master disease.

use Similar layout and options as
COMLEX to fully prepare for test day.
High yield images
wherever
relevant.
High yield
questions and
explanations to
teach what
students
really need to
know.
Provided by COMQUEST Osteopathic Specialists.

level 1: question https://flic.kr/p/6okjAW
A 65-year-old Chinese female presents with
weight loss, generalized pruritis, and dark
urine. She denies any pain but, upon further
history, admits to clay colored stools. Physical
examination reveals jaundice and scleral
icterus. Diagnostic studies are significant for
elevated conjugated bilirubin, alkaline
phosphates, and GGT. Ultrasound reveals a mass
at the confluence of the hepatic ducts. CA19-9
and CEA levels are elevated.
The most likely etiologic organism responsible
for this patient’s condition is

OPTIONS
A: PARAGONIMUS WESTERMANI
B: SCHISTOSOMA JAPONICUM
C: FASCIOLA HEPATICA
D: SCHISTOSOMA HAEMATOBIUM
E: CLONORCHIS SINESIS

EXPLANATION
All of the choices are trematodes / flukes which are non-segmented flatforms. The two types of liver
flukes are Clonorchis sinesis (also called "Chinese liver fluke") and Fasciola hepatica (also called the
"sheep liver fluke"). Clonorchis sinesis is endemic in Korea, China, Taiwan, and Vietnam - but has been
reported in the United States, usually in Asian immigrants.
The transmission is by ingestion of undercooked freshwater fish containing metacercariae. It results in
inflammation and intermittent obstruction of the biliary ducts and long-term infection may lead to
cholangiocarcinoma. All of these flukes are treated with praziquantel (see exception below). Choice A
(Paragonimus westermani) is a lung fluke found in southeast Asia and Japan.
It is spread by ingestion of undercooked or pickled crab or crayfish. Choice B (Schistosoma japonicum) is a
blood fluke found in the Far East. Snails are the intermediate host, and once released, the infective
cercariae swim and penetrate the skin of the human host (human contact with water is necessary for
infection). Choice C (Fasciola hepatica) is also called the sheep liver fluke.
It is found worldwide, in places where sheep and cattle are raised. Transmission is by consumption of raw
watercress. Unlike other flukes, this is treated with triclabendazole. Choice D (Schistosoma haematobium)
is found in Africa and the Middle East. Cystitis and ureteritis with hematuria may be seen and can progress
to bladder cancer.

TAKE HOME MESSAGE
You may not get too many questions on flukes, but a
couple may show up on test day and the previous
information is important to remember. They can all be
treated with praziquantel, except for Fasciola
hepatica (triclabendazole). A serious complication of
Clonorchis sinesis is cholangiocarcinoma.

sample level 2 question
A 12-year-old male presents to the office complaining of
a pruritic rash of the arms, axilla, and buttocks of 1 weeks duration.
Past medical history reveals that the patient has a history of severe
eczema treated with topical steroids and has been treated for tinea
corporis multiples times in the past year. Physical examination reveals
numerous excoriations and clusters of erythematous papules and
vesicles on the sides of the fingers and in the web spaces.
What is the most likely diagnosis?
https://flic.kr/p/dcjJ3i Provided by COMQUEST Osteopathic Specialists.

OPTIONS
A: TINEA CORPORIS
B: ATOPIC DERMATITIS
C: SCABIES
D: URTICARIA
E: ALLERGIC CONTACT DERMATITIS
https://flic.kr/p/5fddH1 Provided by COMQUEST Osteopathic Specialists.

Explanation
Scabies is a contagious skin infection caused by the mite Sarcoptes scabiei. Scabies is characterized by intense pruritis
due to a hypersensitivity reaction induced by the eggs and feces left behind by the female mite as she burrows into the
skin. Scabies can be seen in patients of all ages and household members are frequently infected as well.
The primary lesions are characterized by papules, burrows (seen in the exhibit), vesicles, and pustules. Scratching
results in excoriated papules, crusted lesions, and can lead to secondary bacterial infection. The lesions of scabies
are classically located on the finger webs, flexor surfaces of the wrists, arms, axilla, waistline, umbilicus, genitalia,
and feet. The diagnosis of scabies is often made clinically, but a skin scraping viewed under microscopy allows direct
visualization of the mite, eggs, and feces, and provides a definitive diagnosis.
The treatment of choice is permethrin 5% lotion applied over the entire body for 8 to 12 hours with re-application one
week later. Symptomatic household members should be treated as well. All clothing and bed linens should be washed
to eliminate mites and eggs. Choice A (Tinea corporis) is a fungal skin infection that involves skin regions other than
the scalp (tinea capitis), groin (tinea cruris), hands (tinea manuum), feet (tinea pedis), or nails (onychomycosis). The
condition is classically an annular lesion with erythematous edges and central clearing. Close inspection may reveal
scales.
Treatment of choice is a topical azole. Choice B (Atopic dermatitis) is a non-contagious, inflammatory skin disorder
thought to be caused by a malfunction in the body’s immune system. The skin condition most commonly presents as dry,
scaly, and pruritic patches of the hands, feet, chest, neck, face, or posterior surfaces of the elbows and knees.

Explanation (Cont’d)
Patients often experience multiple relapses. Treatment includes the use of mild soaps, frequent application of
emollients, and the use of topical corticosteroids for acute exacerbations.
On test day, think of atopic dermatitis if the patient also suffers from asthma or allergic rhinitis. The three conditions
are frequently associated and comprise the “allergic triad. Choice D (Urticaria), commonly referred to as hives, is a
hypersensitivity reaction caused by the release of histamine from mast cells and basophils in response to a trigger.
Potential triggers include medications, foods, exercise, and exposure to the cold. On history, patients complain of
severe pruritis and may note that the lesions disappear and reappear in new locations.
On physical examination, urticarial lesions are well circumscribed, red to white, palpable wheals of varying size. In
some instances, urticaria may signify a severe allergic reaction and precede the development of life-threatening
angioedema or anaphylactic shock. The treatment of choice for urticaria is an H1-blocking antihistamine. Epinephrine
should be administered in the case of concurrent angioedema or anaphylactic shock. Choice E (Allergic contact
dermatitis) is a type IV hypersensitivity reaction classically caused by contact with poison ivy, nickel, or latex.
On test day, look for a child with a history of playing in the woods or wearing new jewelry. The lesions are described
as very pruritic and appear as vesicles and papules on a red base. In the case of poison ivy, the lesions appear in linear
streaks as a result of the skin brushing against the leaves. The treatment of choice is a topical corticosteroid and
avoidance of the causal substance.

TAKE HOME MESSAGE
Scabies is a pruritic skin infection caused by the mite Sarcoptes
scabiei. The lesions include papules, burrows, vesicles, and pustules
located on the flex or surfaces of the arms, axilla, waistline,
umbilicus, genitalia, feet, and finger webs.
A definitive diagnosis is made by viewing a skin scraping under
microscopy and identifying the mite, eggs, or feces. The treatment of
choice is permethrin 5% lotion. Clothing and bed linens should be
washed and symptomatic household members should be treated to
prevent reinfection.

THE DAY BEFORE THE TEST
do your favorite recreational activity and exercise. If you feel the URGE to study,
don't fight IT. but don't let it completely take over your day.
https://flic.kr/p/5wcC16

COMLEX LEVEL 1
INCLUDES 400
QUESTIONS TAKEN
OVER A PERIOD OF 8
HOURS.
TRY NOT TO EXHAUST
YOURSELF THE DAY
BEFORE!
https://flic.kr/p/9yhGAR

WAKE UP EARLY
DON’T RUSH OUT. PLAN FOR HAVING BREAKFAST AND LEAVE
ENOUGH TIME FOR ANY UNEXPECTED EVENTS like TRAFFIC.
https://flic.kr/p/4STFMz

GOING OVER
STUDY MATERIALS
ON THE DAY OF THE TEST
PROBABLY WONT DO YOU MUCH
GOOD
https://flic.kr/p/5jArfe

Avoid
people who are
panicking
https://flic.kr/p/us2aa

AVOID THESE
FOR BREAKFAST AND LUNCH
https://flic.kr/p/7bSLnu https://flic.kr/p/6A9jW1
https://flic.kr/p/4Y5emW

BUT DO ENJOY
THESE INSTEAD
https://flic.kr/p/8Fjtfi
https://flic.kr/p/e2xafc
https://flic.kr/p/eGTngM

YOU GET A LOCKER
LEAVE ALL YOUR Personal items,
INCLUDING pens, CELL phones, watches,
hats, electronic devices, outerwear,
purses, and wallets.
!
No food or drink are permitted inside
the testing room.
!
YOU WILL BE ABLE TO ACCESS YOUR
PERSONAL PROPERTY DURING THE LUNCH
TIME BETWEEN SESSIONS, BUT NOT DURING
BREAKS.
http://bit.ly/1C2n5UT

you’re PERMITTED to go to the restroom during two optional, 10 minute breaks
(following sections 2,6), but that will count against your time.
LUNCH BREAKS DON’T count against your total exam time.
https://flic.kr/p/6q549p

breaking down your comlex
The exam consists of two, four-hour exam sessions separated by a 40-
minute lunch break that does not count against your total exam time.
Each of the four-hour sessions allows a 10-minute break which is
subtracted from the four-hour exam time.
https://flic.kr/p/emQhYF

YOU WILL BE
NOTIFIED
VIA EMAIL WHEN YOUR SCORES ARE
READY, TYPICALLY 4-8 WEEKS AFTER
YOU TAKE THE EXAM.
https://flic.kr/p/6osrZ

HELPFUL RESOURCES
OMT Review COMQUEST NBOME osteopathic.com SOMA
https://flic.kr/p/dFqy4S

A Beginners Guide To COMLEX Level 1 - (COMQUEST)

More Related Content

Viewers also liked

Similar to A Beginners Guide To COMLEX Level 1 - (COMQUEST)

Recently uploaded

A Beginners Guide To COMLEX Level 1 - (COMQUEST)