Comlex 2: Misery loves company!

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Just wanted to give a shout out to my fellow DO homies who are in the middle of this aggravating mind numbing experience they call "COMLEX". Were a quater of the way done and I can't wait to tap that kegger on wednesday night. Who's with me?!
 
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Did anyone else feel like they were taking the test for office billing assistant today? I got plenty of questions about what Medicare covers and what it doesn't.

More good times in store tomorrow.
 
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plus....i finally realized not to waste time on vital signs and lab workup on patients....apparently they are not important on comlex 2... :laugh:
 
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yes I got a few on what medicare does and doesnt cover.

anyone else feel like they got more than enough OB/Gyn?? Seems like half my test is OB.

Not much peds as I expected.

Osteopathywise..I got many cranial qs.

Overall halfway through, it's challenging, though not as bad as I expected.

Looking forward to pictures tomorrow 🙂

Good luck everyone!!
 
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i had some favorites actually...

ANAL WINK..,,,,WTF was that

and another good one was the 24 yr old G5P5 or G4P4 (whatever it was)......i guess she got around.....
 
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Here, here. I felt like half the test was OB/gyn. I think that I was ready for it thanks to VentD and the others. Only one more crappy day of obsure questions. Hey, are there going to be any pictures on this exam or what? I shouldn't complaIn b/c the pictures we were given for step 1 were created more qeustions than answers. Good luck guys. Count down to binge drinking begins now.
 
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I most definetly agree with previous test takers. This test is the epitome of being vague. A typical question goes like this: Pt. presents to your clinic with a fever. What is the diagnosis? A. Gastroenteritis B. UTI C.Pneumonia D. Pharyngitis. You get the gist. They don't give you any information in the question. And I agree with the previous post, WTF is an "anal wink". Don't remember seeing that in any of my clinical medicine books. Anyway. good luck to all tomorrow!
 
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can anyone tell me what an anal wink was?

also....what about the kid swallowing a coin and it faces you on coronal view? any guesses??!
 
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joaquin13 said:
can anyone tell me what an anal wink was?

also....what about the kid swallowing a coin and it faces you on coronal view? any guesses??!
Click to expand...

I put that he right main-stemmed it, just because that's where aspirated objects like to go, but I have no real idea.

Ask for "the wink," this is pasted from a websearch:
http://www.religioustolerance.org/ra_baker.htm

The 1983-4 McCuan and Kniffen Trial
The trial was held during 1983 and 1984. Dr. Bruce Woodling testified that his "wink response" tests on the children proved that sodomy had occurred. In the test, the anus is touched with a swab and a reaction is looked for. This test has since been totally discredited. Controlled tests have revealed that anal winking occurs in both abused and non-abused children.

I guessed that there was some bad lovin' going on down in Mexico. So I'm hoping that the writers of COMLEX haven't read any controlled studies in the past 20 years. I'm feeling pretty goods about my odds there.

OK, Time for me to get some sleep.

-Induction Agent
 
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Okay -

a 56 year old male - who wants to be a female - and happens to be black, and his mother is jewish, presents to you with complaints of generalized weakness, N/V, fever of 99.7, abdominal pain, and urinary retention. His vital signs are normal, except for the low-grade fever. He tells you he works with pigeons at the local messenger-pigeon training center when he isn't sleeping with prostitutes. He also mentions that he just returned from a trip around the world where he visited South Africa, India, Japan, and the remote American Southwest. Upon futher questioning, you find that his trip included eating tons of rice, uncooked bovine brain, and many episodes of unprotected sex with a man he met during his travels. Upon physical exam, you note needle tracks on his inner arms, and he sheepish admits to using IV drugs. You also find grade 3/6 systolic and diastolic murmurs on the right side of the sternum in the 2nd intercostal space, the left side of the sturnum, and at the apex of the heart. You find his lung sounds to be absent on the right side - then he mentions he had a lung removed because of a mesothelioma he received due to his years of working in an asbestose factory as a teenager. Rectal exam reveals a normal prostate, but his sphincter tone is lacking. Further examination reveals extreme gynecomastia, and he states he's been taking the 'breast enhancement pills' he saw on a commercial on the WB one saturday evening while he was watching the TV show "Cheaters".

What is your diagnosis?
What is your primary concern with this patient?
 
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Oh my God, I definitely needed some comic relief after today! Thanks for the laugh!




double elle said:
Okay -



a 56 year old male - who wants to be a female - and happens to be black, and his mother is jewish, presents to you with complaints of generalized weakness, N/V, fever of 99.7, abdominal pain, and urinary retention. His vital signs are normal, except for the low-grade fever. He tells you he works with pigeons at the local messenger-pigeon training center when he isn't sleeping with prostitutes. He also mentions that he just returned from a trip around the world where he visited South Africa, India, Japan, and the remote American Southwest. Upon futher questioning, you find that his trip included eating tons of rice, uncooked bovine brain, and many episodes of unprotected sex with a man he met during his travels. Upon physical exam, you note needle tracks on his inner arms, and he sheepish admits to using IV drugs. You also find grade 3/6 systolic and diastolic murmurs on the right side of the sternum in the 2nd intercostal space, the left side of the sturnum, and at the apex of the heart. You find his lung sounds to be absent on the right side - then he mentions he had a lung removed because of a mesothelioma he received due to his years of working in an asbestose factory as a teenager. Rectal exam reveals a normal prostate, but his sphincter tone is lacking. Further examination reveals extreme gynecomastia, and he states he's been taking the 'breast enhancement pills' he saw on a commercial on the WB one saturday evening while he was watching the TV show "Cheaters".

What is your diagnosis?
What is your primary concern with this patient?
Click to expand...
 
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How about that picture of that hairy beast in the PCOS question?
That didn't look like any woman I've ever seen. 😱
 
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ibid on the anal wink. how many of you enjoyed studying the photo of the anus--you know the guy with the painless lesions weeping yellow stuff-----
JP2005 said:
i had some favorites actually...

ANAL WINK..,,,,WTF was that

and another good one was the 24 yr old G5P5 or G4P4 (whatever it was)......i guess she got around.....
Click to expand...
 
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Bubba said:
How about that picture of that hairy beast in the PCOS question?
That didn't look like any woman I've ever seen. 😱
Click to expand...

Damn!!! Was PCOS an anwer choice, I was so distracted by the picture, I think I may have put Cushings.
 
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DO_Surgeon said:
Damn!!! Was PCOS an anwer choice, I was so distracted by the picture, I think I may have put Cushings.
Click to expand...

PCOS as such was not an answer, but Stein-Leventhal, the eponym for it was.

Don't feel bad. I missed roseola infantum yesterday, because I couldn't match it to "exanthem subitum," the answer choice given.
 
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If the coin is in the coronal plane, then it is in the esophagus. Confirm w/ orthagonal or lateral view.
 
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rad_one said:
If the coin is in the coronal plane, then it is in the esophagus. Confirm w/ orthagonal or lateral view.
Click to expand...


If it was in the esophagus, why was the kid coughing and wheezing, and having respiratory symptoms?
 
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InductionAgent said:
PCOS as such was not an answer, but Stein-Leventhal, the eponym for it was.

Don't feel bad. I missed roseola infantum yesterday, because I couldn't match it to "exanthem subitum," the answer choice given.
Click to expand...


Howdy,

And this is exactly why the COMLEX and the AOA has the reputation that it does, because they focus on medical trivia rather than medical knowledge.

I cannot recall how many stems I finished reading and thinking that the next most appropriate step in exam/diagnosis/treatment would be to ask a few more questions. The test started out relating to fairly common and reasonable topics but by the fourth book we were off into left field.

And the pictures! Oh don't get me started on the pictures. Was that a stone or the tip of the 12th rib? Why did we do a hysteroscopy on that poor woman? Quick, someone fire the x-ray tech before they shoot another abdomen in a PA lateral decubitus oblique position. BTW, Why were her staples over her ASIS?

Anyway, it is over for now. Eight weeks of second guessing until the scores are in.

If I were a uterus, I would be bleeding.
 
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How many kids smell like boiled cabbage anyways??



BigSkyDreams said:
Howdy,

And this is exactly why the COMLEX and the AOA has the reputation that it does, because they focus on medical trivia rather than medical knowledge.

I cannot recall how many stems I finished reading and thinking that the next most appropriate step in exam/diagnosis/treatment would be to ask a few more questions. The test started out relating to fairly common and reasonable topics but by the fourth book we were off into left field.

And the pictures! Oh don't get me started on the pictures. Was that a stone or the tip of the 12th rib? Why did we do a hysteroscopy on that poor woman? Quick, someone fire the x-ray tech before they shoot another abdomen in a PA lateral decubitus oblique position. BTW, Why were her staples over her ASIS?

Anyway, it is over for now. Eight weeks of second guessing until the scores are in.

If I were a uterus, I would be bleeding.
Click to expand...
 
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1astmanstanding said:
No wonder why residency programs prefer the USMLE over the COMLEX...who wouldn't?!?!
Click to expand...

Totally agreed. After taking the Step I I thought it was the most poorly written test I had ever taken. I was so frustrated by the end of it. I went in expecting a poorly written test this time, and got it. They really don't know how to write good questions. Especially, I found, when it was an OMM questions with a medicine question linked. Obviously, those OMM docs don't have a clue.

Also, what about the type of questions where you have a lady probably having a panic attack, but risk factors and symptoms consistent with a PE. Yeh, if I were in Vegas I'd put my money on a panic attack. In the ER, she has a PE until all the tests come back negative. It seems stupid trying to guess between things that are all strongly within the differential and try to decide which is most likely.

And that is why I am jumping ship. I will not apply to any DO residency, will not have anything to do with the AOA. I am so sick and tired of it all. I plan on being involved in medical education with my profession. If I were ever an MD program director, I would accept DO's, but I wouldn't accept the COMLEX. It is just such a bad test.

That is just my little bit of complaining and frustrations.
 
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this is what i remember from the exam. book 1 was the easiest. book 4 was the hardest. i had lots of questions about the different types of urinary incontinece, STDs, a pic on late decelarations for OB/GYN, a few cranial and sacral questions and a few questions about where the CNs enter in the skull like CNs 9-11 go through the jugular formen, a lot of ob/gyn related omm questions, stupid medicare questions and whether a guy on home O2 will pay for his O2 with plan A or B, developmental milestones for peds but not a lot of peds questions. i thought the test was mostly ob/gyn. i thought the pictures were average, with some of the x-rays being hard to see. i think i did better on step 2 than on step 1. i also think that for all of the studying that i did, it only helped me on about a third of the questions. does anyone know how many questions are "practice questions"? is the pass rate really 53%? i hope everyone passed. now, its 8 weeks of guessing.
 
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one more thing to add. i think that it is a big hassle that the normal lab values are at the back of the test book. i wish that when ever we are given lab values in a question, they would put the normals right by side it. that way you dont waste time flipping back and forth looking up the normals. but of course, that would be both logical and easier on us. unfortunately, when it comes to writing test questions, the nbome never goes out of their way to write logical and straight forward questions. they would rather try to trick us and ask obscure medical trivia, instead of writing direct questions that test our knowledge of medicine.
 
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I am still not quite sure what to think...there were some questions that were so straight forward that I thought I was missing something....
Then were questions that were soo random and obscure that I really had no idea where they were going...like parts were left out and missing..and God knows what else...

As much as USMLE is all about "Buzzwords"....COMLEX is more like a 16 hour trip through the mind of a schizophrenic...

Ugghhh.....sooo many questions that I was like...could have gone a multitude of ways...

Boy that came back from 1 month in Mexico...chagas or abuse???


I reiterate....UGHHHH
 
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I put PKU.....no???

This was a key part no??

Infants with PKU appear normal at birth. Many have blue
eyes and fairer hair and skin than other family members.

I found this on the PKU info website....no word about the cabbage though...

I was like albinism?? Then the blue eyes..I was like....no....

then again at the 14th hour...people are ready to agree to anything just to get it over with....
 
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I thought the test was very strange as well. It all seemed to be written from the perspective of an old fart--incontinence, BPH, prostatitis...with prostate massage, and the old farts seemed to focus a lot on yougn women having gynecological problems as well? I dont knwo about you guys, but I have yet to accurately look at a laparoscopic picture and say, HEY! I know what that is! Lots of very very bizarre trivia...anal wink (=sexual abuse?) PCOS-who calls it Stein-Leventhal? lots of questions that could go either way, like the guy with a low MCV and no occult blood....it was very frustrating to take the test becasue I felt like I knew the material cold but couldn't reason out exactly what they were looking for...?

Also...about the old fart perspective...I had an epiphany. COMLEX Step I was all about erectile dysfunction. Obviously they have a few favorite topics, along with torticollis.
 
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The "boiled cabbage odor" was due to tyrosinase deficiency. PKU neonates have a musty/mousy odor not "boiled cabbage odor". The question I loved was the kid with the ankle injury with point tenderness above the lateral malleolus, edema, and swelling. What does he have a fibular fracture or a sprain. And if he has a sprain what grade is it? Ok, I am willing to say that 90% of the people taking the test know that they need to have an xray. Can we get an xray please and then maybe an MRI to tell the detail of ligament damage.
 
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From what I recall...Anal Wink was a normal reflex, and is used to check neurological issues/deficits......

I actually had to do that for my MSII OMT Practical Final....uggh...you think that would have solidified my "A"
 
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DireWolf said:
so what does it mean when a boy smells like boiled cabbage?
Click to expand...

Howdy,

OK, I forgot the most of the stem and follow up questions (I think one of them had to do with myofascial release 😉 ) but the child was 2 weeks old and not feeding well. The kid had white hair, light skin and blue eyes. And the father said that he smelled like cabbage.

From this information you should have been able to determine that the child was suffering from tyrosinemia. THere were two ways to figure this out

An unusual odor can be particularly helpful in several disorders:

Odor Disorder
musty phenylketonuria
cabbage tyrosinemia
maple syrup maple syrup urine disease
sweaty feet isovaleric acidemia, glutaric acidemia type II
cat urine 3-methylcrotonyl CoA carboxylase and multiple carboxylase deficiencies

Second, you could have recalled the Point mutations in the murine fumarylacetoacetate hydrolase gene: Animal models for the human genetic disorder hereditary tyrosinemia type 1 [Proc Natl Acad Sci U S A. 2001 January 16; 98 (2): 641?645 Medical Sciences Aponte JL et al]
study which demonstrated that:

All mice were bred at the Life Sciences Division of the Oak Ridge National Laboratory. Generation of ENU-induced mutations mapping to the large 6- to 11-centimorgan c26DVT deletion has been described (27, 28). Briefly, BALB/cRl (albino, c/c) males treated with ENU were mated to (C57BL/10Rl ? C3Hf/Rl) G0 females (+/+). Then G1 females carrying the mutagenized paternal chromosome 7 were mated to males carrying the long deletion (cch/c26DVT; cch is the chinchilla allele at c, and cch/c gives a light chinchilla coat color). Albino G2 progeny were examined for expression of recessive mutations (m), because this phenotypic class carries the mutagenized chromosome 7 opposite the deletion chromosome (c m/c26DVT). All mutations can be maintained by crossing heterozygous carriers (cch +/c m) if the hemizygotes and homozygotes cannot be bred. Newborn mutants lack eye pigment and can be distinguished from wild-type pigmented littermates.

Thus using our deductive reasoning we can confidently answer that this child was bred specifically to demonstrate a hereditary tyrosinemia type 1 and would require rib raising or an indirect technique (HVLA is containdicated on neonates) at T4-T9 to facilitate lymph drainage and sympathetics that would be diminished secondary to the viserosomatic effect of the liver failure, as demonstrated by TART. Simple. 😱

And don't forget to call CPS to report his parents for child abuse. :scared:
 
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As I sat here for the better part of 5 minutes....trying to digest the above post with my tattered and damaged mind...

Wow.....Hats off....to you..

and to everyone else....See ya'll in January???
 
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Great stuff guys,

I only have one question, what the freak does boiled cabbage smell like? I thought it was similar to a mousy odor. And with PKU, you have decreased tyrosine levels which leads to decreased melanin production, hence fair skin. What do you guys think?
 
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HowUdoin said:
Great stuff guys,

I only have one question, what the freak does boiled cabbage smell like? I thought it was similar to a mousy odor. And with PKU, you have decreased tyrosine levels which leads to decreased melanin production, hence fair skin. What do you guys think?
Click to expand...

After doing some research, tyrosinemia is definitely associated with the cabbage-like odor, and certain forms of it also produce fair skin/albinism, because the tyrosine cannot be properly metabolized to melanin, hence its buildup.

If it was a matching question to which you refer, I know I put tyrosinemia on one and PKU on another, but the individual details all blur together, and I wasn't terribly confident with my answers.
 
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Q: 75 y/o female presents to the office with a blood pressure of 210/110. What's the diagnosis?

A: Imperforate hymen
 
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The whole time I was taking the COMLEX-II, I thought I was taking a board certification exam for Ob/Gyn! Almost half the test was OB and Gyn questions (but I guess we had already been warned of that by Vent and others). Also, it seemed like every kid had bronchiolitis, every teenage girl had an imperforate hymen...It was such a strange exam. But I definitely think it was easier than COMLEX-I.

And the PCOS woman... :scared: :scared:
 
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I agree. There were a few questions on legal issues, but not enough to justify spending a lot of time on it. As already mentioned, there was plenty of OB/Women's Health and very little peds. In fact, very little of anything else. I felt like I was sitting for an OB board exam.

As with step one, they continue to concentrate on certain topics. For example, I had at least five pediatric aspirations and at least as many child abuse cases. I also had four imperforate hymens, 5-6 obstructive lung disease pulmonary function findings (reduced FEV1/FVC), tons of urinary tract questions (stones, infections, obstructions, cancer, trauma, and types of tests to order for early/late hematuria), and they really liked Chapman's points this year. In fact, I had very few craniosacral questions. I used Savarese last year and did really well on the OMT portion of the exam, but I am sure it will be my worst section this year. I still think the book is great, but the test was very vague.

Sorry for the long response. I hope it helps.

Take care.
 
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Here is a typical COMLEX step II question:

A 25 yo G8 P5 A4 that is 34 weeks pregnant presents to the clinic. She states her belly has been getting bigger and she noticed some spotting last night. She also tripped on the way to the clinic and has point tenderness over the lateral malleolus with edema and ecchymoses. Oh, and by the way she has a "headache" unlike any in her life. She also wanted to know what this thick velvety stuff was on her back and neck that she has noticed since being diagnosed with DM type I 15 years ago. She states that she is unsure how she got pregnant since everytime she has sex it hurts and her man can't insert his "thingy" due to this large bluish, purple bulge in her vaginal vault. You do a U/A and it demonstrates pos. RBC, pos. Leuk, and pos. Nitrates with numerous bacteria on culture. Also her BP has recently been elevated from start of pregnancy of 135/85 to now 140/90. She also thinks she has a soft, boggy prostate. What is the diagnosis?
A) Pregnancy induced HTN
B) Fibular Fracture
C) Premature Labor
D) Subarachnoid Hemorrhage
E) UTI
F) Acanthosis nigricans
G) Benign Prostatic Hypertrophy
 
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That was a beauitful post...and I would be laughing at this point, aside from the fact that I had to sit through that very exam, and actually answer those questions..

Uggghhhh!!!
 
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Doc_Thks_JC said:
Here is a typical COMLEX step II question:

A 25 yo G8 P5 A4 that is 34 weeks pregnant presents to the clinic. She states her belly has been getting bigger and she noticed some spotting last night. She also tripped on the way to the clinic and has point tenderness over the lateral malleolus with edema and ecchymoses. Oh, and by the way she has a "headache" unlike any in her life. She also wanted to know what this thick velvety stuff was on her back and neck that she has noticed since being diagnosed with DM type I 15 years ago. She states that she is unsure how she got pregnant since everytime she has sex it hurts and her man can't insert his "thingy" due to this large bluish, purple bulge in her vaginal vault. You do a U/A and it demonstrates pos. RBC, pos. Leuk, and pos. Nitrates with numerous bacteria on culture. Also her BP has recently been elevated from start of pregnancy of 135/85 to now 140/90. She also thinks she has a soft, boggy prostate. What is the diagnosis?
A) Pregnancy induced HTN
B) Fibular Fracture
C) Premature Labor
D) Subarachnoid Hemorrhage
E) UTI
F) Acanthosis nigricans
G) Benign Prostatic Hypertrophy
Click to expand...


:laugh: :laugh: :laugh:

That was hysterical! (and unfortunately pretty accurate)
 
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thank you for making me laugh my ass off after spending last week infuriated about this ridiculous exam. how are we ever going to be taken seriously as a profession when that is the type of exam we are given??
 
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is anyone nervous about getting their scores back? i wonder why it takes so long?
 
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yes, i am nervous. sometimes i am sure i passed. other times i am sure i failed. i just have no idea what is going to be in that envelope. i can't believe we have to wait until the end of october - torture!!

zorro21 said:
is anyone nervous about getting their scores back? i wonder why it takes so long?
Click to expand...
 
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Let's just hope that every time the the test writers have sex, they find an imperforate hymen (maybe why they asked so many questions about it). That way at least their genes would be there to pollute future generations.

As for me, this test is what I expected. That is why I plan on taking the USMLE. Not because I need it for my residency plans, but because I don't think that the COMLEX should be a certification test for any physician in this country. I really think our generation of phsyicians are a notch above the old DOs. Look at the AOA and the COMLEX/NBOME as examples. It is just plain sad.
 
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