[COMSAE 114 {COMPREHENSIVE OSTEOPATHIC MEDICAL SELF-
ASSESSMENT EXAMINATION}] – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST
1. A 67-year-old man presents with progressive exertional dyspnea and lower extremity
edema. Physical examination reveals jugular venous distention, bibasilar crackles, and an S3
gallop. Echocardiography demonstrates an ejection fraction of 30%. Which medication has
been shown to reduce mortality in this condition?
A. Furosemide
B. Digoxin
C. Lisinopril
D. Hydrochlorothiazide
════════════════════
Correct Answer: C. Lisinopril
Rationale:
ACE inhibitors such as lisinopril reduce mortality in patients with systolic heart failure by
decreasing afterload and limiting maladaptive cardiac remodeling. Furosemide improves
symptoms but does not improve survival. Digoxin may reduce hospitalizations but has not
shown mortality benefit. Hydrochlorothiazide is not a first-line mortality-reducing therapy for
heart failure with reduced ejection fraction.
════════════════════
2. A 24-year-old woman presents with fever, dysuria, and right flank pain. Urinalysis shows
white blood cell casts. Which diagnosis is most likely?
A. Acute pyelonephritis
B. Acute cystitis
C. Nephrolithiasis
D. Interstitial cystitis
════════════════════
Correct Answer: A. Acute pyelonephritis
,Rationale:
White blood cell casts are highly suggestive of renal parenchymal inflammation and are
classically associated with acute pyelonephritis. Cystitis typically lacks casts and systemic
symptoms. Nephrolithiasis causes hematuria and colicky pain rather than infectious findings.
Interstitial cystitis is a chronic noninfectious bladder condition.
════════════════════
3. A physician is discussing treatment options with a competent patient who refuses a
recommended blood transfusion due to religious beliefs. What is the most appropriate next
step?
A. Seek a court order immediately
B. Respect the patient’s decision
C. Administer the transfusion without consent
D. Ask the family to override the refusal
════════════════════
Correct Answer: B. Respect the patient’s decision
Rationale:
Competent adults have the legal and ethical right to refuse medical treatment, even life-
saving interventions. Seeking a court order or administering treatment against the patient’s
wishes violates patient autonomy. Family members cannot override the decisions of a
competent adult.
════════════════════
4. A 58-year-old smoker presents with hematuria and weight loss. Imaging reveals a centrally
located lung mass associated with hypercalcemia. Which malignancy is most likely
responsible?
A. Small cell carcinoma
B. Adenocarcinoma
C. Large cell carcinoma
D. Squamous cell carcinoma
════════════════════
Correct Answer: D. Squamous cell carcinoma
Rationale:
,Squamous cell carcinoma of the lung is strongly associated with smoking, central lung lesions,
and paraneoplastic hypercalcemia due to parathyroid hormone-related peptide production.
Adenocarcinoma is usually peripheral. Small cell carcinoma commonly causes SIADH or ACTH
production. Large cell carcinoma lacks these classic associations.
════════════════════
5. A 32-year-old woman develops tremors, anxiety, and palpitations several months after
delivery. Laboratory testing reveals suppressed TSH and elevated free T4. Which diagnosis is
most likely?
A. Graves disease
B. Hashimoto thyroiditis
C. Postpartum thyroiditis
D. Subacute thyroiditis
════════════════════
Correct Answer: C. Postpartum thyroiditis
Rationale:
Postpartum thyroiditis commonly occurs within one year after delivery and often presents
initially with transient hyperthyroidism due to autoimmune-mediated thyroid inflammation.
Graves disease usually includes ophthalmopathy and thyroid-stimulating immunoglobulins.
Subacute thyroiditis is typically painful. Hashimoto thyroiditis generally presents with
hypothyroidism.
════════════════════
6. A 45-year-old man with chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is responsible?
A. Vitamin B12
B. Folate
C. Vitamin B6
D. Thiamine
════════════════════
Correct Answer: D. Thiamine
Rationale:
, Wernicke encephalopathy results from thiamine deficiency and classically presents with
confusion, ophthalmoplegia, and ataxia. Chronic alcohol use impairs thiamine absorption and
storage. Vitamin B12 deficiency causes neuropathy and megaloblastic anemia. Folate
deficiency causes megaloblastic anemia without the classic neurologic triad.
════════════════════
7. A patient receiving heparin develops thrombocytopenia and painful cyanotic lesions on the
fingers five days after starting therapy. What is the best next step?
A. Continue heparin and monitor
B. Add aspirin therapy
C. Discontinue heparin immediately
D. Administer vitamin K
════════════════════
Correct Answer: C. Discontinue heparin immediately
Rationale:
Heparin-induced thrombocytopenia is an immune-mediated condition associated with
thrombosis despite low platelet counts. Immediate discontinuation of all heparin products is
essential. Vitamin K reverses warfarin, not heparin. Continuing heparin may worsen
thrombosis risk.
════════════════════
8. A 5-year-old child presents with a barking cough, inspiratory stridor, and hoarseness that
worsens at night. Which diagnosis is most likely?
A. Epiglottitis
B. Asthma
C. Croup
D. Bronchiolitis
════════════════════
Correct Answer: C. Croup
Rationale:
Croup is characterized by a barking cough, inspiratory stridor, and hoarseness caused by viral
laryngotracheitis. Epiglottitis presents with drooling and toxic appearance. Asthma causes
ASSESSMENT EXAMINATION}] – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES |
GUARANTEED PASS | LATEST EXAM UPDATE | EXAM PREP |
STUDY GUIDE | PRACTICE TEST
1. A 67-year-old man presents with progressive exertional dyspnea and lower extremity
edema. Physical examination reveals jugular venous distention, bibasilar crackles, and an S3
gallop. Echocardiography demonstrates an ejection fraction of 30%. Which medication has
been shown to reduce mortality in this condition?
A. Furosemide
B. Digoxin
C. Lisinopril
D. Hydrochlorothiazide
════════════════════
Correct Answer: C. Lisinopril
Rationale:
ACE inhibitors such as lisinopril reduce mortality in patients with systolic heart failure by
decreasing afterload and limiting maladaptive cardiac remodeling. Furosemide improves
symptoms but does not improve survival. Digoxin may reduce hospitalizations but has not
shown mortality benefit. Hydrochlorothiazide is not a first-line mortality-reducing therapy for
heart failure with reduced ejection fraction.
════════════════════
2. A 24-year-old woman presents with fever, dysuria, and right flank pain. Urinalysis shows
white blood cell casts. Which diagnosis is most likely?
A. Acute pyelonephritis
B. Acute cystitis
C. Nephrolithiasis
D. Interstitial cystitis
════════════════════
Correct Answer: A. Acute pyelonephritis
,Rationale:
White blood cell casts are highly suggestive of renal parenchymal inflammation and are
classically associated with acute pyelonephritis. Cystitis typically lacks casts and systemic
symptoms. Nephrolithiasis causes hematuria and colicky pain rather than infectious findings.
Interstitial cystitis is a chronic noninfectious bladder condition.
════════════════════
3. A physician is discussing treatment options with a competent patient who refuses a
recommended blood transfusion due to religious beliefs. What is the most appropriate next
step?
A. Seek a court order immediately
B. Respect the patient’s decision
C. Administer the transfusion without consent
D. Ask the family to override the refusal
════════════════════
Correct Answer: B. Respect the patient’s decision
Rationale:
Competent adults have the legal and ethical right to refuse medical treatment, even life-
saving interventions. Seeking a court order or administering treatment against the patient’s
wishes violates patient autonomy. Family members cannot override the decisions of a
competent adult.
════════════════════
4. A 58-year-old smoker presents with hematuria and weight loss. Imaging reveals a centrally
located lung mass associated with hypercalcemia. Which malignancy is most likely
responsible?
A. Small cell carcinoma
B. Adenocarcinoma
C. Large cell carcinoma
D. Squamous cell carcinoma
════════════════════
Correct Answer: D. Squamous cell carcinoma
Rationale:
,Squamous cell carcinoma of the lung is strongly associated with smoking, central lung lesions,
and paraneoplastic hypercalcemia due to parathyroid hormone-related peptide production.
Adenocarcinoma is usually peripheral. Small cell carcinoma commonly causes SIADH or ACTH
production. Large cell carcinoma lacks these classic associations.
════════════════════
5. A 32-year-old woman develops tremors, anxiety, and palpitations several months after
delivery. Laboratory testing reveals suppressed TSH and elevated free T4. Which diagnosis is
most likely?
A. Graves disease
B. Hashimoto thyroiditis
C. Postpartum thyroiditis
D. Subacute thyroiditis
════════════════════
Correct Answer: C. Postpartum thyroiditis
Rationale:
Postpartum thyroiditis commonly occurs within one year after delivery and often presents
initially with transient hyperthyroidism due to autoimmune-mediated thyroid inflammation.
Graves disease usually includes ophthalmopathy and thyroid-stimulating immunoglobulins.
Subacute thyroiditis is typically painful. Hashimoto thyroiditis generally presents with
hypothyroidism.
════════════════════
6. A 45-year-old man with chronic alcohol use presents with confusion, ataxia, and
ophthalmoplegia. Which vitamin deficiency is responsible?
A. Vitamin B12
B. Folate
C. Vitamin B6
D. Thiamine
════════════════════
Correct Answer: D. Thiamine
Rationale:
, Wernicke encephalopathy results from thiamine deficiency and classically presents with
confusion, ophthalmoplegia, and ataxia. Chronic alcohol use impairs thiamine absorption and
storage. Vitamin B12 deficiency causes neuropathy and megaloblastic anemia. Folate
deficiency causes megaloblastic anemia without the classic neurologic triad.
════════════════════
7. A patient receiving heparin develops thrombocytopenia and painful cyanotic lesions on the
fingers five days after starting therapy. What is the best next step?
A. Continue heparin and monitor
B. Add aspirin therapy
C. Discontinue heparin immediately
D. Administer vitamin K
════════════════════
Correct Answer: C. Discontinue heparin immediately
Rationale:
Heparin-induced thrombocytopenia is an immune-mediated condition associated with
thrombosis despite low platelet counts. Immediate discontinuation of all heparin products is
essential. Vitamin K reverses warfarin, not heparin. Continuing heparin may worsen
thrombosis risk.
════════════════════
8. A 5-year-old child presents with a barking cough, inspiratory stridor, and hoarseness that
worsens at night. Which diagnosis is most likely?
A. Epiglottitis
B. Asthma
C. Croup
D. Bronchiolitis
════════════════════
Correct Answer: C. Croup
Rationale:
Croup is characterized by a barking cough, inspiratory stridor, and hoarseness caused by viral
laryngotracheitis. Epiglottitis presents with drooling and toxic appearance. Asthma causes
