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COMSAE PHASE 1 FORM 111 — OSTEOPATHIC FOUNDATIONAL
SCIENCES BOARD EXAM QUESTIONS WITH DETAILED- VERIFIED
ANSWERS- ALREADY GRADED A+ || NEWEST EXAM
Osteopathic Foundational Sciences / Pre-Clinical Medical Education
COMSAE Phase 1 Form 111-style practice exam covers foundational
basic sciences: Anatomy/Physiology, Pathology Pharmacology,
Microbiology/Immunology, Biochemistry/Genetics,
Neuroscience/Neurology, Osteopathic Principles, Behavioral
Science/Ethics, and Biostatistics/Epidemiology. Emphasis is on basic
science integration, clinical reasoning, and osteopathic principles.
SECTION 1: CARDIOVASCULAR SYSTEM
QUESTION 1
A 72-year-old man with a history of hypertension and type 2 diabetes
presents with acute onset of severe, tearing chest pain radiating to the
back. Blood pressure is 100/60 mmHg in the right arm and 70/40 mmHg
in the left arm. Which of the following is the most appropriate next step?
A. Administer alteplase
B. Obtain a stat chest X-ray
C. Start IV nitroglycerin drip
D. Obtain a stat CT angiography of the chest
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Correct Answer: D. Obtain a stat CT angiography of the chest
Rationale: The presentation of tearing chest pain with a significant blood
pressure differential between arms is classic for aortic dissection. CT
angiography is the definitive diagnostic study for aortic dissection,
providing rapid visualization of the aorta. Alteplase is contraindicated as
it may worsen bleeding. Chest X-ray may show a widened mediastinum
but is insensitive. Nitroglycerin is not appropriate as the primary issue is
dissection, not coronary ischemia.
QUESTION 2
A 65-year-old man presents with exertional chest pain relieved by rest.
ECG shows ST-segment depression during pain episodes. Which is the
most likely diagnosis?
A. Prinzmetal angina
B. Stable angina
C. Unstable angina
D. Acute pericarditis
Correct Answer: B. Stable angina
Rationale: Predictable exertional chest pain relieved by rest with
transient ST-segment depression is most consistent with stable angina
due to fixed atherosclerotic coronary artery disease. Prinzmetal angina
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occurs at rest due to coronary vasospasm. Unstable angina occurs with
increasing frequency or at rest. Acute pericarditis presents with sharp,
positional chest pain.
QUESTION 3
A 45-year-old man presents with acute onset of severe, crushing chest
pain radiating to the left arm. ECG shows ST-segment elevation in leads
V1-V4. Which of the following is the most likely culprit artery?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Correct Answer: A. Left anterior descending artery
Rationale: ST-segment elevation in the anterior leads (V1-V4) indicates
anterior wall myocardial infarction, typically caused by occlusion of the
left anterior descending artery. The right coronary artery causes inferior
wall MI (II, III, aVF). The left circumflex artery causes lateral wall MI (I,
aVL, V5-V6). Left main coronary artery occlusion is usually fatal.
QUESTION 4
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A 70-year-old man presents with acute onset of chest pain and
shortness of breath. ECG shows ST-segment elevation in the inferior
leads (II, III, aVF). Which of the following is the most likely culprit artery?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Correct Answer: B. Right coronary artery
Rationale: ST-segment elevation in the inferior leads indicates inferior
wall myocardial infarction, typically caused by occlusion of the right
coronary artery. The left anterior descending artery causes anterior wall
MI. The left circumflex artery causes lateral wall MI. Left main coronary
artery occlusion is usually fatal.
QUESTION 5
A 28-year-old female with systemic lupus erythematosus presents with
pleuritic chest pain and dyspnea. ECG shows diffuse ST elevations.
Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pericarditis
COMSAE PHASE 1 FORM 111 — OSTEOPATHIC FOUNDATIONAL
SCIENCES BOARD EXAM QUESTIONS WITH DETAILED- VERIFIED
ANSWERS- ALREADY GRADED A+ || NEWEST EXAM
Osteopathic Foundational Sciences / Pre-Clinical Medical Education
COMSAE Phase 1 Form 111-style practice exam covers foundational
basic sciences: Anatomy/Physiology, Pathology Pharmacology,
Microbiology/Immunology, Biochemistry/Genetics,
Neuroscience/Neurology, Osteopathic Principles, Behavioral
Science/Ethics, and Biostatistics/Epidemiology. Emphasis is on basic
science integration, clinical reasoning, and osteopathic principles.
SECTION 1: CARDIOVASCULAR SYSTEM
QUESTION 1
A 72-year-old man with a history of hypertension and type 2 diabetes
presents with acute onset of severe, tearing chest pain radiating to the
back. Blood pressure is 100/60 mmHg in the right arm and 70/40 mmHg
in the left arm. Which of the following is the most appropriate next step?
A. Administer alteplase
B. Obtain a stat chest X-ray
C. Start IV nitroglycerin drip
D. Obtain a stat CT angiography of the chest
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Correct Answer: D. Obtain a stat CT angiography of the chest
Rationale: The presentation of tearing chest pain with a significant blood
pressure differential between arms is classic for aortic dissection. CT
angiography is the definitive diagnostic study for aortic dissection,
providing rapid visualization of the aorta. Alteplase is contraindicated as
it may worsen bleeding. Chest X-ray may show a widened mediastinum
but is insensitive. Nitroglycerin is not appropriate as the primary issue is
dissection, not coronary ischemia.
QUESTION 2
A 65-year-old man presents with exertional chest pain relieved by rest.
ECG shows ST-segment depression during pain episodes. Which is the
most likely diagnosis?
A. Prinzmetal angina
B. Stable angina
C. Unstable angina
D. Acute pericarditis
Correct Answer: B. Stable angina
Rationale: Predictable exertional chest pain relieved by rest with
transient ST-segment depression is most consistent with stable angina
due to fixed atherosclerotic coronary artery disease. Prinzmetal angina
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occurs at rest due to coronary vasospasm. Unstable angina occurs with
increasing frequency or at rest. Acute pericarditis presents with sharp,
positional chest pain.
QUESTION 3
A 45-year-old man presents with acute onset of severe, crushing chest
pain radiating to the left arm. ECG shows ST-segment elevation in leads
V1-V4. Which of the following is the most likely culprit artery?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Correct Answer: A. Left anterior descending artery
Rationale: ST-segment elevation in the anterior leads (V1-V4) indicates
anterior wall myocardial infarction, typically caused by occlusion of the
left anterior descending artery. The right coronary artery causes inferior
wall MI (II, III, aVF). The left circumflex artery causes lateral wall MI (I,
aVL, V5-V6). Left main coronary artery occlusion is usually fatal.
QUESTION 4
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A 70-year-old man presents with acute onset of chest pain and
shortness of breath. ECG shows ST-segment elevation in the inferior
leads (II, III, aVF). Which of the following is the most likely culprit artery?
A. Left anterior descending artery
B. Right coronary artery
C. Left circumflex artery
D. Left main coronary artery
Correct Answer: B. Right coronary artery
Rationale: ST-segment elevation in the inferior leads indicates inferior
wall myocardial infarction, typically caused by occlusion of the right
coronary artery. The left anterior descending artery causes anterior wall
MI. The left circumflex artery causes lateral wall MI. Left main coronary
artery occlusion is usually fatal.
QUESTION 5
A 28-year-old female with systemic lupus erythematosus presents with
pleuritic chest pain and dyspnea. ECG shows diffuse ST elevations.
Which of the following is the most likely diagnosis?
A. Acute myocardial infarction
B. Pericarditis
