Page 1 of 113
COMSAE PHASE 1 FORM 107 — OSTEOPATHIC EXAM QUESTIONS
WITH DETAILED- VERIFIED ANSWERS- ALREADY GRADED A+ ||
NEWEST EXAM
Osteopathic Foundational Sciences / Pre-Clinical Medical Education
This COMSAE Phase 1 Form 107-style exam covers foundational basic
sciences: Anatomy/Physiology, Pathology, Pharmacology,
Microbiology/Immunology, Biochemistry/Genetics,
Neuroscience/Neurology, Osteopathic Principles, Behavioral
Science/Ethics, and Biostatistics/Epidemiology.
SECTION 1: CARDIOVASCULAR SYSTEM
QUESTION 1
A 65-year-old man with a history of hypertension presents with sudden
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
Correct Answer: D. Obtain a stat CT angiography of the chest
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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.
Which is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Myocardial infarction
D. Pericarditis
Correct Answer: A. Stable angina
Rationale: Stable angina is classically exertional, predictable chest pain
relieved by rest or nitroglycerin due to transient myocardial ischemia
from fixed coronary artery stenosis. Unstable angina occurs at rest or
with increasing frequency. Myocardial infarction presents with prolonged
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chest pain and elevated cardiac enzymes. Pericarditis presents with
sharp, positional chest pain.
QUESTION 3
A patient has chest pain at rest, rising troponins, and ST elevation in
leads II, III, aVF. What is the diagnosis?
A. NSTEMI
B. Stable angina
C. STEMI (inferior wall)
D. Pericarditis
Correct Answer: C. STEMI (inferior wall)
Rationale: ST elevation with elevated troponins indicates STEMI; inferior
leads (II, III, aVF) suggest right coronary artery territory involvement.
NSTEMI lacks ST elevation. Stable angina has normal troponins.
Pericarditis has diffuse ST elevations without troponin elevation.
QUESTION 4
During a routine physical exam, you palpate the right radial artery and
note a quick, sharp rise then a sudden collapse. This pulse is most
consistent with which of the following conditions?
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A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Hypertrophic cardiomyopathy
Correct Answer: B. Aortic regurgitation
Rationale: A water-hammer or Corrigan pulse—characterized by a rapid
upstroke and sudden collapse—is classic for aortic regurgitation. This
occurs because blood flows back into the left ventricle during diastole,
causing a large stroke volume and rapid runoff. Aortic stenosis presents
with a pulsus parvus et tardus (weak and delayed). Mitral stenosis
presents with a small, weak pulse. Hypertrophic cardiomyopathy may
present with a bifid pulse.
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
C. Pulmonary embolism
D. Costochondritis
COMSAE PHASE 1 FORM 107 — OSTEOPATHIC EXAM QUESTIONS
WITH DETAILED- VERIFIED ANSWERS- ALREADY GRADED A+ ||
NEWEST EXAM
Osteopathic Foundational Sciences / Pre-Clinical Medical Education
This COMSAE Phase 1 Form 107-style exam covers foundational basic
sciences: Anatomy/Physiology, Pathology, Pharmacology,
Microbiology/Immunology, Biochemistry/Genetics,
Neuroscience/Neurology, Osteopathic Principles, Behavioral
Science/Ethics, and Biostatistics/Epidemiology.
SECTION 1: CARDIOVASCULAR SYSTEM
QUESTION 1
A 65-year-old man with a history of hypertension presents with sudden
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
Correct Answer: D. Obtain a stat CT angiography of the chest
, Page 2 of 113
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.
Which is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Myocardial infarction
D. Pericarditis
Correct Answer: A. Stable angina
Rationale: Stable angina is classically exertional, predictable chest pain
relieved by rest or nitroglycerin due to transient myocardial ischemia
from fixed coronary artery stenosis. Unstable angina occurs at rest or
with increasing frequency. Myocardial infarction presents with prolonged
, Page 3 of 113
chest pain and elevated cardiac enzymes. Pericarditis presents with
sharp, positional chest pain.
QUESTION 3
A patient has chest pain at rest, rising troponins, and ST elevation in
leads II, III, aVF. What is the diagnosis?
A. NSTEMI
B. Stable angina
C. STEMI (inferior wall)
D. Pericarditis
Correct Answer: C. STEMI (inferior wall)
Rationale: ST elevation with elevated troponins indicates STEMI; inferior
leads (II, III, aVF) suggest right coronary artery territory involvement.
NSTEMI lacks ST elevation. Stable angina has normal troponins.
Pericarditis has diffuse ST elevations without troponin elevation.
QUESTION 4
During a routine physical exam, you palpate the right radial artery and
note a quick, sharp rise then a sudden collapse. This pulse is most
consistent with which of the following conditions?
, Page 4 of 113
A. Aortic stenosis
B. Aortic regurgitation
C. Mitral stenosis
D. Hypertrophic cardiomyopathy
Correct Answer: B. Aortic regurgitation
Rationale: A water-hammer or Corrigan pulse—characterized by a rapid
upstroke and sudden collapse—is classic for aortic regurgitation. This
occurs because blood flows back into the left ventricle during diastole,
causing a large stroke volume and rapid runoff. Aortic stenosis presents
with a pulsus parvus et tardus (weak and delayed). Mitral stenosis
presents with a small, weak pulse. Hypertrophic cardiomyopathy may
present with a bifid pulse.
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
C. Pulmonary embolism
D. Costochondritis
