COMSAE Form 102 Rapid Review: Questions,
Answers, and Rationales for Osteopathic
Medical Students
Section 1: Cardiovascular Medicine
,1. A 67-year-old man presents with exertional chest pain relieved by rest. He has hypertension
and hyperlipidemia. ECG is normal at rest. What is the most appropriate next diagnostic test?
A) Coronary angiography
B) Exercise stress test
C) Chest X-ray
D) D-dimer
Answer: B) Exercise stress test
Rationale: This patient has stable angina. A treadmill exercise stress test is the first-line
noninvasive diagnostic modality when baseline ECG is normal and the patient can exercise.
Coronary angiography is reserved for high-risk features or abnormal stress test results.
,2. A patient presents with sudden severe tearing chest pain radiating to the back. Blood pressure
is unequal in both arms. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe "tearing" chest pain radiating
to the back, with pulse deficits or blood pressure discrepancies between arms. This is a surgical
emergency.
, 3. A 65-year-old woman with long-standing hypertension presents with progressive dyspnea.
Echocardiogram shows concentric left ventricular hypertrophy with preserved ejection fraction.
What pressure–volume loop change is expected?
A) Rightward shift with decreased contractility
B) Leftward shift with decreased compliance
C) Increased end-systolic volume with decreased afterload
D) Decreased end-diastolic volume due to increased compliance
E) Increased stroke volume with decreased preload
Answer: B) Leftward shift with decreased compliance
Rationale: Long-standing hypertension leads to pressure overload, causing concentric LVH and
diastolic dysfunction with decreased compliance. The pressure-volume loop shifts leftward/upward
with higher LVEDP while ejection fraction remains normal.
Answers, and Rationales for Osteopathic
Medical Students
Section 1: Cardiovascular Medicine
,1. A 67-year-old man presents with exertional chest pain relieved by rest. He has hypertension
and hyperlipidemia. ECG is normal at rest. What is the most appropriate next diagnostic test?
A) Coronary angiography
B) Exercise stress test
C) Chest X-ray
D) D-dimer
Answer: B) Exercise stress test
Rationale: This patient has stable angina. A treadmill exercise stress test is the first-line
noninvasive diagnostic modality when baseline ECG is normal and the patient can exercise.
Coronary angiography is reserved for high-risk features or abnormal stress test results.
,2. A patient presents with sudden severe tearing chest pain radiating to the back. Blood pressure
is unequal in both arms. What is the most likely diagnosis?
A) Myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Aortic dissection classically presents with sudden, severe "tearing" chest pain radiating
to the back, with pulse deficits or blood pressure discrepancies between arms. This is a surgical
emergency.
, 3. A 65-year-old woman with long-standing hypertension presents with progressive dyspnea.
Echocardiogram shows concentric left ventricular hypertrophy with preserved ejection fraction.
What pressure–volume loop change is expected?
A) Rightward shift with decreased contractility
B) Leftward shift with decreased compliance
C) Increased end-systolic volume with decreased afterload
D) Decreased end-diastolic volume due to increased compliance
E) Increased stroke volume with decreased preload
Answer: B) Leftward shift with decreased compliance
Rationale: Long-standing hypertension leads to pressure overload, causing concentric LVH and
diastolic dysfunction with decreased compliance. The pressure-volume loop shifts leftward/upward
with higher LVEDP while ejection fraction remains normal.
