COMSAE Phase 3 Comprehensive Osteopathic
Medical Self-Assessment Examination V2
1. A 62-year-old male with a history of hypertension and smoking presents with cramp-like
calf pain that occurs after walking two blocks and is relieved by rest. His ankle-brachial index
(ABI) is 0.65. Which of the following is the most appropriate next step in management?
A. High-intensity statin and aspirin therapy
B. Urgent surgical revascularization
C. Bed rest and elevation of the legs
D. Venous duplex ultrasound of the lower extremities
Correct Answer: A
Explanation: The clinical presentation and ABI of 0.65 are diagnostic of peripheral artery
disease (PAD). Management focuses on cardiovascular risk reduction, including smoking
cessation, high-intensity statins, and antiplatelet therapy to prevent major adverse
cardiovascular events. A common examination pitfall is selecting surgical intervention
before attempting conservative medical management and exercise therapy.
2. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Physical
examination reveals a diffuse, non-tender enlargement of the thyroid gland. Laboratory
results show an elevated TSH and a low free T4. Which of the following antibodies is most
likely to be present?
A. Thyrotropin receptor antibodies
,B. Anti-smooth muscle antibodies
C. Antimicrosomal (anti-TPO) antibodies
D. Anti-mitochondrial antibodies
Correct Answer: C
Explanation: The patient’s symptoms and lab findings are consistent with primary
hypothyroidism, most commonly caused by Hashimoto thyroiditis in the United States.
Anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin antibodies are markers for this
autoimmune destruction of the thyroid. Clinical significance involves lifelong levothyroxine
replacement and monitoring for other autoimmune conditions.
3. A 28-year-old G1P0 at 34 weeks gestation presents with a blood pressure of 165/110
mmHg and 3+ proteinuria. She denies headache or visual changes. Which of the following is
the most appropriate immediate management?
A. Immediate cesarean delivery
B. Intravenous magnesium sulfate and hydralazine
C. Expectant management until 37 weeks
D. Outpatient follow-up in 24 hours
Correct Answer: B
Explanation: This patient meets the criteria for preeclampsia with severe features based
on her blood pressure. Immediate management requires seizure prophylaxis with
,magnesium sulfate and blood pressure control with intravenous agents like hydralazine or
labetalol. A common pitfall is delaying treatment to wait for 37 weeks, as severe
preeclampsia requires stabilization and typically delivery at 34 weeks.
4. A 52-year-old male presents for a routine check-up. Osteopathic examination reveals a
somatic dysfunction at T5. The segment is restricted in extension and is more posterior on the
right. When the patient slumps into a flexed position, the right posteriority improves. What is
the correct diagnosis?
A. T5 Flexed, Rotated Left, Sidebent Left
B. T5 Extended, Rotated Right, Sidebent Right
C. T5 Flexed, Rotated Right, Sidebent Right
D. T5 Extended, Rotated Left, Sidebent Left
Correct Answer: C
Explanation: The restriction in extension implies the segment prefers flexion.
Improvement of the posteriority in flexion confirms a flexed position, and the right
posteriority indicates rotation to the right. According to Fryette’s second law for a single
segment (Type II), rotation and sidebending occur to the same side.
, 5. A 19-year-old college student presents with a 3-day history of fever, sore throat, and
severe fatigue. Physical exam shows posterior cervical lymphadenopathy and splenomegaly.
A heterophile antibody test is positive. Which of the following is the most appropriate
recommendation?
A. Amoxicillin for 10 days
B. Oseltamivir treatment
C. Immediate splenectomy
D. Avoidance of contact sports for 4 weeks
Correct Answer: D
Explanation: Infectious mononucleosis, caused by EBV, carries a risk of splenic rupture,
especially during the first 3-4 weeks of illness. Patients must avoid contact sports to
mitigate this risk. Clinicians must avoid amoxicillin in these patients as it can cause a
characteristic maculopapular rash.
6. A 75-year-old male with a history of atrial fibrillation presents with sudden onset of severe
abdominal pain. His physical exam is notable for a soft, non-tender abdomen despite his
reports of 10/10 pain. What is the most likely diagnosis?
A. Acute mesenteric ischemia
B. Acute cholecystitis
C. Perforated peptic ulcer
D. Small bowel obstruction
Medical Self-Assessment Examination V2
1. A 62-year-old male with a history of hypertension and smoking presents with cramp-like
calf pain that occurs after walking two blocks and is relieved by rest. His ankle-brachial index
(ABI) is 0.65. Which of the following is the most appropriate next step in management?
A. High-intensity statin and aspirin therapy
B. Urgent surgical revascularization
C. Bed rest and elevation of the legs
D. Venous duplex ultrasound of the lower extremities
Correct Answer: A
Explanation: The clinical presentation and ABI of 0.65 are diagnostic of peripheral artery
disease (PAD). Management focuses on cardiovascular risk reduction, including smoking
cessation, high-intensity statins, and antiplatelet therapy to prevent major adverse
cardiovascular events. A common examination pitfall is selecting surgical intervention
before attempting conservative medical management and exercise therapy.
2. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Physical
examination reveals a diffuse, non-tender enlargement of the thyroid gland. Laboratory
results show an elevated TSH and a low free T4. Which of the following antibodies is most
likely to be present?
A. Thyrotropin receptor antibodies
,B. Anti-smooth muscle antibodies
C. Antimicrosomal (anti-TPO) antibodies
D. Anti-mitochondrial antibodies
Correct Answer: C
Explanation: The patient’s symptoms and lab findings are consistent with primary
hypothyroidism, most commonly caused by Hashimoto thyroiditis in the United States.
Anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin antibodies are markers for this
autoimmune destruction of the thyroid. Clinical significance involves lifelong levothyroxine
replacement and monitoring for other autoimmune conditions.
3. A 28-year-old G1P0 at 34 weeks gestation presents with a blood pressure of 165/110
mmHg and 3+ proteinuria. She denies headache or visual changes. Which of the following is
the most appropriate immediate management?
A. Immediate cesarean delivery
B. Intravenous magnesium sulfate and hydralazine
C. Expectant management until 37 weeks
D. Outpatient follow-up in 24 hours
Correct Answer: B
Explanation: This patient meets the criteria for preeclampsia with severe features based
on her blood pressure. Immediate management requires seizure prophylaxis with
,magnesium sulfate and blood pressure control with intravenous agents like hydralazine or
labetalol. A common pitfall is delaying treatment to wait for 37 weeks, as severe
preeclampsia requires stabilization and typically delivery at 34 weeks.
4. A 52-year-old male presents for a routine check-up. Osteopathic examination reveals a
somatic dysfunction at T5. The segment is restricted in extension and is more posterior on the
right. When the patient slumps into a flexed position, the right posteriority improves. What is
the correct diagnosis?
A. T5 Flexed, Rotated Left, Sidebent Left
B. T5 Extended, Rotated Right, Sidebent Right
C. T5 Flexed, Rotated Right, Sidebent Right
D. T5 Extended, Rotated Left, Sidebent Left
Correct Answer: C
Explanation: The restriction in extension implies the segment prefers flexion.
Improvement of the posteriority in flexion confirms a flexed position, and the right
posteriority indicates rotation to the right. According to Fryette’s second law for a single
segment (Type II), rotation and sidebending occur to the same side.
, 5. A 19-year-old college student presents with a 3-day history of fever, sore throat, and
severe fatigue. Physical exam shows posterior cervical lymphadenopathy and splenomegaly.
A heterophile antibody test is positive. Which of the following is the most appropriate
recommendation?
A. Amoxicillin for 10 days
B. Oseltamivir treatment
C. Immediate splenectomy
D. Avoidance of contact sports for 4 weeks
Correct Answer: D
Explanation: Infectious mononucleosis, caused by EBV, carries a risk of splenic rupture,
especially during the first 3-4 weeks of illness. Patients must avoid contact sports to
mitigate this risk. Clinicians must avoid amoxicillin in these patients as it can cause a
characteristic maculopapular rash.
6. A 75-year-old male with a history of atrial fibrillation presents with sudden onset of severe
abdominal pain. His physical exam is notable for a soft, non-tender abdomen despite his
reports of 10/10 pain. What is the most likely diagnosis?
A. Acute mesenteric ischemia
B. Acute cholecystitis
C. Perforated peptic ulcer
D. Small bowel obstruction
