COMSAE Phase 3 Comprehensive Osteopathic
Medical Self-Assessment Examination V1
1. A 64-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents with increased shortness of breath and productive cough. Physical examination
reveals hyperinflation of the chest and distant breath sounds. Osteopathic examination
shows tissue texture changes at the level of T2-T5. Which of the following osteopathic
techniques is most appropriate to help improve this patient’s respiratory excursion by
modulating sympathetic tone?
A. Sacral rocking
B. Rib raising
C. Cranial manipulation
D. Muscle energy to the upper extremities
Correct Answer: B
Explanation: Rib raising is an osteopathic technique specifically designed to modulate
sympathetic nervous system activity by affecting the sympathetic chain ganglia located
anterior to the rib heads. In patients with COPD, decreasing sympathetic overactivity can
help reduce bronchoconstriction and improve the efficiency of respiratory effort. A
common pitfall is confusing parasympathetic treatments, such as suboccipital release, with
techniques aimed at the sympathetic chain in thoracic pathologies.
,2. A 28-year-old female at 34 weeks gestation presents with a blood pressure of 162/110
mmHg and 3+ proteinuria on dipstick. She complains of a persistent headache and blurry
vision. What is the most appropriate next step in the management of this patient?
A. Oral labetalol and follow-up in one week
B. Immediate delivery and IV magnesium sulfate
C. Bed rest and repeat urinalysis
D. Low-dose aspirin and calcium supplementation
Correct Answer: B
Explanation: This patient meets the criteria for preeclampsia with severe features, which
include a blood pressure of at least 160/110 mmHg and end-organ symptoms like
headache and visual changes. The definitive treatment for preeclampsia at 34 weeks or
beyond is delivery combined with magnesium sulfate for seizure prophylaxis. Delaying
treatment in these cases can lead to eclampsia or placental abruption, which are significant
risks in the Phase 3 clinical context.
3. A 72-year-old male presents for a routine follow-up. He has a history of hypertension and
osteoarthritis. During the osteopathic structural examination, you note a left-on-left sacral
torsion. Which of the following findings would be consistent with this diagnosis?
A. Negative spring test
B. Positive seated flexion test on the right
C. Deep sulcus on the right
,D. Posterior ILA on the left
Correct Answer: A
Explanation: In a forward sacral torsion like a left-on-left (LoL), the spring test is negative
because the sacrum has moved forward into its physiological position of ease. A positive
seated flexion test would occur on the side opposite the rotation in a torsion, which is the
right side in this case, but the spring test is the most definitive differentiator between
forward and backward torsions. Candidates often confuse the findings of forward versus
backward torsions, but remembering that forward torsions (neutral) have negative spring
tests is key.
4. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Lab results
show a TSH of 12.5 mIU/L (normal: 0.4-4.0) and a low free T4. What is the most common
underlying etiology for this patient’s condition in the United States?
A. Iodine deficiency
B. Subacute granulomatous thyroiditis
C. Hashimoto thyroiditis
D. Pituitary adenoma
Correct Answer: C
Explanation: Hashimoto thyroiditis is the most common cause of primary hypothyroidism
in the United States, characterized by autoimmune destruction of the thyroid gland. It is
, often identified by the presence of anti-thyroid peroxidase (TPO) antibodies. While iodine
deficiency is a leading cause globally, it is rare in developed countries where salt is iodized.
5. A 52-year-old male presents with acute onset of severe pain in his right first
metatarsophalangeal joint. Arthrocentesis reveals needle-shaped, negatively birefringent
crystals. Which of the following is the most appropriate initial treatment for this acute
presentation?
A. Indomethacin
B. Probenecid
C. Allopurinol
D. Febuxostat
Correct Answer: A
Explanation: Acute gouty arthritis is best managed with nonsteroidal anti-inflammatory
drugs (NSAIDs) like indomethacin, colchicine, or corticosteroids. Allopurinol and
probenecid are used for long-term urate-lowering therapy and should not be initiated
during an acute flare as they can worsen symptoms. Understanding the timing of gout
management is a frequent point of testing on the COMLEX-USA exams.
6. A 19-year-old male presents with a cough and low-grade fever for two weeks. A chest X-ray
shows diffuse interstitial infiltrates. Sputum culture is negative for typical bacteria. What is
the most likely pathogen?
A. Streptococcus pneumoniae
Medical Self-Assessment Examination V1
1. A 64-year-old male with a history of chronic obstructive pulmonary disease (COPD)
presents with increased shortness of breath and productive cough. Physical examination
reveals hyperinflation of the chest and distant breath sounds. Osteopathic examination
shows tissue texture changes at the level of T2-T5. Which of the following osteopathic
techniques is most appropriate to help improve this patient’s respiratory excursion by
modulating sympathetic tone?
A. Sacral rocking
B. Rib raising
C. Cranial manipulation
D. Muscle energy to the upper extremities
Correct Answer: B
Explanation: Rib raising is an osteopathic technique specifically designed to modulate
sympathetic nervous system activity by affecting the sympathetic chain ganglia located
anterior to the rib heads. In patients with COPD, decreasing sympathetic overactivity can
help reduce bronchoconstriction and improve the efficiency of respiratory effort. A
common pitfall is confusing parasympathetic treatments, such as suboccipital release, with
techniques aimed at the sympathetic chain in thoracic pathologies.
,2. A 28-year-old female at 34 weeks gestation presents with a blood pressure of 162/110
mmHg and 3+ proteinuria on dipstick. She complains of a persistent headache and blurry
vision. What is the most appropriate next step in the management of this patient?
A. Oral labetalol and follow-up in one week
B. Immediate delivery and IV magnesium sulfate
C. Bed rest and repeat urinalysis
D. Low-dose aspirin and calcium supplementation
Correct Answer: B
Explanation: This patient meets the criteria for preeclampsia with severe features, which
include a blood pressure of at least 160/110 mmHg and end-organ symptoms like
headache and visual changes. The definitive treatment for preeclampsia at 34 weeks or
beyond is delivery combined with magnesium sulfate for seizure prophylaxis. Delaying
treatment in these cases can lead to eclampsia or placental abruption, which are significant
risks in the Phase 3 clinical context.
3. A 72-year-old male presents for a routine follow-up. He has a history of hypertension and
osteoarthritis. During the osteopathic structural examination, you note a left-on-left sacral
torsion. Which of the following findings would be consistent with this diagnosis?
A. Negative spring test
B. Positive seated flexion test on the right
C. Deep sulcus on the right
,D. Posterior ILA on the left
Correct Answer: A
Explanation: In a forward sacral torsion like a left-on-left (LoL), the spring test is negative
because the sacrum has moved forward into its physiological position of ease. A positive
seated flexion test would occur on the side opposite the rotation in a torsion, which is the
right side in this case, but the spring test is the most definitive differentiator between
forward and backward torsions. Candidates often confuse the findings of forward versus
backward torsions, but remembering that forward torsions (neutral) have negative spring
tests is key.
4. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Lab results
show a TSH of 12.5 mIU/L (normal: 0.4-4.0) and a low free T4. What is the most common
underlying etiology for this patient’s condition in the United States?
A. Iodine deficiency
B. Subacute granulomatous thyroiditis
C. Hashimoto thyroiditis
D. Pituitary adenoma
Correct Answer: C
Explanation: Hashimoto thyroiditis is the most common cause of primary hypothyroidism
in the United States, characterized by autoimmune destruction of the thyroid gland. It is
, often identified by the presence of anti-thyroid peroxidase (TPO) antibodies. While iodine
deficiency is a leading cause globally, it is rare in developed countries where salt is iodized.
5. A 52-year-old male presents with acute onset of severe pain in his right first
metatarsophalangeal joint. Arthrocentesis reveals needle-shaped, negatively birefringent
crystals. Which of the following is the most appropriate initial treatment for this acute
presentation?
A. Indomethacin
B. Probenecid
C. Allopurinol
D. Febuxostat
Correct Answer: A
Explanation: Acute gouty arthritis is best managed with nonsteroidal anti-inflammatory
drugs (NSAIDs) like indomethacin, colchicine, or corticosteroids. Allopurinol and
probenecid are used for long-term urate-lowering therapy and should not be initiated
during an acute flare as they can worsen symptoms. Understanding the timing of gout
management is a frequent point of testing on the COMLEX-USA exams.
6. A 19-year-old male presents with a cough and low-grade fever for two weeks. A chest X-ray
shows diffuse interstitial infiltrates. Sputum culture is negative for typical bacteria. What is
the most likely pathogen?
A. Streptococcus pneumoniae
