FLORIDA BOARD OF OSTEOPATHIC
MEDICINE DOCTOR OF OSTEOPATHIC
MEDICINE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
Question 1
A 67-year-old man with a 45-pack-year smoking history presents with
sudden onset of severe substernal chest pain radiating to his left arm. He
is diaphoretic and nauseated. Blood pressure is 86/58 mm Hg, heart rate
is 112/min, respiratory rate is 24/min, and oxygen saturation is 93% on
room air. ECG demonstrates ST-segment elevations in leads II, III, and
aVF, with reciprocal ST depressions in leads I and aVL. Which of the
following is the most appropriate immediate management?
A. Administer sublingual nitroglycerin and observe for symptom
improvement
B. Administer aspirin and initiate immediate reperfusion therapy
C. Administer intravenous furosemide
D. Perform an exercise stress test
E. Begin oral beta-blocker therapy and discharge the patient
Answer: B. Administer aspirin and initiate immediate reperfusion
therapy
Rationale: This patient has an acute inferior ST-elevation myocardial
infarction (STEMI), complicated by hypotension. The priority is
immediate antiplatelet therapy with aspirin and urgent reperfusion,
1
,preferably primary PCI when available within the appropriate time
window. Inferior STEMI may involve the right ventricle, so aggressive
nitrate administration can worsen hypotension by reducing preload. A
stress test is contraindicated during acute STEMI, and outpatient
therapy is inappropriate.
Question 2
A 24-year-old woman presents with fatigue, weight gain, constipation,
cold intolerance, and menorrhagia. Examination reveals dry skin,
delayed relaxation of deep tendon reflexes, and a diffusely enlarged,
nontender thyroid gland. Laboratory studies show an elevated TSH and
low free T4. Which antibody is most strongly associated with the
underlying condition?
A. Anti-double-stranded DNA antibody
B. Anti-centromere antibody
C. Anti-thyroid peroxidase antibody
D. Anti-mitochondrial antibody
E. Anti-glomerular basement membrane antibody
Answer: C. Anti-thyroid peroxidase antibody
Rationale: The patient's symptoms and laboratory findings are
characteristic of primary hypothyroidism due to Hashimoto thyroiditis.
Anti-thyroid peroxidase antibodies are strongly associated with
Hashimoto disease. Anti-thyroglobulin antibodies may also occur.
Anti-dsDNA is associated with systemic lupus erythematosus, anti-
centromere with limited systemic sclerosis, anti-mitochondrial with
primary biliary cholangitis, and anti-GBM with Goodpasture
syndrome.
Question 3
2
,A 58-year-old man with hypertension, diabetes mellitus, and chronic
kidney disease presents with progressive exertional dyspnea and
bilateral lower-extremity edema. Echocardiography demonstrates a left
ventricular ejection fraction of 30%. Which medication combination
provides the greatest mortality benefit in chronic heart failure with
reduced ejection fraction?
A. Furosemide and digoxin alone
B. ACE inhibitor, beta blocker, mineralocorticoid receptor antagonist,
and evidence-based additional guideline-directed therapy
C. Nitrate monotherapy
D. Calcium-channel blocker and thiazide diuretic
E. Aspirin and clopidogrel
Answer: B. ACE inhibitor, beta blocker, mineralocorticoid receptor
antagonist, and evidence-based additional guideline-directed
therapy
Rationale: Heart failure with reduced ejection fraction requires
guideline-directed therapy aimed at reducing mortality and
hospitalization. Neurohormonal blockade with an evidence-based beta
blocker and renin-angiotensin-system-directed therapy, together with
mineralocorticoid receptor antagonism when appropriate, forms a
major foundation. Contemporary management also incorporates
ARNI or other guideline-directed agents depending on the patient.
Loop diuretics primarily improve congestion and symptoms rather
than independently providing the same mortality benefit.
Question 4
A 73-year-old woman develops sudden right facial droop, right arm
weakness, and expressive aphasia 45 minutes before arrival at the
emergency department. CT of the head shows no hemorrhage. Blood
3
, glucose is normal. She is not taking anticoagulants. Which intervention
should be considered urgently if she meets eligibility criteria?
A. Intravenous thrombolytic therapy
B. Aspirin only after 72 hours
C. High-dose corticosteroids
D. Immediate carotid endarterectomy
E. Observation without treatment
Answer: A. Intravenous thrombolytic therapy
Rationale: The patient has an acute ischemic stroke within a
potentially treatable time window. After exclusion of intracranial
hemorrhage and other contraindications, intravenous thrombolysis
should be considered urgently in eligible patients. Mechanical
thrombectomy may also be appropriate in selected patients with large-
vessel occlusion. Treatment decisions are highly time dependent
because neuronal injury progresses rapidly.
Question 5
A 32-year-old woman presents with episodic palpitations, diaphoresis,
tremulousness, headaches, and severe hypertension. During an episode,
plasma metanephrines are markedly elevated. CT reveals a 4-cm adrenal
mass. Which sequence is most appropriate before definitive surgery?
A. Beta blockade followed by alpha blockade
B. Alpha blockade followed by beta blockade
C. Beta blockade alone
D. Calcium supplementation followed by beta blockade
E. Immediate surgery without pharmacologic preparation
Answer: B. Alpha blockade followed by beta blockade
Rationale: The patient has a pheochromocytoma. Preoperative alpha-
adrenergic blockade is initiated first to prevent catecholamine-induced
4
MEDICINE DOCTOR OF OSTEOPATHIC
MEDICINE EXAM WITH ACTUAL
QUESTIONS AND VERIFIED ANSWERS,
PLUS EXPLAINED RATIONALES/EXPERT
VERIFIED FOR GUARANTEED 100% PASS
2026/LATEST UPDATE/INSTANT
DOWNLOAD PDF
Question 1
A 67-year-old man with a 45-pack-year smoking history presents with
sudden onset of severe substernal chest pain radiating to his left arm. He
is diaphoretic and nauseated. Blood pressure is 86/58 mm Hg, heart rate
is 112/min, respiratory rate is 24/min, and oxygen saturation is 93% on
room air. ECG demonstrates ST-segment elevations in leads II, III, and
aVF, with reciprocal ST depressions in leads I and aVL. Which of the
following is the most appropriate immediate management?
A. Administer sublingual nitroglycerin and observe for symptom
improvement
B. Administer aspirin and initiate immediate reperfusion therapy
C. Administer intravenous furosemide
D. Perform an exercise stress test
E. Begin oral beta-blocker therapy and discharge the patient
Answer: B. Administer aspirin and initiate immediate reperfusion
therapy
Rationale: This patient has an acute inferior ST-elevation myocardial
infarction (STEMI), complicated by hypotension. The priority is
immediate antiplatelet therapy with aspirin and urgent reperfusion,
1
,preferably primary PCI when available within the appropriate time
window. Inferior STEMI may involve the right ventricle, so aggressive
nitrate administration can worsen hypotension by reducing preload. A
stress test is contraindicated during acute STEMI, and outpatient
therapy is inappropriate.
Question 2
A 24-year-old woman presents with fatigue, weight gain, constipation,
cold intolerance, and menorrhagia. Examination reveals dry skin,
delayed relaxation of deep tendon reflexes, and a diffusely enlarged,
nontender thyroid gland. Laboratory studies show an elevated TSH and
low free T4. Which antibody is most strongly associated with the
underlying condition?
A. Anti-double-stranded DNA antibody
B. Anti-centromere antibody
C. Anti-thyroid peroxidase antibody
D. Anti-mitochondrial antibody
E. Anti-glomerular basement membrane antibody
Answer: C. Anti-thyroid peroxidase antibody
Rationale: The patient's symptoms and laboratory findings are
characteristic of primary hypothyroidism due to Hashimoto thyroiditis.
Anti-thyroid peroxidase antibodies are strongly associated with
Hashimoto disease. Anti-thyroglobulin antibodies may also occur.
Anti-dsDNA is associated with systemic lupus erythematosus, anti-
centromere with limited systemic sclerosis, anti-mitochondrial with
primary biliary cholangitis, and anti-GBM with Goodpasture
syndrome.
Question 3
2
,A 58-year-old man with hypertension, diabetes mellitus, and chronic
kidney disease presents with progressive exertional dyspnea and
bilateral lower-extremity edema. Echocardiography demonstrates a left
ventricular ejection fraction of 30%. Which medication combination
provides the greatest mortality benefit in chronic heart failure with
reduced ejection fraction?
A. Furosemide and digoxin alone
B. ACE inhibitor, beta blocker, mineralocorticoid receptor antagonist,
and evidence-based additional guideline-directed therapy
C. Nitrate monotherapy
D. Calcium-channel blocker and thiazide diuretic
E. Aspirin and clopidogrel
Answer: B. ACE inhibitor, beta blocker, mineralocorticoid receptor
antagonist, and evidence-based additional guideline-directed
therapy
Rationale: Heart failure with reduced ejection fraction requires
guideline-directed therapy aimed at reducing mortality and
hospitalization. Neurohormonal blockade with an evidence-based beta
blocker and renin-angiotensin-system-directed therapy, together with
mineralocorticoid receptor antagonism when appropriate, forms a
major foundation. Contemporary management also incorporates
ARNI or other guideline-directed agents depending on the patient.
Loop diuretics primarily improve congestion and symptoms rather
than independently providing the same mortality benefit.
Question 4
A 73-year-old woman develops sudden right facial droop, right arm
weakness, and expressive aphasia 45 minutes before arrival at the
emergency department. CT of the head shows no hemorrhage. Blood
3
, glucose is normal. She is not taking anticoagulants. Which intervention
should be considered urgently if she meets eligibility criteria?
A. Intravenous thrombolytic therapy
B. Aspirin only after 72 hours
C. High-dose corticosteroids
D. Immediate carotid endarterectomy
E. Observation without treatment
Answer: A. Intravenous thrombolytic therapy
Rationale: The patient has an acute ischemic stroke within a
potentially treatable time window. After exclusion of intracranial
hemorrhage and other contraindications, intravenous thrombolysis
should be considered urgently in eligible patients. Mechanical
thrombectomy may also be appropriate in selected patients with large-
vessel occlusion. Treatment decisions are highly time dependent
because neuronal injury progresses rapidly.
Question 5
A 32-year-old woman presents with episodic palpitations, diaphoresis,
tremulousness, headaches, and severe hypertension. During an episode,
plasma metanephrines are markedly elevated. CT reveals a 4-cm adrenal
mass. Which sequence is most appropriate before definitive surgery?
A. Beta blockade followed by alpha blockade
B. Alpha blockade followed by beta blockade
C. Beta blockade alone
D. Calcium supplementation followed by beta blockade
E. Immediate surgery without pharmacologic preparation
Answer: B. Alpha blockade followed by beta blockade
Rationale: The patient has a pheochromocytoma. Preoperative alpha-
adrenergic blockade is initiated first to prevent catecholamine-induced
4
