COMSAE PHASE 1 FORM 114
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 55-year-old male with a history of hypertension presents with sharp, tearing chest pain
radiating to the back. His blood pressure is 180/110 mmHg in the right arm and 150/90 mmHg
in the left arm. Which of the following is the most likely pathological finding?
A. Transmural inflammation of the arterial wall
B. Granulomatous inflammation of the aortic arch
C. Intimal tear with creation of a false lumen
D. Medial calcific sclerosis
Answer: C
Conceptual Explanation: The presentation of tearing chest pain radiating to the back with
asymmetric blood pressures is classic for aortic dissection, which involves an intimal tear.
2. A 24-year-old female presents with frequent urination and thirst. Laboratory results show
a high serum sodium level and low urine osmolality. Administration of desmopressin does
not increase the urine osmolality. What is the most likely site of the defect?
A. Posterior pituitary gland
,B. Hypothalamic nuclei
C. Renal collecting duct
D. Proximal convoluted tubule
Answer: C
Conceptual Explanation: Failure of urine osmolality to increase with desmopressin
indicates nephrogenic diabetes insipidus, which is a defect in the V2 receptors at the renal
collecting ducts.
3. An osteopathic physician performs a physical exam on a patient with epigastric pain.
Palpation reveals a Chapman point located in the right 5th intercostal space. Which organ is
most likely involved?
A. Stomach (Acidity)
B. Pancreas
C. Gallbladder
D. Liver
Answer: D
Conceptual Explanation: The anterior Chapman point for the liver is the right 5th
intercostal space (liver/gallbladder area; specifically liver is 5th and 6th on the right).
, 4. A 30-year-old patient presents with symptoms of Muscle Energy failure. The diagnosis is T5
FRrSr. Which of the following describes the initial positioning for corrective treatment?
A. Flexion, Right Rotation, Right Sidebending
B. Extension, Left Rotation, Left Sidebending
C. Extension, Right Rotation, Right Sidebending
D. Neutral, Left Rotation, Right Sidebending
Answer: B
Conceptual Explanation: Muscle Energy is a direct technique; the patient is moved into
the restrictive barrier, which is opposite the diagnosis (Extension, Rotation Left,
Sidebending Left).
5. Which of the following microorganisms is most likely to be associated with staghorn calculi
in the renal pelvis?
A. Escherichia coli
B. Enterococcus faecalis
C. Proteus mirabilis
D. Klebsiella pneumoniae
Answer: C
Conceptual Explanation: Proteus mirabilis produces urease, which increases urine pH
and leads to the formation of struvite (magnesium ammonium phosphate) staghorn calculi.
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 55-year-old male with a history of hypertension presents with sharp, tearing chest pain
radiating to the back. His blood pressure is 180/110 mmHg in the right arm and 150/90 mmHg
in the left arm. Which of the following is the most likely pathological finding?
A. Transmural inflammation of the arterial wall
B. Granulomatous inflammation of the aortic arch
C. Intimal tear with creation of a false lumen
D. Medial calcific sclerosis
Answer: C
Conceptual Explanation: The presentation of tearing chest pain radiating to the back with
asymmetric blood pressures is classic for aortic dissection, which involves an intimal tear.
2. A 24-year-old female presents with frequent urination and thirst. Laboratory results show
a high serum sodium level and low urine osmolality. Administration of desmopressin does
not increase the urine osmolality. What is the most likely site of the defect?
A. Posterior pituitary gland
,B. Hypothalamic nuclei
C. Renal collecting duct
D. Proximal convoluted tubule
Answer: C
Conceptual Explanation: Failure of urine osmolality to increase with desmopressin
indicates nephrogenic diabetes insipidus, which is a defect in the V2 receptors at the renal
collecting ducts.
3. An osteopathic physician performs a physical exam on a patient with epigastric pain.
Palpation reveals a Chapman point located in the right 5th intercostal space. Which organ is
most likely involved?
A. Stomach (Acidity)
B. Pancreas
C. Gallbladder
D. Liver
Answer: D
Conceptual Explanation: The anterior Chapman point for the liver is the right 5th
intercostal space (liver/gallbladder area; specifically liver is 5th and 6th on the right).
, 4. A 30-year-old patient presents with symptoms of Muscle Energy failure. The diagnosis is T5
FRrSr. Which of the following describes the initial positioning for corrective treatment?
A. Flexion, Right Rotation, Right Sidebending
B. Extension, Left Rotation, Left Sidebending
C. Extension, Right Rotation, Right Sidebending
D. Neutral, Left Rotation, Right Sidebending
Answer: B
Conceptual Explanation: Muscle Energy is a direct technique; the patient is moved into
the restrictive barrier, which is opposite the diagnosis (Extension, Rotation Left,
Sidebending Left).
5. Which of the following microorganisms is most likely to be associated with staghorn calculi
in the renal pelvis?
A. Escherichia coli
B. Enterococcus faecalis
C. Proteus mirabilis
D. Klebsiella pneumoniae
Answer: C
Conceptual Explanation: Proteus mirabilis produces urease, which increases urine pH
and leads to the formation of struvite (magnesium ammonium phosphate) staghorn calculi.
