COMSAE PHASE 2 ADVANCED
CLINICAL REVIEW EXAM QUESTIONS
AND ANSWERS
1. A 24-year-old male presents with right lower quadrant pain. Palpation reveals a pinpoint
area of tenderness on the tip of the right 12th rib. Which of the following conditions is most
likely associated with this Chapman point?
A. Liver disease
B. Cecum dysfunction
C. Gallbladder disease
D. Appendicitis
Answer: D
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the right 12th rib. The posterior point is at the transverse process of T11.
2. A 68-year-old male with a history of hypertension and atrial fibrillation presents with
sudden onset of severe abdominal pain. On physical exam, his abdomen is soft and non-
tender despite the reported pain level. What is the most likely diagnosis?
A. Acute mesenteric ischemia
,B. Acute cholecystitis
C. Perforated peptic ulcer
D. Diverticulitis
Answer: A
Conceptual Explanation: Pain out of proportion to exam in a patient with a history of
atrial fibrillation is classic for acute mesenteric ischemia, usually due to an embolic event.
3. A patient is diagnosed with a sacral torsion. Structural exam reveals a positive seated
flexion test on the left, L5 is rotated left, and the sacral base is deep on the right. What is the
correct diagnosis?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Right-on-left backward torsion
D. Left-on-right backward torsion
Answer: C
Conceptual Explanation: A positive seated flexion test on the left indicates a left-sided
restriction. L5 rotated left means the sacral axis is right. A deep right sacral base (posterior
left) indicates a backward torsion (Right-on-left).
, 4. A 32-year-old female G2P1 at 34 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She complains of a severe headache. What is the
immediate next step in management?
A. Lisinopril administration
B. Immediate Cesarean section
C. Intravenous Magnesium sulfate
D. Bed rest and monitoring
Answer: C
Conceptual Explanation: This patient meets criteria for preeclampsia with severe
features. Magnesium sulfate is the gold standard for seizure prophylaxis, followed by blood
pressure control and stabilization for delivery.
5. A 19-year-old college student presents with a 2-week history of hearing voices and believe
the FBI is tracking him through his toaster. He has no prior psychiatric history. What is the
most likely diagnosis?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Delusional disorder
Answer: A
CLINICAL REVIEW EXAM QUESTIONS
AND ANSWERS
1. A 24-year-old male presents with right lower quadrant pain. Palpation reveals a pinpoint
area of tenderness on the tip of the right 12th rib. Which of the following conditions is most
likely associated with this Chapman point?
A. Liver disease
B. Cecum dysfunction
C. Gallbladder disease
D. Appendicitis
Answer: D
Conceptual Explanation: The anterior Chapman point for the appendix is located at the
tip of the right 12th rib. The posterior point is at the transverse process of T11.
2. A 68-year-old male with a history of hypertension and atrial fibrillation presents with
sudden onset of severe abdominal pain. On physical exam, his abdomen is soft and non-
tender despite the reported pain level. What is the most likely diagnosis?
A. Acute mesenteric ischemia
,B. Acute cholecystitis
C. Perforated peptic ulcer
D. Diverticulitis
Answer: A
Conceptual Explanation: Pain out of proportion to exam in a patient with a history of
atrial fibrillation is classic for acute mesenteric ischemia, usually due to an embolic event.
3. A patient is diagnosed with a sacral torsion. Structural exam reveals a positive seated
flexion test on the left, L5 is rotated left, and the sacral base is deep on the right. What is the
correct diagnosis?
A. Left-on-left forward torsion
B. Right-on-right forward torsion
C. Right-on-left backward torsion
D. Left-on-right backward torsion
Answer: C
Conceptual Explanation: A positive seated flexion test on the left indicates a left-sided
restriction. L5 rotated left means the sacral axis is right. A deep right sacral base (posterior
left) indicates a backward torsion (Right-on-left).
, 4. A 32-year-old female G2P1 at 34 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She complains of a severe headache. What is the
immediate next step in management?
A. Lisinopril administration
B. Immediate Cesarean section
C. Intravenous Magnesium sulfate
D. Bed rest and monitoring
Answer: C
Conceptual Explanation: This patient meets criteria for preeclampsia with severe
features. Magnesium sulfate is the gold standard for seizure prophylaxis, followed by blood
pressure control and stabilization for delivery.
5. A 19-year-old college student presents with a 2-week history of hearing voices and believe
the FBI is tracking him through his toaster. He has no prior psychiatric history. What is the
most likely diagnosis?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Delusional disorder
Answer: A
