COMSAE EXAM 2026/2027 COMPLETE
ACCURATE EXAM APPROVED
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with right upper quadrant pain. Physical examination reveals a
positive Murphy’s sign. Which viscerosomatic reflex level is most likely associated with this
patient’s condition?
A. T2-T4 on the right
B. T5-T9 on the right
C. T10-T11 on the right
D. T12-L2 on the right
Answer: B
Conceptual Explanation: The gallbladder and liver have viscerosomatic reflexes at the T5-
T9 level on the right side. T2-T4 is typically associated with the heart, T10-T11 with the
kidneys/upper ureters, and T12-L2 with the lower colon and pelvic organs.
,2. In a patient with a left-on-left sacral torsion, which of the following findings would be
expected during the physical examination?
A. A positive seated flexion test on the right
B. A deep right sacral sulcus
C. A posterior left sacral base
D. L5 rotated left
Answer: B
Conceptual Explanation: In a left-on-left (forward) sacral torsion, the sacrum rotates left
on a left oblique axis. This results in a positive seated flexion test on the right (opposite the
axis), a deep right sacral sulcus, and a more posterior right inferior lateral angle. L5 should
rotate opposite to the sacral rotation, so L5 would be rotated right.
3. A 24-year-old female presents with primary amenorrhea. Physical exam shows a blind-
ending vaginal pouch and no uterus. Karyotype is 46,XY. What is the most likely diagnosis?
A. Mullerian Agenesis
B. Androgen Insensitivity Syndrome
C. Turner Syndrome
D. Polycystic Ovary Syndrome
Answer: B
, Conceptual Explanation: Androgen Insensitivity Syndrome (AIS) presents with a 46,XY
karyotype, female phenotype, blind vaginal pouch, and absent uterus. Mullerian Agenesis
also lacks a uterus but has a 46,XX karyotype. Turner syndrome is 45,X and has a uterus.
4. Which of the following cranial strain patterns occurs when the sphenoid and occiput rotate
in the same direction about two transverse axes?
A. Vertical Strain
B. Sidebending Rotation
C. Torsion
D. Superior Shear
Answer: A
Conceptual Explanation: A vertical strain occurs when the sphenoid and occiput rotate in
the same direction about two transverse axes, causing the sphenoid base to move
superiorly (superior strain) or inferiorly (inferior strain) relative to the occiput.
5. A 65-year-old male with a history of smoking presents with painless hematuria. What is the
most appropriate next step in management?
A. Cystoscopy
B. Renal ultrasound
C. Urinalysis and culture
D. Watchful waiting
ACCURATE EXAM APPROVED
QUESTIONS AND ANSWERS
1. A 45-year-old male presents with right upper quadrant pain. Physical examination reveals a
positive Murphy’s sign. Which viscerosomatic reflex level is most likely associated with this
patient’s condition?
A. T2-T4 on the right
B. T5-T9 on the right
C. T10-T11 on the right
D. T12-L2 on the right
Answer: B
Conceptual Explanation: The gallbladder and liver have viscerosomatic reflexes at the T5-
T9 level on the right side. T2-T4 is typically associated with the heart, T10-T11 with the
kidneys/upper ureters, and T12-L2 with the lower colon and pelvic organs.
,2. In a patient with a left-on-left sacral torsion, which of the following findings would be
expected during the physical examination?
A. A positive seated flexion test on the right
B. A deep right sacral sulcus
C. A posterior left sacral base
D. L5 rotated left
Answer: B
Conceptual Explanation: In a left-on-left (forward) sacral torsion, the sacrum rotates left
on a left oblique axis. This results in a positive seated flexion test on the right (opposite the
axis), a deep right sacral sulcus, and a more posterior right inferior lateral angle. L5 should
rotate opposite to the sacral rotation, so L5 would be rotated right.
3. A 24-year-old female presents with primary amenorrhea. Physical exam shows a blind-
ending vaginal pouch and no uterus. Karyotype is 46,XY. What is the most likely diagnosis?
A. Mullerian Agenesis
B. Androgen Insensitivity Syndrome
C. Turner Syndrome
D. Polycystic Ovary Syndrome
Answer: B
, Conceptual Explanation: Androgen Insensitivity Syndrome (AIS) presents with a 46,XY
karyotype, female phenotype, blind vaginal pouch, and absent uterus. Mullerian Agenesis
also lacks a uterus but has a 46,XX karyotype. Turner syndrome is 45,X and has a uterus.
4. Which of the following cranial strain patterns occurs when the sphenoid and occiput rotate
in the same direction about two transverse axes?
A. Vertical Strain
B. Sidebending Rotation
C. Torsion
D. Superior Shear
Answer: A
Conceptual Explanation: A vertical strain occurs when the sphenoid and occiput rotate in
the same direction about two transverse axes, causing the sphenoid base to move
superiorly (superior strain) or inferiorly (inferior strain) relative to the occiput.
5. A 65-year-old male with a history of smoking presents with painless hematuria. What is the
most appropriate next step in management?
A. Cystoscopy
B. Renal ultrasound
C. Urinalysis and culture
D. Watchful waiting
