COMSAE PHASE 1 COMPREHENSIVE
REVIEW EXAM QUESTIONS AND
ANSWERS
1. A 24-year-old male presents with acute onset of right lower quadrant pain. Physical
examination reveals tenderness at McBurney’s point. Which of the following anterior
Chapman points is most likely to be found positive in this patient?
A. The tip of the 12th rib on the right side
B. The tip of the 11th rib on the right side
C. The right 10th intercostal space
D. The right 6th intercostal space
Answer: B
Conceptual Explanation: The anterior Chapman reflex point for the appendix is located at
the tip of the right 11th rib. The 12th rib relates to the colon/rectum, while the 10th
intercostal space relates to the ovaries or testes.
,2. A patient is diagnosed with a sacral torsion. Structural exam reveals a positive seated
flexion test on the left, a deep right sacral sulcus, and a posterior left inferior lateral angle. L5
is found to be neutral, sidebent left, and rotated right. What is the most likely diagnosis?
A. Left-on-left forward torsion
B. Left-on-right backward torsion
C. Right-on-left backward torsion
D. Right-on-right forward torsion
Answer: B
Conceptual Explanation: A positive seated flexion test on the left indicates the
dysfunction is on the left. A deep right sulcus and posterior left ILA indicate left rotation.
Since the L5 is neutral, sidebent left, and rotated right (opposite sacral rotation), it follows
the rule for a backward torsion. A backward torsion on a right axis is a Left-on-right
torsion.
3. A 55-year-old diabetic patient presents with new-onset peripheral edema. Urinalysis shows
4+ proteinuria and fatty casts. A renal biopsy is performed, showing thickened basement
membranes and ‘spike and dome’ appearances on electron microscopy. What is the most
likely diagnosis?
A. Minimal change disease
B. Focal segmental glomerulosclerosis
C. Membranoproliferative glomerulonephritis
, D. Membranous nephropathy
Answer: D
Conceptual Explanation: Membranous nephropathy is characterized by thickened
basement membranes and subepithelial deposits that create a ‘spike and dome’ pattern on
electron microscopy. It is a common cause of nephrotic syndrome in adults.
4. Which of the following describes the mechanism of action of Metformin in the treatment
of Type 2 Diabetes Mellitus?
A. Inhibition of the SGLT2 transporter in the kidneys
B. Activation of AMP-activated protein kinase (AMPK)
C. Inhibition of DPP-4 enzyme
D. Binding to PPAR-gamma receptors
Answer: B
Conceptual Explanation: Metformin works primarily by activating AMPK, which leads to
inhibited gluconeogenesis in the liver and increased insulin sensitivity in peripheral
tissues.
5. A 60-year-old male with a history of chronic smoking presents with a cough and weight
loss. Imaging shows a central lung mass. Laboratory results show hypercalcemia. Which type
of lung cancer is most likely?
A. Squamous cell carcinoma
REVIEW EXAM QUESTIONS AND
ANSWERS
1. A 24-year-old male presents with acute onset of right lower quadrant pain. Physical
examination reveals tenderness at McBurney’s point. Which of the following anterior
Chapman points is most likely to be found positive in this patient?
A. The tip of the 12th rib on the right side
B. The tip of the 11th rib on the right side
C. The right 10th intercostal space
D. The right 6th intercostal space
Answer: B
Conceptual Explanation: The anterior Chapman reflex point for the appendix is located at
the tip of the right 11th rib. The 12th rib relates to the colon/rectum, while the 10th
intercostal space relates to the ovaries or testes.
,2. A patient is diagnosed with a sacral torsion. Structural exam reveals a positive seated
flexion test on the left, a deep right sacral sulcus, and a posterior left inferior lateral angle. L5
is found to be neutral, sidebent left, and rotated right. What is the most likely diagnosis?
A. Left-on-left forward torsion
B. Left-on-right backward torsion
C. Right-on-left backward torsion
D. Right-on-right forward torsion
Answer: B
Conceptual Explanation: A positive seated flexion test on the left indicates the
dysfunction is on the left. A deep right sulcus and posterior left ILA indicate left rotation.
Since the L5 is neutral, sidebent left, and rotated right (opposite sacral rotation), it follows
the rule for a backward torsion. A backward torsion on a right axis is a Left-on-right
torsion.
3. A 55-year-old diabetic patient presents with new-onset peripheral edema. Urinalysis shows
4+ proteinuria and fatty casts. A renal biopsy is performed, showing thickened basement
membranes and ‘spike and dome’ appearances on electron microscopy. What is the most
likely diagnosis?
A. Minimal change disease
B. Focal segmental glomerulosclerosis
C. Membranoproliferative glomerulonephritis
, D. Membranous nephropathy
Answer: D
Conceptual Explanation: Membranous nephropathy is characterized by thickened
basement membranes and subepithelial deposits that create a ‘spike and dome’ pattern on
electron microscopy. It is a common cause of nephrotic syndrome in adults.
4. Which of the following describes the mechanism of action of Metformin in the treatment
of Type 2 Diabetes Mellitus?
A. Inhibition of the SGLT2 transporter in the kidneys
B. Activation of AMP-activated protein kinase (AMPK)
C. Inhibition of DPP-4 enzyme
D. Binding to PPAR-gamma receptors
Answer: B
Conceptual Explanation: Metformin works primarily by activating AMPK, which leads to
inhibited gluconeogenesis in the liver and increased insulin sensitivity in peripheral
tissues.
5. A 60-year-old male with a history of chronic smoking presents with a cough and weight
loss. Imaging shows a central lung mass. Laboratory results show hypercalcemia. Which type
of lung cancer is most likely?
A. Squamous cell carcinoma
