COMSAE 115 COMPREHENSIVE
PRACTICE EXAM 2026/2027 QUESTIONS
AND ANSWERS
1. A 45-year-old male presents with acute onset of severe pain in his first
metatarsophalangeal joint. Arthrocentesis reveals needle-shaped, negatively birefringent
crystals. Which of the following is the most appropriate initial pharmacological management?
A. Allopurinol
B. Indomethacin
C. Probenecid
D. Febuxostat
Answer: B
Conceptual Explanation: Indomethacin, an NSAID, is a first-line treatment for acute gouty
arthritis. Allopurinol and febuxostat are for chronic management and can worsen an acute
flare.
,2. In a patient with a right-on-right forward sacral torsion, what are the expected findings for
L5?
A. L5 rotated left, sidebent left
B. L5 rotated right, sidebent right
C. L5 rotated left, sidebent right
D. L5 rotated right, sidebent left
Answer: C
Conceptual Explanation: In sacral torsions, L5 rotates in the opposite direction of the
sacrum and sidebends toward the side of the seated oblique axis. For a right-on-right
torsion, the axis is right, so L5 sidebends right and rotates left.
3. A 62-year-old female with a history of hypertension presents with sudden onset of ‘the
worst headache of her life.’ A non-contrast CT of the head is negative. What is the next best
step in management?
A. MRI of the brain
B. Lumbar puncture
C. Repeat CT in 24 hours
D. Cerebral angiography
Answer: B
, Conceptual Explanation: If subarachnoid hemorrhage is suspected and the CT is negative,
a lumbar puncture must be performed to look for xanthochromia or red blood cells.
4. Which Chapman point is located at the level of the 2nd intercostal space near the sternum?
A. Thyroid
B. Esophagus
C. Upper Lung
D. Heart
Answer: D
Conceptual Explanation: The anterior Chapman point for the heart is found in the 2nd
intercostal space, near the sternum.
5. A 28-year-old pregnant woman at 32 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She begins to have a generalized tonic-clonic seizure.
What is the most appropriate immediate treatment?
A. Magnesium sulfate
B. Diazepam
C. Hydralazine
D. Phenytoin
Answer: A
PRACTICE EXAM 2026/2027 QUESTIONS
AND ANSWERS
1. A 45-year-old male presents with acute onset of severe pain in his first
metatarsophalangeal joint. Arthrocentesis reveals needle-shaped, negatively birefringent
crystals. Which of the following is the most appropriate initial pharmacological management?
A. Allopurinol
B. Indomethacin
C. Probenecid
D. Febuxostat
Answer: B
Conceptual Explanation: Indomethacin, an NSAID, is a first-line treatment for acute gouty
arthritis. Allopurinol and febuxostat are for chronic management and can worsen an acute
flare.
,2. In a patient with a right-on-right forward sacral torsion, what are the expected findings for
L5?
A. L5 rotated left, sidebent left
B. L5 rotated right, sidebent right
C. L5 rotated left, sidebent right
D. L5 rotated right, sidebent left
Answer: C
Conceptual Explanation: In sacral torsions, L5 rotates in the opposite direction of the
sacrum and sidebends toward the side of the seated oblique axis. For a right-on-right
torsion, the axis is right, so L5 sidebends right and rotates left.
3. A 62-year-old female with a history of hypertension presents with sudden onset of ‘the
worst headache of her life.’ A non-contrast CT of the head is negative. What is the next best
step in management?
A. MRI of the brain
B. Lumbar puncture
C. Repeat CT in 24 hours
D. Cerebral angiography
Answer: B
, Conceptual Explanation: If subarachnoid hemorrhage is suspected and the CT is negative,
a lumbar puncture must be performed to look for xanthochromia or red blood cells.
4. Which Chapman point is located at the level of the 2nd intercostal space near the sternum?
A. Thyroid
B. Esophagus
C. Upper Lung
D. Heart
Answer: D
Conceptual Explanation: The anterior Chapman point for the heart is found in the 2nd
intercostal space, near the sternum.
5. A 28-year-old pregnant woman at 32 weeks gestation presents with a blood pressure of
165/110 mmHg and 3+ proteinuria. She begins to have a generalized tonic-clonic seizure.
What is the most appropriate immediate treatment?
A. Magnesium sulfate
B. Diazepam
C. Hydralazine
D. Phenytoin
Answer: A
