Page 1 of 74
COMSAE PHASE 1 FORM 113 PRACTICE EXAM |
QUESTIONS AND VERIFIED ANSWERS |
ALREADY GRADED A+ | PLUS RATIONALES (3
SECTIONS)
Course Name: COMSAE Phase 1 Comprehensive Assessment
Subject: Osteopathic Medical Principles and Clinical Sciences
Section 1: Questions 1-50
1. A 28-year-old male presents with acute-onset, severe testicular pain
that began 2 hours ago while lifting weights. He reports no trauma,
fever, or dysuria. On examination, the left testicle is tender, swollen,
and retracted, with an absent cremasteric reflex. The right testicle is
normal. Which of the following is the most appropriate next step in
management?
A. Antibiotics and supportive care
B. Outpatient scrotal ultrasound
C. Immediate surgical exploration
D. Urinalysis and culture
Correct Answer: C
Rationale: The presentation of acute onset, severe pain with an absent
cremasteric reflex is classic for testicular torsion, a surgical emergency
that requires immediate exploration and detorsion to save the testicle.
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Outpatient imaging would delay care. Antibiotics are for epididymitis,
which is less acute and typically presents with a positive cremasteric
reflex and fever.
2. A 55-year-old female presents with right upper quadrant pain,
nausea, and vomiting after a fatty meal. She has a low-grade fever and
is jaundiced. Laboratory findings show elevated alkaline phosphatase,
bilirubin, and AST. Which of the following anatomical structures is
most likely obstructed?
A. Cystic duct
B. Common bile duct
C. Left hepatic duct
D. Pancreatic duct
Correct Answer: B
Rationale: The presentation of RUQ pain, jaundice, and elevated
bilirubin and alkaline phosphatase points to obstructive jaundice.
Obstruction of the common bile duct is the most common cause of this
presentation, often from a gallstone. Cystic duct obstruction alone
would cause cholecystitis without jaundice.
3. A 45-year-old male with a history of chronic alcoholism presents
with confusion, ataxia, and ophthalmoplegia. Which vitamin
deficiency is the most likely cause of his symptoms?
A. Vitamin B12
B. Thiamine (B1)
C. Niacin (B3)
D. Pyridoxine (B6)
Correct Answer: B
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia is
Wernicke's encephalopathy, caused by a severe deficiency in thiamine
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(vitamin B1), commonly seen in chronic alcoholics. Vitamin B12
deficiency causes subacute combined degeneration of the spinal cord.
Niacin deficiency causes pellagra (diarrhea, dermatitis, dementia).
Pyridoxine deficiency can cause peripheral neuropathy.
4. A patient with mitral valve stenosis is at the highest risk for
developing which of the following complications?
A. Aortic regurgitation
B. Infective endocarditis
C. Left atrial enlargement and atrial fibrillation
D. Hypertrophic cardiomyopathy
Correct Answer: C
Rationale: Mitral valve stenosis leads to increased left atrial pressure,
causing left atrial enlargement. This predisposes the patient to atrial
fibrillation, which further increases the risk of thromboembolism. While
infective endocarditis is a risk, it's not the most common complication.
The stenosis is a structural issue, not a dynamic one like hypertrophic
cardiomyopathy.
5. A 32-year-old female presents with a 3-month history of fatigue,
joint pain, and a butterfly-shaped rash on her face. Laboratory tests
reveal anemia, leukopenia, and antinuclear antibodies. What is the
most common cause of death in patients with this condition?
A. Renal failure
B. Myocardial infarction
C. Infection
D. Stroke
Correct Answer: A
Rationale: The presentation is classic for Systemic Lupus Erythematosus
(SLE). While infection is a major cause of death, renal failure (lupus
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nephritis) is the most common cause of mortality in these patients.
Myocardial infarction and stroke are also risk factors but are not the
most common cause of death.
6. A 62-year-old male with a history of COPD presents with worsening
shortness of breath and a productive cough. Arterial blood gas shows
pH 7.31, PaCO2 60 mmHg, and HCO3- 28 mEq/L. This blood gas
pattern is most consistent with which of the following?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: The blood gas shows a low pH (acidemia), high PaCO2, and
elevated HCO3-. This is a respiratory acidosis. The HCO3- is elevated,
indicating renal compensation, which takes days to occur. Therefore, it is
a chronic respiratory acidosis. An acute respiratory acidosis would have
a normal or minimally elevated HCO3-.
7. Which of the following is the primary mechanism of action of
thiazide diuretics?
A. Inhibition of the Na-K-2Cl cotransporter in the thick ascending limb
B. Inhibition of the Na-Cl cotransporter in the distal convoluted tubule
C. Inhibition of the epithelial sodium channel (ENaC) in the collecting
duct
D. Osmotic diuresis by non-reabsorbable solutes in the proximal tubule
Correct Answer: B
Rationale: Thiazide diuretics act on the distal convoluted tubule to
inhibit the Na-Cl cotransporter. Loop diuretics inhibit the Na-K-2Cl
COMSAE PHASE 1 FORM 113 PRACTICE EXAM |
QUESTIONS AND VERIFIED ANSWERS |
ALREADY GRADED A+ | PLUS RATIONALES (3
SECTIONS)
Course Name: COMSAE Phase 1 Comprehensive Assessment
Subject: Osteopathic Medical Principles and Clinical Sciences
Section 1: Questions 1-50
1. A 28-year-old male presents with acute-onset, severe testicular pain
that began 2 hours ago while lifting weights. He reports no trauma,
fever, or dysuria. On examination, the left testicle is tender, swollen,
and retracted, with an absent cremasteric reflex. The right testicle is
normal. Which of the following is the most appropriate next step in
management?
A. Antibiotics and supportive care
B. Outpatient scrotal ultrasound
C. Immediate surgical exploration
D. Urinalysis and culture
Correct Answer: C
Rationale: The presentation of acute onset, severe pain with an absent
cremasteric reflex is classic for testicular torsion, a surgical emergency
that requires immediate exploration and detorsion to save the testicle.
,Page 2 of 74
Outpatient imaging would delay care. Antibiotics are for epididymitis,
which is less acute and typically presents with a positive cremasteric
reflex and fever.
2. A 55-year-old female presents with right upper quadrant pain,
nausea, and vomiting after a fatty meal. She has a low-grade fever and
is jaundiced. Laboratory findings show elevated alkaline phosphatase,
bilirubin, and AST. Which of the following anatomical structures is
most likely obstructed?
A. Cystic duct
B. Common bile duct
C. Left hepatic duct
D. Pancreatic duct
Correct Answer: B
Rationale: The presentation of RUQ pain, jaundice, and elevated
bilirubin and alkaline phosphatase points to obstructive jaundice.
Obstruction of the common bile duct is the most common cause of this
presentation, often from a gallstone. Cystic duct obstruction alone
would cause cholecystitis without jaundice.
3. A 45-year-old male with a history of chronic alcoholism presents
with confusion, ataxia, and ophthalmoplegia. Which vitamin
deficiency is the most likely cause of his symptoms?
A. Vitamin B12
B. Thiamine (B1)
C. Niacin (B3)
D. Pyridoxine (B6)
Correct Answer: B
Rationale: The classic triad of confusion, ataxia, and ophthalmoplegia is
Wernicke's encephalopathy, caused by a severe deficiency in thiamine
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(vitamin B1), commonly seen in chronic alcoholics. Vitamin B12
deficiency causes subacute combined degeneration of the spinal cord.
Niacin deficiency causes pellagra (diarrhea, dermatitis, dementia).
Pyridoxine deficiency can cause peripheral neuropathy.
4. A patient with mitral valve stenosis is at the highest risk for
developing which of the following complications?
A. Aortic regurgitation
B. Infective endocarditis
C. Left atrial enlargement and atrial fibrillation
D. Hypertrophic cardiomyopathy
Correct Answer: C
Rationale: Mitral valve stenosis leads to increased left atrial pressure,
causing left atrial enlargement. This predisposes the patient to atrial
fibrillation, which further increases the risk of thromboembolism. While
infective endocarditis is a risk, it's not the most common complication.
The stenosis is a structural issue, not a dynamic one like hypertrophic
cardiomyopathy.
5. A 32-year-old female presents with a 3-month history of fatigue,
joint pain, and a butterfly-shaped rash on her face. Laboratory tests
reveal anemia, leukopenia, and antinuclear antibodies. What is the
most common cause of death in patients with this condition?
A. Renal failure
B. Myocardial infarction
C. Infection
D. Stroke
Correct Answer: A
Rationale: The presentation is classic for Systemic Lupus Erythematosus
(SLE). While infection is a major cause of death, renal failure (lupus
, Page 4 of 74
nephritis) is the most common cause of mortality in these patients.
Myocardial infarction and stroke are also risk factors but are not the
most common cause of death.
6. A 62-year-old male with a history of COPD presents with worsening
shortness of breath and a productive cough. Arterial blood gas shows
pH 7.31, PaCO2 60 mmHg, and HCO3- 28 mEq/L. This blood gas
pattern is most consistent with which of the following?
A. Acute respiratory acidosis
B. Chronic respiratory acidosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: B
Rationale: The blood gas shows a low pH (acidemia), high PaCO2, and
elevated HCO3-. This is a respiratory acidosis. The HCO3- is elevated,
indicating renal compensation, which takes days to occur. Therefore, it is
a chronic respiratory acidosis. An acute respiratory acidosis would have
a normal or minimally elevated HCO3-.
7. Which of the following is the primary mechanism of action of
thiazide diuretics?
A. Inhibition of the Na-K-2Cl cotransporter in the thick ascending limb
B. Inhibition of the Na-Cl cotransporter in the distal convoluted tubule
C. Inhibition of the epithelial sodium channel (ENaC) in the collecting
duct
D. Osmotic diuresis by non-reabsorbable solutes in the proximal tubule
Correct Answer: B
Rationale: Thiazide diuretics act on the distal convoluted tubule to
inhibit the Na-Cl cotransporter. Loop diuretics inhibit the Na-K-2Cl
