Page 1 of 80
COMSAE FORM 113 PRACTICE EXAM VERSION
2 | QUESTIONS AND VERIFIED ANSWERS |
ALREADY GRADED A+ | PLUS RATIONALES (3
SECTIONS)
Course Name: Comprehensive Osteopathic Medical Self-Assessment
Examination (COMSAE) Phase 2
Subject: Osteopathic Clinical Medicine and Comprehensive Medical
Knowledge
SECTION 1: Questions 1–50
1. A 32-year-old female presents with a 3-month history of fatigue,
weight gain, cold intolerance, and constipation. On examination, she
has dry skin, bradycardia, and a non-tender, firm goiter. Laboratory
studies reveal an elevated TSH and low free T4. Anti-thyroid
peroxidase antibodies are markedly elevated. Which of the following
is the most appropriate initial management?
A. Levothyroxine replacement therapy
B. Levothyroxine replacement therapy with close monitoring of TSH
levels
C. Radioactive iodine ablation
D. Methimazole therapy
,Page 2 of 80
❖ Rationale: This patient presents with classic signs and symptoms
of hypothyroidism with a firm goiter and positive anti-TPO
antibodies, consistent with Hashimoto's thyroiditis. The standard
of care is thyroid hormone replacement with levothyroxine,
starting at a low dose and titrating to normalize TSH levels.
Radioactive iodine ablation and methimazole are treatments for
hyperthyroidism .
2. A 55-year-old male with a 40-pack-year smoking history presents
with a 2-month history of progressive dyspnea, cough, and weight
loss. Chest X-ray reveals a right hilar mass and mediastinal widening. A
CT-guided biopsy of the mass reveals small cell lung cancer. Which
paraneoplastic syndrome is this patient at highest risk for developing?
A. Hypertrophic pulmonary osteoarthropathy
B. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C. Hypercalcemia
D. Clubbing
❖ Rationale: Small cell lung cancer is strongly associated with
paraneoplastic syndromes, most commonly SIADH due to ectopic
ADH production, as well as Lambert-Eaton myasthenic syndrome.
Hypertrophic pulmonary osteoarthropathy and hypercalcemia are
more commonly associated with squamous cell carcinoma .
3. A 68-year-old male with a history of hypertension and type 2
diabetes presents to the emergency department with sudden onset of
severe, tearing chest pain radiating to his back. His blood pressure is
,Page 3 of 80
190/110 mmHg in the right arm and 160/90 mmHg in the left arm.
Which of the following is the most appropriate initial imaging study to
confirm the diagnosis?
A. Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography of the chest
D. Magnetic resonance angiography (MRA)
❖ Rationale: This patient presents with classic symptoms of acute
aortic dissection: sudden-onset tearing chest pain radiating to the
back with unequal blood pressures in the arms. CT angiography of
the chest is the imaging modality of choice for rapid diagnosis, as
it can visualize the intimal flap and extent of dissection .
4. A 45-year-old female presents with progressive muscle weakness,
diplopia that worsens with sustained gaze, and ptosis that worsens at
the end of the day. She reports that her symptoms improve after
resting. Which of the following is the most likely diagnosis?
A. Guillain-Barré syndrome
B. Myasthenia gravis
C. Lambert-Eaton myasthenic syndrome
D. Multiple sclerosis
❖ Rationale: This patient's presentation of fatigable muscle
weakness, ptosis, and diplopia that worsens with use and
improves with rest is characteristic of myasthenia gravis.
Myasthenia gravis is caused by autoantibodies against
acetylcholine receptors at the neuromuscular junction .
, Page 4 of 80
5. A 60-year-old patient presents with unilateral facial weakness,
inability to close the left eye, and drooping of the left side of the
mouth. Which nerve is most likely affected?
A. Trigeminal nerve (CN V)
B. Facial nerve (CN VII)
C. Glossopharyngeal nerve (CN IX)
D. Hypoglossal nerve (CN XII)
❖ Rationale: The facial nerve (CN VII) controls motor function of the
facial muscles. Bell's palsy, characterized by unilateral facial
weakness and inability to close the eye, results from facial nerve
dysfunction .
6. Which of the following is a key principle of osteopathic medicine
regarding the body's relationship to disease?
A. The body is passive and requires external intervention
B. The body has inherent self-regulatory and self-healing mechanisms
C. Disease is solely caused by external pathogens
D. Structure and function are independent variables
❖ Rationale: Osteopathic medicine emphasizes that the body
possesses inherent self-regulatory and self-healing mechanisms.
This fundamental principle guides the osteopathic approach to
treating patients by supporting these natural processes .
COMSAE FORM 113 PRACTICE EXAM VERSION
2 | QUESTIONS AND VERIFIED ANSWERS |
ALREADY GRADED A+ | PLUS RATIONALES (3
SECTIONS)
Course Name: Comprehensive Osteopathic Medical Self-Assessment
Examination (COMSAE) Phase 2
Subject: Osteopathic Clinical Medicine and Comprehensive Medical
Knowledge
SECTION 1: Questions 1–50
1. A 32-year-old female presents with a 3-month history of fatigue,
weight gain, cold intolerance, and constipation. On examination, she
has dry skin, bradycardia, and a non-tender, firm goiter. Laboratory
studies reveal an elevated TSH and low free T4. Anti-thyroid
peroxidase antibodies are markedly elevated. Which of the following
is the most appropriate initial management?
A. Levothyroxine replacement therapy
B. Levothyroxine replacement therapy with close monitoring of TSH
levels
C. Radioactive iodine ablation
D. Methimazole therapy
,Page 2 of 80
❖ Rationale: This patient presents with classic signs and symptoms
of hypothyroidism with a firm goiter and positive anti-TPO
antibodies, consistent with Hashimoto's thyroiditis. The standard
of care is thyroid hormone replacement with levothyroxine,
starting at a low dose and titrating to normalize TSH levels.
Radioactive iodine ablation and methimazole are treatments for
hyperthyroidism .
2. A 55-year-old male with a 40-pack-year smoking history presents
with a 2-month history of progressive dyspnea, cough, and weight
loss. Chest X-ray reveals a right hilar mass and mediastinal widening. A
CT-guided biopsy of the mass reveals small cell lung cancer. Which
paraneoplastic syndrome is this patient at highest risk for developing?
A. Hypertrophic pulmonary osteoarthropathy
B. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
C. Hypercalcemia
D. Clubbing
❖ Rationale: Small cell lung cancer is strongly associated with
paraneoplastic syndromes, most commonly SIADH due to ectopic
ADH production, as well as Lambert-Eaton myasthenic syndrome.
Hypertrophic pulmonary osteoarthropathy and hypercalcemia are
more commonly associated with squamous cell carcinoma .
3. A 68-year-old male with a history of hypertension and type 2
diabetes presents to the emergency department with sudden onset of
severe, tearing chest pain radiating to his back. His blood pressure is
,Page 3 of 80
190/110 mmHg in the right arm and 160/90 mmHg in the left arm.
Which of the following is the most appropriate initial imaging study to
confirm the diagnosis?
A. Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography of the chest
D. Magnetic resonance angiography (MRA)
❖ Rationale: This patient presents with classic symptoms of acute
aortic dissection: sudden-onset tearing chest pain radiating to the
back with unequal blood pressures in the arms. CT angiography of
the chest is the imaging modality of choice for rapid diagnosis, as
it can visualize the intimal flap and extent of dissection .
4. A 45-year-old female presents with progressive muscle weakness,
diplopia that worsens with sustained gaze, and ptosis that worsens at
the end of the day. She reports that her symptoms improve after
resting. Which of the following is the most likely diagnosis?
A. Guillain-Barré syndrome
B. Myasthenia gravis
C. Lambert-Eaton myasthenic syndrome
D. Multiple sclerosis
❖ Rationale: This patient's presentation of fatigable muscle
weakness, ptosis, and diplopia that worsens with use and
improves with rest is characteristic of myasthenia gravis.
Myasthenia gravis is caused by autoantibodies against
acetylcholine receptors at the neuromuscular junction .
, Page 4 of 80
5. A 60-year-old patient presents with unilateral facial weakness,
inability to close the left eye, and drooping of the left side of the
mouth. Which nerve is most likely affected?
A. Trigeminal nerve (CN V)
B. Facial nerve (CN VII)
C. Glossopharyngeal nerve (CN IX)
D. Hypoglossal nerve (CN XII)
❖ Rationale: The facial nerve (CN VII) controls motor function of the
facial muscles. Bell's palsy, characterized by unilateral facial
weakness and inability to close the eye, results from facial nerve
dysfunction .
6. Which of the following is a key principle of osteopathic medicine
regarding the body's relationship to disease?
A. The body is passive and requires external intervention
B. The body has inherent self-regulatory and self-healing mechanisms
C. Disease is solely caused by external pathogens
D. Structure and function are independent variables
❖ Rationale: Osteopathic medicine emphasizes that the body
possesses inherent self-regulatory and self-healing mechanisms.
This fundamental principle guides the osteopathic approach to
treating patients by supporting these natural processes .
